KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2021

( ISO : 9001 - 2015 Certified Recruitment Process )

APPLICATION FOR THE POST OF POLICE SUB INSPECTOR (CIVIL) (MEN & WOMEN) INCLUDING INSERVICE OF
RESIDUAL & KALYANA KARNATAKA (LOCAL)-2021

¥ÉÆ°Ã¸ï ¸À¨ï-E£ïì¥ÉPÀÖgï (¹«¯ï) (¥ÀÄgÀĵÀ ªÀÄvÀÄÛ ªÀÄ»¼Á) ºÁUÀÆ ¸ÉêÉAiÀÄ°ègÀĪÀªÀgÀÄ («ÄPÀÄ̽zÀ) ªÀÄvÀÄÛ PÀ¯Áåt PÀ£ÁðlPÀ ¥ÀæzÉñÀzÀ (¸ÀܽÃAiÀÄ)
ºÀÄzÉÝUÉ Cfð - 2021
Notification No.08/Recruitment-2/2021-22

Application No : 5085220 Post PSI (CIVIL) : 376 + 26

Applying as a : Direct Candidate

01 Applicant's Full Name / : KARTHIK SR

CfðzÁgÀ£À ¥ÀÆtð ºÉ¸ÀgÀÄ

02 Mother's Name / vÁ¬ÄAiÀÄ : LAXMI DEVI

ºÉ¸ÀgÀÄ

03 Father's Name / vÀAzÉAiÀÄ : RAMANNA DS

ºÉ¸ÀgÀÄ

04 Gender / °AUÀ : Male

06 Offer your preferences as to which Range/ Commissionerate you are Interested to work / DzÀåvÉAiÀÄ C£ÀĸÁgÀ PÀvÀðªÀå : PSI(CIVIL)
¤ªÀð»¸À®Ä EaѸÀĪÀ ªÀ®AiÀÄ / PÀ«ÄõÀ£ÀgÉÃmï w½¹

As per your priority of Units will be allotted on the basis of Merit & Category, but this unit allotment is subject to further changes in Unit, as per
the consolidated list due to certain candidates getting Unfit / Not willing in various stages of recruitment process.

1 COP, Bengaluru City Priority 4

2 COP, Belagavi city Priority 8
3 COP, Mangaluru City Priority 3
4 COP, Hubballi- Dharwad Priority 7
5 DIGP, Railways Priority 2
6 Southern Range, Mysuru Priority 1
7 Eastern Range, Davangere Priority 6
8 Central Range, Bengaluru Priority 5
9 Northern Range, Belagavi Priority 10
10 North Eastern Range, Kalaburgi Priority 11
11 Kalaburgi City Priority 9

07 Address / «¼Á¸À : Shri male mahadeshwara nilaya,Shri mann football nagegowda road kirgandur 3rd
cr,Marigowda badavane,Mandya,Mandya,Karnataka,571401

7a Native District / ¸ÀéAvÀ f¯Éè : Mysuru 7b Other / EvÀgÉ : N/A

08 Email Id / E-ªÉÄïï Lr : karthik1151403gttc@gmail.com 09 Mobile Number / ªÉƨÉÊ¯ï ¸ÀASÉå. : 9738428508

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 KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2021
( ISO : 9001 - 2015 Certified Recruitment Process )

10 Category / ¥ÀæªÀUÀð : 3A 10a Aadhar Card No /DzsÁgï PÁqïð : 590514302271

¸ÀASÉå

10b Caste / eÁw : VOKKALIGA 10c Date of issue of Caste Certificate / eÁw : 29 Oct 2018
¥ÀæªÀiÁt ¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ
Height of the Candidate / C¨sÀåyðAiÀÄ : 170 Weight of the Candidate / C¨sÀåyðAiÀÄ vÀÆPÀ : N/A
JvÀÛgÀ

14 Do you belong to a family of an Ex-servicemen who while in service was permanently disabled or died in action ? / : No
¤ÃªÀÅ, PÀvÀðªÀåzÀ°è ±Á±ÀévÀªÁV zÉÊ»PÀ «PÀ®vÉ CxÀªÁ ªÀÄgÀt ºÉÆA¢zÀ ªÀiÁf ¸ÉʤPÀ£À ÀÄlÄA§PÉÌ ¸ÉÃjgÀÄ«gÁ?

