HARYANA STAFF SELECTION COMMISSION

BAYS NO. 67-70, SECTOR-2, PANCHKULA-134151
(Website: www.hssc.gov.in)
AUvt. Mc. 2 l 2O'2 Oate cI |ULIIcatIcr: 26.O6.2O'2
CIcsIrg Uate Icr receI|t cI a||IIcatIcrs Ir tle CcnnIssIcr's cIIIce:
26.OT.2O'2
AppIications arè invitèd through RegIstereU Pcst Ior thè undèr mèntionèd posts
on thè prèscribèd appIication Iorm, thè Iormat oI which is givèn at thè ènd. Thè candidatès arè
advisèd to strictIy usè this Iormat oI thè appIication Iorm onIy othèrwisè thèir appIication wiII
bè rè|èctèd. Thè Iormat givèn at thè ènd shouId bè photocopièd (ènIargèd) on a thick papèr. A
cut out Irom thè nèwspapèr shouId not bè usèd. Thè numbèr oI posts givèn bèIow is IiabIè to
variation. Thè candidatè shouId spèciIy on thè top oI thè ènvèIopè thè word- Advt. No., Namè
and catègory oI thè post appIièd Ior:-
OETA!LS OF POSTS AMO QUAL!F!CAT!OMS
FOOO & SUPPL!EO OEPARTNEMT MARYAMA
Cat. Mc. ' S2 |csts cI AUUItcrs ('4 |csts Icr MeaU QUarter) & ('S |csts Icr SUL
OIIIce)
(GEN=16, SC=4, BCA=4, ESM GEN=1, ESM SC=1, ESM BCA=2, ESM BCB=1,
OSP SC=1, OSP BCA=2)
E.Q. i) Dègrèè oI rècognizèd Univèrsity or its èquivaIènt.
ii) Hindi/ Sanskrit upto Matric Standard.
Age 'T-4O years
Pay ScaIe ` DSOO-S4SOO÷ ` S2OO GraUe Pay.
PUBL!C WORKS OEPARTNEMT ( B & R Brarcl) Maryara
Cat. Mc. 2 '2 |csts cI 1UrIcr ErgIreer (NeclarIcaI)
(GEN=4, SC=2, BCA=2, ESM GEN=1, ESM SC=1, ESM BCB=1, OSP BCB=1)
E.Q. i) Has passèd thrèè yèars NationaI CèrtiIicatè (ThèorèticaI) Coursè in
MèchanicaI Enginèèring conductèd by Statè Board or has quaIiIièd thè
samè Irom any othèr rècognizèd institution.
ii) Hindi / Sanskrit upto Matric standard.
Age 'T-4O years
Pay ScaIe ` DSOO-S4SOO ÷ ` S6OOl- GraUe Pay
!MFORNAT!OM, PUBL!C RELAT!OMS & CULTURAL AFFA!RS MARYAMA
Cat. Mc. S 6 |csts cI AssIstart PULIIc ReIatIcrs OIIIcer
(GEN=3, BCA=1, ESM BCA=1, ESM BCB=1)
E.Q. i) Graduatè Irom a rècognizèd Univèrsity or its èquivaIènt.
ii) DipIoma in |ournaIism Irom a rècognizèd Univèrsity/ Institutè or its èquivaIènt.
OR
Onè yèar coursè Irom Indian Institutè oI Mass Communications.
iii) Onè yèar èxpèrièncè in a PubIicity Organization oI a Union or Statè Govèrnmènt in a post oI
comparabIè rèsponsibiIity.
OR
Onè yèar èxpèrièncè as:
a) a whoIè-timè corrèspondènt in a daiIy nèwspapèr with a circuIation oI not Ièss than 10,000 duIy
cèrtiIièd by Audit Burèau oI CircuIation.
OR
b) an Editor or a Sub-Editor or a WèèkIy nèwspapèr with a circuIation oI not Ièss than 5,000 duIy
cèrtiIièd by Audit Burèau oI CircuIation.
OR
c) a whoIè-timè corrèspondènt in a nèws agèncy. No honorary or part timè èxpèrièncè shaII bè
countèd.
iv) KnowIèdgè oI Hindi/Sanskrit upto Matric Standard.
Age 'T-4O years
Pay ScaIe ` DSOO-S4SOO ÷ ` 4OOOl- GraUe Pay.
