TELANGANA STATE PUBLIC SERVICE COMMISSION: HYDERABAD

Recruitment to the posts of Steno cum-Typist, Junior Assistant -cum- Typist,

Junior Assistant & Technician in Telangana State Pollution Control Board

(GENERAL RECRUITMENT)

NOTIFICATION NO: 12/2017

BASIC INFORMATION DATA

(CHECK LIST)

(To be filled by the candidate)

TSPSC ID :

Ref ID : PHOTO OF THE

CANDIDATE
HALL TICKET NO :

DATE OF VERIFICATION:

Signature
Name of the Candidate
01
( as per SSC)

02 Fathers Name

03 Mothers Name

04 Gender Male Female

Date of Birth D D M M Y Y Y Y
05
( as per SSC)

Years Months days

(Age as on 01/07/2017)
06

Date of Name of the

Qualification acquiring Board/Univer
qualification sity

Qualification
As per
(as on 04/02/2017)
07
Notification Official use :
 Type writing

Shorthand
08 Technical Qualification
(as on 04/02/2017
Official use :

OC SC ST BC

A B C D E

Community(integrated
Community Certificate
Issued by M.R.O for
09
SC/ST/BC from
Telangana State Govt) Official use :

Whether non-creamy
YES NO
layer certificate
BC Candidates should
produced
Submit Non Creamy
Layer certificate as per
G.O.Ms.No:8 of 2014
Official use :
10 &

MemoNo.3009/BCW/
OP/2011, Dt:18-12-
2015.

If age relaxation is Whether relevant Certificate

claimed, specify Years Produced
.
1) Retrenched Census (No. of years claimed for YES NO
Employee relaxation)
2) Telangana State
Govt. Employee
3) N.C.C
4) Ex-Service Men
11
5) SC/ST and BC Official use :
 Class Year District State

IV
Indicate the evidence
(Original Study
V
Certificate to be
produced) OR
12 VI
Residence certificate for
7 yrs. Prior to SSC if
private Study. VII

VIII

IX

District you belong to

13
as per 4th class to 10th
class
Preference
Name of the Post
I Preference
14
Post Preference II Preference

III Preference

Official use:
Present Employment
details
15
(Government Employees
should submit NOC)
 Declaration

I hereby declare that

i) All the columns filled in by me containing my biodata and other particulars, are true to the best of
my Knowledge.

ii) The certificates such as, my educational qualification, community certificate, date of birth (SSC),
study/residence in support of my claim for local candidature are genuine.

iii) I did not resort to any irregular or improper means in connection with my candidature for
selection.

iv) I am liable for permanent debarment from appearing for the recruitment to be conducted by
TSPSC and other PSCs and also criminal prosecution, if I am found involved in any unfair means
/ malpractice.

15
v) I further declare that the information furnished by me is correct and my candidature shall be
cancelled at any stage if it is found incorrect.

Address.

..

Mobile No

Place:
Date: Signature of the candidate.

TO BE USED FOR ADMISSION (OFFICIAL USE)

The Candidate Admitted for Oral Test.

Jr. ASST./A.S.O SECTION OFFICER ASST. SECRETARY

TO BE USED FOR REJECTION

The Candidate Rejected for Oral Test with the following reason.

Jr. ASST./A.S.O SECTION OFFICER ASST. SECRETARY SECRETARY

MEMBER CHAIRMAN