14a Death while in service / PÀvÀðªÀå : No 14c Permanently disabled while in : No

¤ªÀð»¸ÀĪÁUÀ ªÀÄgÀt ºÉÆA¢zÀÝgÉ Service / PÀvÀðªÀå ¤ªÀð»¸ÀĪÁUÀ
±Á±ÀévÀ «PÀ®vÉ ºÉÆA¢zÀÝgÉ

14b Wife, Husband, Children, Step : No 14d Relationship / ¸ÀA§AzsÀ : N/A

Children / ºÉAqÀw, UÀAqÀ,
ªÀÄPÀ̼ÀÄ, ªÀÄ® ªÀÄPÀ̼ÀÄ

14e Date of issue of Dependent : N/A

Certificate / CªÀ®A©vÀ ¥ÀæªÀiÁt
¥ÀvÀæ «vÀgÀuÁ ¢£ÁAPÀ

15 Rural Reservation/ UÁæ«ÄÃt «ÄøÀ¯Áw : No

16 Kannada Medium Reservation/PÀ£ÀßqÀ ªÀiÁzsÀåªÀÄ «ÄøÀ¯Áw : No

17 Project Displaced Person Reservation/AiÉÆÃd£Á ¤gÁ²ævÀ C¨sÀåyð «ÄøÀ¯Áw : No

18 Are you a candidate belonging to Kalyana-Karnataka Region? / ¤ÃªÀÅ PÀ¯Áåt-PÀ£ÁðlPÀ ¥ÀæzÉñÀzÀC¨sÀåyðAiÉÄÃ? : No

J) PÀ¯Áåt PÀ£ÁðlPÀ ¥ÀæzÉñÀzÀ ¸ÀܽÃAiÀÄ ªÀåQÛUÀ¼ÀÄ ¸ÀܽÃAiÀÄ ªÀÈAzÀzÀ ºÀÄzÉÝ ºÁUÀÆ «ÄPÀÄ̽zÀ ªÀÈAzÀzÀ (¥ÀgÀ¸ÀܽÃAiÀÄ) ºÀÄzÉÝ F JgÀqÀÆ ªÀÈAzÀzÀ ºÀÄzÉÝUÀ½UÉ Cfð ¸À°è¸À®Ä CºÀðjgÀÄvÁÛgÉ.

18a If yes, to which District you belong to ? / ºËzÁzÀ°è, AiÀiÁªÀ f¯ÉèUÉ ¸ÀA§A¢ü¹¢ÝÃgÁ ? : N/A

19 Are you claiming Kalyana Karnataka local cadre posts ?/ºÉÊzÁæ¨Ázï-PÀ£ÁðlPÀ ¸ÀܽÃAiÀÄ ªÀÈAzÀzÀ : No
ºÀÄzÉÝUÀ½UÉ DAiÉÄÌ §AiÀĸÀÄ«gÁ?

19 a Are you interested to submit the application for residual cadre posts also ?/«ÄPÀÄ̽zÀ ªÀÈAzÀzÀ : No
ºÀÄzÉÝUÀ½UÀÆ ¸ÀºÀ Cfð ¸À°è¸À®Ä §AiÀĸÀÄ«gÁ?

19b If you are eligible for both local and Residual Cadre, which cadre would you like to be selected?/¤ÃªÀÅ ¸ÀܽÃAiÀÄ ºÁUÀÆ
«ÄPÀÄ̽zÀ JgÀqÀÆ ªÀÈAzÀzÀ ºÀÄzÉÝUÀ¼À DAiÉÄÌUÉ CºÀðgÁzÀ°è, AiÀiÁªÀ ªÀÈAzÀzÀ ºÀÄzÉÝUÉ DAiÉÄÌ §AiÀĸÀÄ«j?

