Veiw Application Form


Roll Number : 478790

2. Details of Fee paid : Fee to be paid is Rs. 200/-(Female/SC/ST/Physically challenged candidates are not required to pay any fee) Name of Post Office / Value of CRF Indian Stamps / Indian Mission with complete Mission Receipt address.

Space for affixing Central Recuritment Fee Stamps (This is the sole mode prescribed for payment of fee)

Total Value : N.B Indian Postal Orders/Bank Draft/Money Orders/Crossed Cheque/Treasury Challan/Currency : Notes/Postage/Revenue/Court Fee Stamps etc. are not acceptable. Roll No :-478790 Candidate Signature

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.. (if any) | (d) E-mail address (if any) | rakeshkumar. 4 Note 1: Candidates belonging to OBCs but coming in the "Creamy Layer" and thus not being entitled to OBC reservation should indicate their community as "General Category (Others) Code (e) Permanent Postal address (if any) (in BLOCK CAPITALS | S/O MR JANKI RAMAN in English) SHAHI............ (b) State your religion if you belong to S.......(Please use abbreviations to the extent | Post Office : BISHNUDUTTPUR possible) | District : MUZAFFARPUR............ | State Code : BIHAR | Pin : 843113 (b) Telephone No........VILLAGE..... Note 2 :.........) Examination will ordinarily be allowed by the commission.... (If any) with STD Code.. 4"..........Name (as recoreded in Matriculation /Higher Secondary or equivalent Examination Certificate in BLOCK CAPITALS) RAKESH KUMAR 4........... WRITE GENDER : | MALE Community In words Code No....REPURA | Post Office : BISHNUDUTTPUR | District : MUZAFFARPUR...........REPURA is to be sent. | State Code : BIHAR | Pin : 843113 | | 5....php 3......VILLAGE.... 3 General Category(Others) ....... 1 Scheduled Tribe......... (a) Address for correspondence ( excluding candidate's name) | S/O MR JANKI RAMAN in English BLOCK CAPITALS to which communication SHAHI..Veiw Application Form http://upsconline.......... General 4 6. (If SC....... (a) Community : Scheduled Caste.ST or OBC enclose a copy of certificate in support of your claim) Roll No :..................478790 | Candidate Signature 2 of 15 30/08/2011 03:37 ...No Change in community status indicated by a candidate in his / her application form for the civil services (pre.nic....... |(c) Fax No....... 2 Other Backward Classes(OBCs) ....

(i)(a) Do you hail from Arunchal Pradesh/Manipur/Meghalaya | No /Mizoram/Nagaland/Sikkim and are claming exemption from appearing in INDIAN LANGUAGE FOR PAPER I ? | If "Yes".478790 Candidate Signature | ENGLISH | | | ENGLISH | 3 of 15 30/08/2011 03:37 .nic. :documentary evidence. 36012/22/93-Estt. ENGINEERING 10.(a) Indicate LANGUAGE MEDIUM OF EXAMINATION FOR ESSAY. 8. (b) If reply to (a) above is "No". dated 8-9-1993 referred to above. Roll No :. mention the name of the | minority community in the box opposite. 9 above (only ONE language to be indicated) In case the language medium be Santali or Sindhi. please enclose a copy of the certificate from the | competent authority.(SCT) dated | 08-09-1993. (iii) Indicate SECOND OPTIONAL SUBJECT FOR PAPERS VIII &| MECHANICAL IX . indicate the appropriate clause(s) of the Rules and enclose | Rule No.M. 36033/3/2004--\Estt(Res. please state whether you belong to Creamy | Layer or not with reference to the Department of Personnel and Training O. (a) Date of Birth (in Christian Era) as recorded in Matriculation / | 18-04-89 Higher Secondary or equivalent examination certificate.f.M No. If not. | (d) If you belong to any of the minority communities notified by the | Government ( Muslims / Christians / Sikhs / Budhists / Zoroastrians (Parsis) .in/daf/viewapplications. CHOICE OF CENTRE FOR MAIN EXAMINATION :-| DELHI 9. (Copy of certificate is to enclosed) | (b) Do you claim age relaxation in terms of Rule 6 ? | No If yes.Veiw Application Form http://upsconline. (ii) Indicate FIRST OPTIONAL SUBJECT FOR PAPERS VI & VII | MATHEMATICS . para 27 of the instrucations to Candidates).O.) dated 14-10-2008. GENERAL STUDIES AND FOR OPTIONAL SUBJECTS as at (ii) and (iii) of col. indicate INDIAN LANGUAGE | HINDI FOR PAPER I . (c. (b) Indicate LANGUAGE MEDIUM FOR INTERVIEW TEST. 7.php (c) If you belong to OBC.Please clarify in OBC proforma | (Annexure 7 of instruction) as to why should not be treated as belonging to Creamy Layer with reference to each of | the Category I to VI mentioned in the schedule of the O.M No. indicate the Script also.