SPEC!AL !MSTRUCT!OMS :
Thè prèscribèd èssèntiaI quaIiIication doès not èntitIè a candidatè to bè caIIèd Ior
intèrvièw. Thè Commission may short Iist thè candidatès Ior intèrvièw by hoIding a writtèn
èxamination or on thè basis oI a rationaIè critèrion to bè adoptèd by thè Commission. Thè
dècision oI thè Commission in aII mattèrs rèIating to accèptancè or rè|èction oI an appIication,
èIigibiIity/suitabiIity oI thè candidatès, modè oI, and critèria Ior sèIèction ètc. wiII bè IinaI and
binding on thè candidatès. No inquiry or corrèspondèncè wiII bè èntèrtainèd in this règard.
MOW TO APPLY-GEMERAL !MSTRUCT!OMS :
A candidatè whèthèr hè bèIongs to gènèraI catègory or rèsèrvèd catègoriès viz.
SC, BC, ESM/DESM can submit onIy onè appIication Ior particuIar catègory oI post. AppIication
Iorm compIètè in aII rèspècts duIy IiIIèd in by thè candidatès in thèir own handwriting in
capitaI Ièttèrs and signèd in thè spèciIièd spacè shouId bè sènt onIy tlrcUgl RegIstereU
Pcst to thè Sècrètary, Haryana StaII SèIèction Commission, Bays No. 67-70, Sèctor-2,
PanchkuIa P!M- 'S4'6'. AII thè coIumn oI thè appIication Iorm shouId bè IiIIèd in.
Applications related to RTI should be sent by writing ‘RTI Application’ on top of
envelopes.
Thè candidatè shouId givè dètaiIs oI aII thè èxaminations passèd Irom MatricuIation or
its èquivaIènt onwards and mèntion totaI and |ercertage cI narRs obtainèd and maximum
marks in èach èxamination. Tle carUIUates are aUvIseU tc attacl |lctccc|y crIy cI
essertIaI çUaIIIIcatIcr certIIIcateslUI|IcnalUegree vItl tle a||IIcatIcr Icrn
aIcrgvItl EIIgILIIIty CertIIIcate Ir case cI OESN arU S|crts GraUatIcr CertIIIcate Ir
case cI OUtstarUIrg S|crts Perscr categcry arU PMC CertIIIcate Ircn tle
Ccn|etert AUtlcrIty. Thè candidatès, who havè obtainèd dègrèès or DipIomas or
CèrtiIicatès Ior thè various coursès Irom any institution dècIarèd Iakè by thè Univèrsity Grants
Commission, shaII not bè èIigibIè Ior bèing considèrèd Ior rècruitmènt to thè posts advèrtisèd.
SERV!MG GOVERMNEMT ENPLOYEES SMOULO SEMO TME!R
APPL!CAT!OM FORN WELL !M T!NE TMROUGM PROPER CMAMMEL. TMEY NAY,
MOWEVER, SEMO AM AOVAMCE COPY O!RECT TO TME CONN!SS!OM.
FEE:- Fèè at thè IoIIowing ratès shouId bè dèpositèd in thè Haryana Govt. Trèasury
undèr thè Hèad `0051-H.P.S.C.-(103)-StaII SèIèction Commission, Haryana-
AppIication Ièè and othèr rècèipts."
GereraI CarUIUates SClBC carUIUates
cI Maryara crIy
Cat. Mc. ' tc S Rs. '6Ol- Rs. S6l-
No concèssion oI Ièè is admissibIè to SC/BC/PHC appIicants oI othèr Statès.
Thè ESM candidatès arè èxèmptèd Irom paymènt oI Fèè, but thèir dèpèndènts
arè rèquirèd to pay thè Ièè as Ior GènèraI, SC or BC candidatès as casè may bè. Candidatès
rèsiding outsidè Haryana and Chandigarh can sènd thè Ièè in thè Iorm oI Indian PostaI Ordèrs
which shouId bè madè payabIè to thè Sècrètary, Haryana StaII SèIèction Commission at
PanchkuIa. Fèè sènt in thè Iorm oI BarR OraIt cr Ncrey OrUer cr Casl vIII rct Le
acce|teU. Fèè oncè sènt with thè appIication Iorm is nèithèr transIèrabIè nor
rèIundabIè/ad|ustabIè. Trèasury chaIIans / PostaI Ordèrs purchasèd bèIorè thè pubIication oI
this advèrtisèmènt and aItèr thè cIosing datè wiII not bè accèptèd.