N/A

Note:- If the Kalyana Karnataka local candidate is opted and appointed for the Residual cadre, then the
candidate will not be provided with any of the facilities under Article 371(j) in his/her entire Service.

n¥ÀàtÂ: MAzÀÄ ªÉÃ¼É ¸ÀܽÃAiÀÄ C¨sÀåyðAiÀÄÄ «ÄPÀÄ̽zÀ ªÀÈAzÀzÀ ºÀÄzÉÝAiÀÄ£ÀÄß DAiÉÄÌ ªÀiÁrPÉÆAqÀÄ £ÉêÀÄPÁw ºÉÆA¢zÀ°è, CAvÀºÀ
C¨sÀåyðUÉ eÁjAiÀÄ°ègÀĪÀ ¤AiÀĪÀÄzÀAvÉ vÀ£Àß ¸ÉêÁ CªÀ¢üAiÀÄ°è C£ÀÄZÉÒÃzsÀ 371(eÉ) «ÄøÀ¯Áw ¸Ë®¨sÀåªÀÅ zÉÆgÉAiÀÄĪÀÅ¢®è JA§ÄzÀ£ÀÄß
¸Àà¶ÖÃPÀj¸À¯ÁVzÉ.

21 Are you a Government Employee ? /¤ÃªÀÅ ¸ÀPÁðj : No 21a Designation / ¥ÀzÀ£ÁªÀÄ : N/A
£ËPÀgÀgÉÃ?
21b Department / E¯ÁSÉ : N/A
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 KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2021
( ISO : 9001 - 2015 Certified Recruitment Process )
N/A

21c Service rendered / ¸À°è¹zÀ ¸ÉêÁªÀ¢ : N/A N/A N/A

21d Date of issue of NOC / ¤gÁPÉëÃ¥ÀuÁ ¥ÀæªÀiÁt ¥ÀvÀæ «vÀgÀuÁ : N/A

¢£ÁAPÀ
21e Date Of Government Joining? : N/A

22 Date of Birth (as in SSLC or its equivalent : 02 Oct 1998 ( Your Age is 22 Years, 7 Months, 1 Days as on cut off
Marks Card) / ºÀÄnÖzÀ ¢£ÁAPÀ (J¸ïJ¸ïJ¯ï¹ date 03/05/2021 )
CxÀªÁ vÀvÀìªÀiÁ£À CAPÀ ¥ÀnÖAiÀÄ°ègÀĪÀAvÉ)

23 Have you been involved in any Criminal : No 23a give details / «ªÀgÀ ¤ÃqÀĪÀÅzÀÄ : N/A
Case ? / AiÀiÁªÀÅzÁzÀgÀÆ C¥ÀgÁzsÀ ¥ÀæPÀgÀtzÀ°è
?

24a Have you been convicted in a Criminal : No 24a give details / «ªÀgÀ ¤ÃqÀĪÀÅzÀÄ : N/A
Case ? / ¤ÃªÀÅ C¥ÀgÁzsÀ ªÉÆPÀzÀݪÉÄAiÀÄ°è
²PÉëUÉ M¼À¥ÀnÖgÀÄ«gÁ?
24b Have you been Involved in any Dept : No 24c give details / «ªÀgÀ ¤ÃqÀĪÀÅzÀÄ : N/A
Enq Case ? /

QUALIFICATION DETAILS
25 Are you a Degree holder or holder of a : Yes 25a Which Degree / AiÀiÁªÀ ¥ÀzÀ« : BE
Equivalent qualification from
Recognized University ? / ¤ÃªÀÅ CAVÃPÀÈvÀ
«±Àé«zÁå®AiÀÄ¢AzÀ ¥ÀzÀ« CxÀªÁ vÀvÀìªÀiÁ£À
«zÁåºÀðvÉ ºÉÆA¢gÀÄ«gÁ?
25b Year Of Passing / GwÛÃtðgÁzÀ ªÀµÀð : 2020 25c Have you studied kannada language in S S L : Yes
C Examination as First or Second language?