nic.478790 Candidate Signature 4 of 15 30/08/2011 03:37 .in/daf/viewapplications. Details of the Educational Institution attended from 1st standard to the last degree:Class Name of the School /College Place District State /Institution From To Shishu Shiksha Sadan Javahar Navodaya Vidyalaya SASTRA University Repura Kharonadih Muzaffarpur BIHAR Muzaffarpur BIHAR 1 6 5 12 Year From To 1995 2000 2000 2007 Thirumalaisamudram Thanjavur B TAMIL Tech B Tech 2007 2011 NADU 1st 4th yr yr Roll No :.Veiw Application Form http://upsconline. (Enclose copy of the Certificate if answer is 'Yes'. Whether passed Degree or equivalent Examination.php 11. || Yes || 12.

Hindi Mechanical 2011 Engineering Javahar Navodaya Vidyalaya CBSE Javahar Navodaya Vidyalaya SASTRA University CBSE SASTRA University Candidate Signature 5 of 15 30/08/2011 03:37 .4 B Tech Roll No :. Science. Hindi. Social 2005 AISSCE 1 87. English Mathematics. Particulars of all examinations passed commencing with matriculation or equivalent examination:Examination Passed Class/Division/ Percentage Year Grade of marks Subject Name of School/College Name of Board/University /Institution AISSE 1 86.Veiw Application Form http://upsconline.nic.8 Mathematics. 2007 Chemistry.478790 1 92. English. Physics.php 13.

REPURA | | BISHNUDUTTPUR | MUZAFFARPUR | Bihar | 843113 | FARMING | HOUSEWIFE | NOT AT ANY POST | | NOT AT ANY POST | | indicate the post held by him at the time of his retirement).0 Roll No :. indicate the post held by her (If retired.what is the nationality of | your spouse ? 16.REPURA | | BISHNUDUTTPUR | MUZAFFARPUR | Bihar | 843113 | VILLAGE. Marital Status :-| (a) Are you married ? | UNMARRIED (b) If the answer is "Yes". indicate the post held by her at the time of his retirement). (k) Annual income of your Father (l) Annual income of your Mother | JANKI RAMAN SHAHI | CHANDRAKALA SHAHI | INDIAN | INDIAN | VILLAGE.nic.CITIZENSHIP STATUS (Give correct Code |1 Number (See item V of Annexure of Annexure of instructions to candidates for filling | up this column).Veiw Application Form http://upsconline. 15. (j) If your Mother is in service.36000 | Rs. (a) Name of Father (b) Name of Mother (c) Nationality of Father (d) Nationality of Mother (e) Father's present postal Address(If deceased give last address) Post Office: District/City : State : Pincode : (f) Mother's present postal Address(If deceased give last address) Post Office: District/City : State : Pincode : (g) Father's Profession : (h) Mother's Profession : (i) If your Father is in service.478790 Candidate Signature 6 of 15 30/08/2011 03:37 . indicate the post held by him (If retired.php 14.

nic.php (m) District and State to which your Father originally belongs (n) District and State to which your Mother originally belongs 17.Veiw Application Form http://upsconline. State:-Bihar | | MUZAFFARPUR | MUZAFFARPUR | BIHAR | | HINDI | Candidate Signature 18. Indicate your mother tongue Roll No :. Place of birth Town/Village * District State | 7 of 15 30/08/2011 03:37 . State:-Bihar | District:-MUZAFFARPUR.