Relaxation in Age : i) In the case of SC/BC candidates, the upper age limit is relaxable as
per Haryana Govt. instruction. For Ex-servicemen candidates
relaxation up to continuous Military service added by three years is
permissible.
ii) The upper age limit in respect of widow, legally separated woman,
divorcee, deserted woman and unmarried woman will be upto 45 years
as per Government instructions.
ReservatIcr cI |csts:- Rèsèrvation wiII bè as pèr Haryana Govèrnmènt Instructions.
Fcr OIsaLIeU ESNlOe|erUert cI KIIIeUl OIsaLIeU Ir actIcr
rèsèrvation wiII bè as pèr Haryana Govt. instructions containèd in Ièttèr No. 945-GS-II
72/6451, datèd thè 6
th
March, 1972.
Thè rèsèrvation Ior ESM wiII bè utiIizèd in thè ordèr givèn bèIow:-
i) DisabIèd èx-sèrvicèmèn with disabiIity bètwèèn 20% to 50%.
ii) Up to two dèpèndènts oI Sèrvicè pèrsonnèI kiIIèd/disabIèd bèyond
50%
iii) Othèr èx-sèrvicèmèn.
Notè:-1. DisabIèd èx-sèrvicèmèn wiII mèan èx-sèrvicèmèn who, whiIè sèrving in thè
Armèd Forcès oI thè Union wèrè disabIèd in opèrations against thè ènèmy
or in disturbèd arèas.
Notè:-2. Thè dèpèndènts wiII incIudè bèsidès wiIè/widow, dèpèndènt
sons/daughtèrs.
Thè dèpèndènt sons oI ESM who IuIIiII aII conditions oI quaIiIications, agè ètc.
prèscribèd Ior posts wiII bè considèrèd on mèrit Ior thè posts rèsèrvèd Ior ESM to thè èxtènt oI
non-avaiIabiIity oI suitabIè ESM candidatès. Thè chiIdrèn and thè grand-chiIdrèn oI Frèèdom
Fightèrs (DFF) wouId bè considèrèd to thè èxtènt mèntionèd in Haryana Govt. Ièttèr No.
22/20/83-3GSIII, datèd 26.7.1984 as amèndèd Irom timè to timè, iI thè quota rèsèrvèd Ior
Ex-sèrvicèmèn, rèmains unIiIIèd duè to non-avaiIabiIity oI suitabIè Ex-sèrvicèmèn or thèir
dèpèndènts.
ESM/DESM candidatès oI Haryana cIaiming bènèIit wiII havè to producè thè Irèsh
EIigibiIity CèrtiIicatè Irom thè concèrnèd ZiIa Sainik Board at thè timè oI intèrvièw. Mèrè
dèpèndènt cèrtiIicatè wiII not bè èntèrtainèd. ESM candidatès shouId aIso producè at thè timè
oI intèrvièw attèstèd photo copy oI Idèntity Card issuèd by concèrnèd ZiIa Sainik Board.
NONE OF THE PERSON BELOW SHALL FALL WITHIN THE DEFINITION OF WORD DEPENDENT OF
EX-SERVICEMEN IN TERMS OF HARYANA GOVT. LETTER NO. 12/37/79-GSII,
DATED 21-11-1980 :-
i) A pèrson may bè working on an adhoc basis against thè post advèrtisèd or
somèwhèrè èIsè.
ii) A pèrson may bè unèmpIoyèd at thè timè oI making thè appIication but hè may
havè othèr sourcè oI incomè viz. Irom agricuIturè, tradè, propèrty, Bank BaIancè
ètc.
iii) A pèrson who is a mèmbèr oI thè |oint Hindu IamiIy and rèmains dèpèndènt upon
thè Karta tiII thèrè is partition in thè IamiIy or hè cèasès to bè a mèmbèr oI thè
|oint Hindu
iv) IamiIy and is obIigèd to pass on aII his incomè to thè Karta and hè draws monèy
Ior his subsistèncè Irom thè pooI oI thè |oint Hindu IamiIy with thè consènt oI thè
Karta.
v) A candidatè who is a mèmbèr oI thè |oint Hindu IamiIy is èmpIoyèd on adhoc
basis but hè is othèrwisè dèpèndènt on his Iathèr.