25d Have you obtained your degree from a : Regular Course 25e Percentage : 72.4
Regular University / Distance
Open/¤ÃªÀÅ ¸ÁªÀiÁ£Àå ¥ÀzÀ«AiÀÄ£ÀÄß
¥ÀÆtðUÉƽ¹¸À¢ÝgÁ CxÀªÁ ªÀÄÄPÀÛ
«±Àé«zÁå®AiÀÄ / zÀÆgÀ ²Pàët ¥ÀzÀ«AiÀÄ£ÀÄß
¥ÀqÉ¢¢ÝgÁ ?
25f Which State ? / AiÀiÁªÀ gÁdå? : Karnataka 25g Date of Announcement of the Final Degree : 02 Aug 2020
Result?
25h Which University ? /AiÀiÁªÀ «±Àé«zÁå®AiÀÄ? : VTU 25h UniversityRegNo?/«±Àé«zÁå®AiÀÄzÀ £ÉÆÃAzÀt : 4bw17me408
¸ÀASÉå?

ACCEPTABLE IDENTITY CARDS

Select the Uploading Identity Card? Identify Card No. 59051430227

26. C¥ï¯ÉÆÃqï ªÀiÁqÀĪÀ UÀÄgÀÄw£À aÃnAiÀÄ£ÀÄß DAiÉÄÌ : AADHAR CARD 27 UÀÄgÀÄw£À aÃnAiÀÄ ¸ÀASÉå :
ªÀiÁqÀĪÀÅzÀÄ 1

Identification Marks in body ( any two)

27 a /zÉúÀzÀ°è£À UÀÄgÀÄvÀÄ ( JgÀqÀÄ ) : A Stiched mark in face B Black spot in left hand

Have you applied for PSI Civil Posts (

27 b 545) / ¤ÃªÀÅ ¦J¸ïL ¹«¯ï 545 : No

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 KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2021
( ISO : 9001 - 2015 Certified Recruitment Process )

Notification No. 98/Rect-2/2020- 21

1 Application no : N/A

FEES DETAILS

28 Date of Challan Generation / ZÀ®£ï : N/A 29 Fee Paid /¥ÁªÀw¹zÀ ±ÀÄ®Ì : 500
¸ÀÈf¹zÀ ¢£ÁAPÀ
30 Date of Payment / ±ÀÄ®Ì ¥ÁªÀw¹zÀ ¢£ÁAPÀ : 29 Apr 2021 31 Journal No./ Trans Serial d£Àð¯ï : 123456
¸ÀASÉå
32 your application no : 123456 33 Bank / Post Office/¨ÁåAPï / CAZÉ PÀbÉÃj : HDFC

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 KARNATAKA STATE POLICE SUB INSPECTOR RECRUITMENT - 2021
( ISO : 9001 - 2015 Certified Recruitment Process )

I Agree/ £Á£ÀÄ M¦àgÀÄvÉÛãÉ.