478790 8 of 15 30/08/2011 03:37 .and 18.17. (Indicate your first preference as 01 and second preference as 02 and so on.16.php 19.Meghalaya 1 1 Bihar 14 14 Chhattisgarh 8 8 Gujarat 7 7 Haryana 15 15 Himachal Pradesh 9 9 Jammu & Kashmir 2 2 Jharkhand 16 16 Karnataka 10 10 Kerala 17 17 Madhya Pradesh 18 18 Maharashtra 19 19 Manipur Tripura 20 20 Nagaland 21 21 Orissa 6 6 Punjab 22 22 Rajasthan 23 23 Sikkim 11 11 Tamil Nadu 24 24 Uttarakhand 3 3 Uttar Pradesh 4 4 West Bengal Candidate Signature Roll No :.indicate your order of preference for various State caders forwhich you would like to be considered . 20.Veiw Application Form http://upsconline. In case you are considered for appointment to IAS/IPS. Having regard to answers given against Columns 12.) State Cadres Indicate Your order of Preference IAS IPS 12 12 Andhra Pradesh 5 AGMUT 5 13 13 is the State/Union | BIHAR Territory that you would claim as your home State/U.nic.

Daman&Diu and Nil Dadra & Nagar Haveli Police Service. the word 'NIL shall be indicated against each services(s).Civil Service . (I.(Please write your first perference as 1 and second perference as 2 and so on ).Group "A" 11 Indian Railway Personnel Service.478790 Candidate Signature 9 of 15 30/08/2011 03:37 . In case no perference is exercised.php 21.Group "A" (Asstt.Group "A" 8 Indian Revenue Service. Security Officer .Veiw Application Form http://upsconline.Group "B" The Delhi .Group "A" 12 Post Of Asstt.Group 'B'(Section Nil Officers'Grade) The Delhi . Group "B" Nil Nil Pondicherry Police Service .Group "A" 6 Indian Information Service .nic. Indicate your order of preference against the Services/Posts given "A" 10 Indian Railway Accounts Service .Daman&Diu and Nil Dadra & Nagar Haveli Civil Service.Lakshadweep.Group "A" (Grade III) 7 Indian Corporate Law Service .for which you wolud like to be considered for appointment.' Name of Services/Post Order of Preference Indian Administrative Service 1 Indian Foreign Service 3 Indian Police Service 2 Indian P&T Accounts & Finance Service Group "A" Nil Indian Audit & Accounts Service.) Group "A" Nil Indian Ordance Factories Service.Lakshadweep.andaman and Nicobar Island.Group "B" Pondicherry Civil Service . Works 9 Manager.Group "A" Nil Indian Railway Traffic Service.(Customs and Central Excise)Group "A" 4 Indian Defence Accounts Service . Group "B" Roll No :. Group "A" Nil Indian Revenue Service.(Junior Grade) Group "A" Nil Indian Trade Service.Group "A" Nil Armed Forces Headquarters .Group "A" 5 Indian Civil Accounts Service "A" in Railway Protection Force Nil Indian Defence Estates Service .Non-Technical) Indian Postal Service.andaman and Nicobar Island.

478790 Candidate Signature 10 of 15 30/08/2011 03:37 .php 22. if you have not been employed so far.nic. of Address of Office where employed years months * Need not be Application Form http://upsconline. Roll No :. Were you ever Employed : Details of your employment(in chronological order-till date):Desigation Scale of Permanent/Temporary/Ad Pay hoc From NO Period To No.