Mcte :- I) Tle LereIIt cI reservatIcr vIII Le gIver crIy tc tlcse SClBCl PMC arU
ESN arU cUtstarUIrg s|crts|erscr carUIUates vlc are UcnIcIIe cI
Maryara State. Tle SCl BClPMC carUIUates are reçUIreU tc sULnIt
SClBClPMC CertIIIcate UUIy IssUeU Ly tle ccn|etert aUtlcrIty at tle
tIne cI IrtervIev. LIRevIse tle OUtstarUIrg S|crts Perscr slaII Le
reçUIreU tc attacl tle s|crt graUatIcr certIIIcate vItl tle a||IIcatIcr
Icrn as |er Gcverrnert IrstrUctIcrs UUIy IssUeU Ly tle ccn|etert
aUtlcrIty. OESN slaII Le reçUIreU tc attacl tle Iresl EIIgILIIIty
CertIIIcate UUIy IssUeU Ly tle res|ectIve ZIIa SaIrIR BcarU vItl tle
a||IIcatIcr Icrn.
II) QUaIIIIcatIcr vIII Le UeternIreU vItl regarU tc tle Iast Uate II×eU Icr
receI|t cI a||IIcatIcrs.
III) CarUIUates a||IyIrg Icr a |cst nUst ersUre tlat tley IUIIIII aII tle
eIIgILIIIty ccrUItIcrs cr tle Iast Uate cI a||IIcatIcr. !I cr verIIIcatIcr at
ary tIne LeIcre cr aIter tle vrItter e×anIratIcr cr IrtervIev cr
a||cIrtnert, It Is IcUrU tlat tley Uc rct IUIIIII ary cI tle eIIgILIIIty
ccrUItIcr cr It Is IcUrU tlat tle IrIcrnatIcr IUrrIsleU Is IaIse cr
Irccrrect tleIr carUIUatUre vIII Le carceIIeU.
Iv) Tle e×|erIerce vIII Le ccrsIUereU crIy aIter acçUIrIrg tle essertIaI
çUaIIIIcatIcr.
OOCUNEMTS TO BE ATTACMEO W!TM TME APPL!CAT!OM FORN
i) Onè copy oI Iatèst stamp sizè photograph duIy attèstèd shouId bè pastèd on thè
appIication Iorm.
ii) Attèstèd photocopy oI Trèasury ChaIIan.
iii) Attèstèd photocopy oI èssèntiaI quaIiIications and abovè /dipIoma/dègrèè shouId
bè attachèd with thè appIication Iorm.
iv) Attèstèd copy oI Irèsh EIigibiIity CèrtiIicatè in casè oI DESM candidatès duIy
issuèd by thè rèspèctivè ZiIa Sainik Board.
v) Attèstèd copy oI Sport Gradation CèrtiIicatè in casè oI Outstanding Sports
Pèrsons, duIy issuèd by thè Compètènt Authority.
vi) Attèstèd photo copy oI BC / SC / PHC CèrtiIicatè issuèd by compètènt authority.
Thè candidatès rèsiding outsidè thè statè oI Haryana shouId sènd originaI Indian
PostaI Ordèrs with thè appIication Iorms aItèr rètaining countèrIoiI oI IPO´s with thèm.
Thèy wiII producè thè originaI Trèasury ChaIIan/ IPO (Countèr FoiI), and aII othèr
rèIèvant documènts aIong with Photostat attèstèd copiès, at thè timè oI intèrvièw.
2. Tle carUIUates are aUvIseU tlat tle |lctccc|y cI aII çUaIIIIcatIcrs slcUIU Le
attacleU vItl tle a||IIcatIcr Icrn.
Mcte :- An appIication Iorm wiII bè summariIy rè|èctèd in thè IoIIowing èvènts :-
(I) !I a carUIUate naRes ncre tlar cre a||IIcatIcr Icr a |artIcUIar categcry.
(II) !I tle a||IIcatIcr Is rct Ir tle |rescrILeU Icrnat a||erUeU vItl tlIs
aUvertIsenert.
(III) !I tle a||IIcatIcr Is UrsIgreUlIrccn|Iete.
(Iv) !I IUII Iee Is rct Ue|csIteU Ir tle narrer |rescrILeU cr |rccI tlerecI rct
attacleU.
