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CENTRAL INDUSTRIAL SECURITY FORCE

APPLICATION FORM FOR RECRUITMENT OF HEAD
CONSTABLE/MIN-2019
1.)Application Number HCM1902198943

2.)Post Applied for HC/MIN

3.)Candidate Name HARI SHANKAR CHAUDHARY

4.)Fathers's Name GUPTESHWAR NATH CHAUDHARY

5.)Date of Birth 26-05-1995

6.)Gender male
7.)Nationality INDIAN
8.)Religion HINDU
9.)Category OBC
10.)Belongs to Hill Area NO
11.)Are you Child / dependent of victims
KILLED in the 1984 riots/2002 communal YES
riots in Gujarat ?
12.)Were you domiciled in the State of J
& K during the period from 1st Jan 1980 NO
to 31st Dec 1989?

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13.)Whether you are a ward of West

Pakistani Refugee(WPR) settled in J & K NO
?
14.)(A)Communication Address: (B)Permanent Address:
H.No: A-79 H.No: A-79
Village: VINDHYANAGAR Village: VINDHYANAGAR
Post: VINDHYANAGAR Post: VINDHYANAGAR
PS: VINDHYANAGAR PS: VINDHYANAGAR
District: SINGRAULI District: SINGRAULI
State: MADHYA PRADESH State: MADHYA PRADESH
Pincode:486885 Pincode:486885
15.)Identification Marks: (a)MOLE ON RIGHT HAND SHOULDER
(b)MOLE ON LEFT HAND BACKSIDE MIDDLE OF THE HAND
16.)Educational Details: Civil:GRADUATION
Army:
17.)EX-SERVICEMEN: N/A
18.)CISF PERSON: N/A
19.)GOVERNMENT EMPLOYEE: N/A
20.)Fee Details: Reference Number CPN4953588
Amount 100
Status Success
21.)Have you ever been convicted by any
court of law or any other judicial NO
Institution?
22.)Is there any case pending against you
NO
in any court of law?
23.)Has any FIR been lodged and case is
NO
pending against you?
27.)Was any FIR ever lodged against you
NO
in the past?
24.)Have you ever been dismissed from
any service under the Central or State NO
Govt.?

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25.)Have your services ever been

NO
terminated while on probation?
DECLARATION

(i) I hereby certify and declare that all the statements made in the application are true, complete and correct to
the best of my knowledge and belief. In the event of information or part thereof being found false or detected
incorrect during the process of recruitment or at any stage thereafter and that i am not satisfying the eligibility
criteria prescribed in this notice, my candidature/appointment is liable to be cancelled/terminated automatically
without any notice to me and action can be taken against me by the CISF.

(ii) I have read the provisions in the notice of the examination carefully and hereby undertake to abide by them.

(iii) I Further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, etc.
prescribed for admission to the examination. I have enclosed photocopies of certificates in support of claim for
Educational Qualifications, age, category (SC/ST/OBC) and age relaxation etc.

(iv) I also declare that I do not stand debarred from Government Service as on date and have never been
convicted by any court of law.

(v) I have not submitted any other application for this examination. I am aware that if I contravene this rule, my
application will be rejected summarily.

(vi) * For Employees of CISF seeking age relaxation.

  I declare that I am serving in CISF and completed 3 years regular service or regular length of service
stipulated in the Notice of the examination on or before date of closing submitting application form given in the
notice.

(vii) * For Candidate belonging Ex-Servicemen.

  I declare that I fulfill all the eligibility conditions relating to Ex-Servicemen as per Notice of Examination.

(viii) * For Candidate belonging to OBC.

  I declare that I belong to the community which is recognized as a backward class by the Govt. of India for
the purpose of reservation in services as per order contained the Department of Personnel and Training Office
Memorandum No.36012/22/93-Estt(SCT) dated 8-9-1993. I also declare that I do not belong to the
person/sections(Creamy Layer) mentioned in column 3 of OM No.36012/22/93-Estt.(SCT) dated 8-9-1993 and
modified vide Government of India DOP&T OM.36033/3/2004-Estt.(Res.) dated 9-3-2004.

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Singnature

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