Playing Volleyball.2.(Such as hobbies etc. REGIONAL LEVEL AND NATIONAL LEVEL ORGANIZER OF CONFERENCE AND FESTIVALS IN COLLEGE Cooking.medals.C. Singing.(Write | 1. | Yes NDA Selection.nic.including CS(P).(a).2011. Have you ever been debarred by any Public Service Commission or Staff Selection Commission from any of their Examinations/Selections? (b). (a) basis of a Civil Service Commission Examination held in earlier years? (b) If the answer to (a) above is 'yes'. including the current Examination held in May. because of | angiokaratoma(birth mark) on my left thigh represented my school in science congress. WON VOLLEYBALL FOR SCHOOL AT OPEN DISTRICT LEVEL. Have you ever accepted allocation to a Service/Post on the 26.C.php 23.etc. | Team/Games/Sports/N.etc. Particulars of for the examination: (b) 11 of 15 30/08/2011 03:37 .4. qualified for national mathematics CAPTIAN OF VOLLEYBALL TEAM AT DISTRICT LEVEL. A-CERTIFICATE HOLDER OF NCC LEAD MY SCHOOL FOR REGIONAL SCIENCE CONGRESS. best innovation award for designing water rocket. write year or years of examination in which you appeared so far.) 25.Veiw Application Form http://upsconline. If the answer to above is yes give details. top 2 high scorer in university PLAYED VOLLEYBALL AT NATIONAL LEVEL. Table Tennis 24. | Position(s) of distinction/Leadership held in School/College | Other extra curricular activities and interests.2011 in ascending chronological order..5. (a) | How many times have you appeared at the Civil |1 Services(Preliminary)Examination so far.. in the opposite box as the case may be) | | 2011 | | | No | | | | | If you have already appeared at the Civil Services(Preliminary)Examination held by the UPSC. indicate:-: Year of the Civil Services Examination on the basis of (i) which you had been last allocated to service/post : (ii) Name of service/post to which allocated: (iii) Your Roll No.3.

Veiw Application Form (iv) Whether you are continuing in that Service/Post? Roll No :.nic.478790 | Candidate Signature 12 of 15 30/08/2011 03:37 .

C Examinations/Recruitments by Selection applied for/appeared(including the Civil Services Examination):Month and Year of Whether you appeared Whether you were Name of Examination/Advt.478790 May 2007 May 2011 0 0 Yes Yes Candidate Signature Yes No 13 of 15 30/08/2011 03:37 . Examination/Interview appointment for Recruitment NDA Engineering Service Roll No 27.nic.Veiw Application Form http://upsconline.S.Whether you have applied / appeared for examinations YES / Recuritment conducted by upsc ? Particular of U. Roll No at the recommended for Examination/Post /Item No./No.

indicate the category i.Veiw Application Form http://upsconline.php 28. Section II(B) of Rules for the examination also see para 22 A of DAF) (b) Do you claim age relaxation and fee exemption as physically challenged candidates ? 29. (a) (i) Indicate whether you are a physically challenged candidate.indicate your percentage of disability as indicated in certificate. Section-II (B) of rules for the examination. Attested/Certified Copy of the certificate of educational qualifications.C. (ii) If yes.D. Any Others Roll No :. (iv) Please specify.(Please check the box even if you are exempted) Attested/Certified Copy of certificate of Age.if you would require the facility of a scribe in the Examination. Note-2.f. Orthopaedically/Visually challenged/Deaf mute.please see Rule 22 of rules for the examination. (enclose prescribed certificate) (c. candidates below appendix I. List of Enclosures sent by the candidates :-- | NO | | | | | | | | | | | | | | NO | Central Recruitment Fee Stamps for the prescribed fee paid/exempted.P. if you would require the extra time of 20 minutes per hour (applicable for L.e. For the definition of "blind" (visually challenged) please see General Instructions below Appendix-1. Note:-1.para 22 of instruction to candidates) (iii) If yes. (for visually challenged candidates only) (v) Please specify. For entitlement to reservation as physically Candidate Signature 14 of 15 30/08/2011 03:37 .nic.

.. I have read rule 14 of the Rules of the Examination and understand that in the event of any information being found false or ineligibility being detected before or after the examination... if not applicable.... I have not exhausted the number of attempts admissible to me under the rule 4 of the Rules of the Examination...............php DECLARATION TO BE SIGNED BY THE CANDIDATE I..... I further declare that I fullfill all the eligibility conditions regarding age limits...... * I have informed my Head of the Office/ Department in writting that I am applying for this examination...... * Strike off this sentence.. Print 15 of 15 30/08/2011 03:37 .................... Date: ....... I have read the rules and instructions carefully and I hereby undertake to abide by them........ ** Signature of the Candidate Place: .. educational qualifications etc.....nic... complete and correct to the best of my knowlege and Application Form http://upsconline................................... prescribed for admission to the Examination.......... hereby declare that all statements and entries made in columns 1 to 29 of this application are true....... action can be taken against me by the Commission... ** Application not signed by candidate is liable to rejection.

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