(v) !I tle a||IIcatIcr Is rct sert tlrcUgl RegIstereU Pcst.
(vI) !I tle e×|erIerce certIIIcate Is vItlcUt UetaII cI saIary |er ncrtl
receIveU (vlerever tle ccrUItIcr cI e×|erIerce a||Iy).
(vII) !I tle a||IIcatIcr Is receIveU Ir CcnnIssIcr's cIIIce aIter tle cIcsIrg
Uate, MSSC vIII rct Le res|crsILIe Icr ary |cstaI UeIay.
(vIII) !I a carUIUate Uces rct |cssess tle çUaIIIIcatIcr cI MIrUIlSarsRrIt U| tc
NatrIc StarUarUl MIgler StarUarU.
(I×) !I a carUIUate Uces rct |cssess tle reçUIsIte acaUenIc çUaIIIIcatIcr cr
tle cUt cII Uate.
(×) !I a carUIUate Is UrUeragelcverage cr tle cUt cII Uate.
(×I) !I a carUIUate Uces rct IrUIcate vIsILIe IUertIIIcatIcr narR Ir ccIUnr 'S
cI tle a||IIcatIcr Icrn.
PIacè : PanchkuIa Sècrètary,
Datèd: 25.06.2012 Haryana StaII SèIèction Commission,
PanchkuIa.
USE OF MOBILE PHONE, PAGER AND OTHER ELECTRONICS DEVICE IN HARYANA STAFF
SELECTION COMMISSION EXAMINATION/ INTERVIEW IS STRICTLY PROHIBITED.
BY REGISTERED POST ONLY
HARYANA STAFF SELECTION COMMISSION
Bays No. 67-70, Sector-2, Panchkula-134151
_____________________________________________________________________________
F O R O F F I C E U S E O N L Y
CONTROL NO. ROLL NO. SCRUTINY BY
A P P L I C A T I O N F O R M
Treasury / Post office Name Try. Ch ./I. P.O. No. Date Amount
IMPORTANT INSTRUCTIONS
1. Please read instructions given in advertisement carefully before filling in each column.
2. Use only Black/Blue ball pen to write or tick the box.
3. Please tick ‘Yes’ as and ‘Not’ as
4. Put on the column which is not applicable.
5. The candidates belonging to ESM/DESM/DFF/OSP will be required to both the columns
i.e. their Category as well as caste which they belong.
Advertisement No. Category No. Name of the post
1. CANDIDATE’S NAME in capital letters as given in class X Certificate (in English)
2. Father’s Name in capital letters as given in class X Certificate (in English)
3. Date of Birth : Date Month Year
4. Age as on eligibility date : Years Months Days
5. Sex : Male Female
Gen S C BCA BCB ESM DESM DFF OSP PHC
6. Category :
7. Are you domicile of Haryana : Yes No 8. Nationality : Indian other
9. Write Name and complete mailing address, in block letters, with black sketch pen only : -
10. Educational qualifications :-
Educational Qualifications Year of
Passing
Marks
Obtained
Total
Marks
%
age
Division Name of
Board/
University
Subjects
10
th
(Matric)
10+2(Senior Secondary)
ITI/Vocational
Diploma/Degree
B.A./B.Sc./B.Com/B.E.
M.A./M.Sc./M.Com./M.E.
11. Any other higher qualification specify___________________________________________________
12. Experience : Years Months Days
Name of Organization : ______________________________________Total Salary : Rs._________________
13. Visible identification mark on the body of the candidate __________________________________________
14. Declaration : I hereby declare that :-
1. All statements made in this application form are true, complete and correct to the best of my
knowledge and belief. In the event of any information being found false or incorrect, or ineligibility
being detected before or after the interview/appointment/selection, my candidature may be cancelled
and action can be taken against me.
2. I have read the provisions in advertisement of the Commission carefully and I hereby undertake to
abide by them. I fulfill all the conditions of eligibility regarding age limits, educational qualifications etc.
prescribed in the advertisement and other relevant rules and instructions.
3 I have never been convicted by Criminal Court.
PLACE : ___________________________ SIGNATURE OF THE CANDIDATE
(unsigned application will be rejected)
DATE : _____________________________
Paste here
your latest
stamp size,
attested
photograph
Name :
Address :
With Telephone No., if any
Pin Code
Signature of Candidate

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