STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH, MANGALAGIRI.

FILLED IN ONLINE APPLICATION FORM

Recruitment for the posts of SCT PC (Civil) (Men & Women)- Post Code No.21,SCT PC (AR) (Men & Women)-Post Code No.22,
SCT PC (APSP) (Men)- Post Code No. 23, Warder (Men) - Post Code No. 24, Warder (Women) - Post Code No. 25
in Prisons and Correctional Services Dept. and Firemen (Men)-Post Code No. 26 in Fire Services Dept.,
-2018, vide Notification No. 215/R&T/Rect.2/2018, dt:- 12.11.2018.

1. Name (As per SSC/Equivalent Certificate) GORREMUCHU SANDEEP

2. Father's/ Husband's Name BABURAO Preserve the REGISTRATION
3. Mother's Name SUJATHA NUMBER for all your future
correspondence.
4. Gender Male
Date of Birth
5.
(As per SSC/Equivalent certificate)
23-05-1988 4237029
SSC/Equivalent Roll No. / 12.
6.
Year of passing
0297963 / 2004
7. Upload Certificate (SSC or Equivalent) Uploaded
Educational Qualifications
8. Intermediate
(as per Notification)
9. Community SC
Upload Community Certificate
10.
(For BC, SC and ST )
Uploaded
11. Do you belong to Ex-servicemen? No
If Yes, furnish the following i) Date Of Entry ---
ii) Date Of Discharge ---
Identification Marks
14.
(As per SSC/Equivalent certificate)
A MOLE ON THE RIGHT ELBOW JOINT
13.
A MOLE ON THE LEFT EAR
15. Mobile No. 8143280143
16. e-mail id sandymunny@gmail.com
17. (a) Do you have Aadhaar Card? Yes
(b) If yes, please mention number 872796038132
What is your preferred medium
18.
of Examination
Telugu
19. Which is your preferred place for 1st Vijayawada(Krishna)
writing Preliminary written
examination? 2nd Guntur(Guntur)
3rd Eluru(West Godavari)
20. Post applied for as per your eligibility as per 21 - SCT PC (Civil) (Men & Women)
notification 22 - SCT PC (AR) (Men & Women)
26 - Firemen (Men)
24 - Warder (Men)
23 - SCT PC (APSP) (Men)

21. Which is preferred District for 1st Krishna

appearing in PMT/PET after you
qualified in Preliminary Written 2nd West Godavari
Exam?
22. Are you a local of State of Andhra Pradesh? Yes
If yes, which is your Local District? Krishna If No, which State/UT you belong to? ---
If you have selected 'Telangana' as State to which you belong, as per GSR 591E of Govt. of India, Candidates who migrate
from Telangana to Andhra Pradesh with in a period of 5 years from the 2nd Day of June, 2014 shall be regarded as local No
candidate in Andhra Pradesh, Do you belong to this Category?
Do you claim benefit of Age Relaxation (Please read Para No.10(b) of
Notification)
Yes
if yes, specify the applicable category
a) BC No b) SC Yes
c) ST AND ABOST No d) AP Govt. Employee No
e) Ex-Servicemen No f) NCC Instructor No
g) AP State Census Dept. No h) AP Home Guard Yes
i) Widow / Divorced / Judicially separated women No
As per Rule 3 (G) and as mentioned in Notification at Para Nos.25, 26 and 27, the candidates falling under certain categories shall be disqualified for
23.
recruitment. (Please go through the Notification)
Do you come under those categories?
If yes, please note that you are not eligible for recruitment.
No

24. Address for Communication H.NO 34-3-26,LIBRARY STREET ,KASTHURI BAI PET,Krishna,VIJAYAWADA,520010
25. Fee Paid through : Payment Gateway Transaction Id./Reference Id. PUR26919240750 Fee : 150
I Certify that I have read the Notification and I am proceeding to submit this application form after having understood the eligibility and other criteria mentioned in
the Notification. I undertake total responsibility for submitting correct information to the best of my ability.

28-11-2018 07:30:43 PM