¥sÉÆõÀuÉ
1. CfðAiÀÄ°è w½¹gÀĪÀ «ªÀgÀUÀ¼ÀÄ £À£ÀUÉ w½zÀ ªÀÄnÖUÉ ªÀÄvÀÄÛ £À£ÀÄ £ÀA§ÄªÀµÀÖgÀ ªÀÄnÖUÉ ¤dªÉAzÀÄ ªÀÄvÀÄÛ ¸Àj¬ÄzÉAiÉÄAzÀÄ, F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ. £Á£ÀÄ ¤ÃqÀ¯ÁzÀ AiÀiÁªÀÅzÉÃ
ªÀiÁ»wAiÀÄÄ ¥ÀjÃPÉë/£ÉêÀÄPÁw ªÀÄÄAZÉ, £ÀqÉAiÀÄĪÁUÀ CxÀªÁ vÀgÀĪÁAiÀÄ ¸ÀļÀÄî CxÀªÁ vÀ¥ÉàAzÀÄ PÀAqÀÄ §AzÀ ¸ÀAzÀ¨sÀðzÀ°è CxÀªÁ C£ÀºÀðvÉ ¥ÀvÉÛAiÀiÁzÀ ¸ÀAzÀ¨sÀðzÀ°è £ÉêÀÄPÁw
¸À«ÄwAiÀÄÄ £À£Àß «gÀÄzÀÝ ¤AiÀiÁªÀiÁ£ÀĸÁgÀ PÀæªÀÄ PÉÊUÉƼÀÀÄzÀÄ JAzÀÄ £À£ÀUÉ w½¢gÀÄvÀÛzÉ.
2. £Á£ÀÄ C¢ü¸ÀÆZÀ£ÉAiÀÄ®è £ÀªÀÄÆ¢¹gÀĪÀ ¤AiÀĪÀÄ ªÀÄvÀÄÛ «¤AiÀĪÀÄUÀ¼À£ÀÄß ºÁUÀÆ J¯ÁèµÀgÀvÀÄÛUÀ¼À£ÀÄß eÁUÀgÀÆPÀvɬÄAzÀ N¢gÀÄvÉÛÃ£É ªÀÄvÀÄÛ CªÀÅUÀ½UÉ §zÀÝ£ÁVzÀÄÝ, PÀlÄÖ¤mÁÖV
¥Á°¸ÀÄvÉÛãÉAzÀÄ WÉÆö¸ÀÄvÉÛãÉ. £Á£ÀÄ Cfð ¸À°è¹zÀ ºÀÄzÉÝAiÀÄ £ÉêÀÄPÁw ¤UÀ¢ ¥Àr¹zÀ ªÀAiÉÆëÄw, «zÁåºÀðvÉ ªÀÄÄAvÁzÀ EvÀgÉ µÀgÀvÀÄÛUÀ¼À£ÀÄß ¥ÀÆgÉʹgÀÄvÉÛãÉ. £Á£ÀÄ F
¥ÀjÃPÉëAiÀi°è ºÁdgÁUÀ®Ä F »AzÉ GZÁÑl¸À®ànÖ®èªÉAzÀÄ F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ.
3. £Á£ÀÄ F ºÀÄzÉÝAiÀÄ DAiÉÄÌAiÀÄ ¸À®ÄªÁV Cfð ¸À°è¸ÀÄwÛgÀĪÀÅzÀÄ F ºÀÄzÉÝAiÀÄ ¤AiÀĪÀÄ ªÀÄvÀÄÛ «¤AiÀĪÀÄUÀ¼À£ÀÄß M¦àPÉÆAqÀAvÉ DVgÀÄvÀÛzÉAzÀÄ £À£ÀUÉ ¸ÀA¥ÀÆtðªÁV w½¢gÀÄvÀÛzÉ.
4. £Á£ÀÄ F ºÀÄzÉÝAiÀÄ ¸À®ÄªÁV ¸À»µÀÄÚvÉ ¥ÀjÃPÉëUÉ ªÀÄvÀÄÛ zÉÊ»PÀ ¥ÀjÃPÉëUÉ £Á£ÀÄ ¸Àé EZÉѬÄAzÀ ¨sÁUÀªÀ»¸ÀÄwÛzÉÝãÉ. ºÁUÀÆ ¸ÀzÀj ¸À»µÀÄÚvÀ ªÀÄvÀÄÛ zÉÊ»PÀ ¥ÀjÃPÉëUÉ £Á£ÀÄ
¸ÀzÀÈqsÀ£ÁVgÀÄvÉÛãÉAzÀÄ F ªÀÄÆ®PÀ ¥ÀæªÀiÁtÂÃPÀj¸ÀÄvÉÛÃ£É ºÁUÀÆ ¸À»µÀÄÚvÉ ¥ÀjÃPÉëAiÀÄ ¸ÀAzÀ¨sÀðzÀ°è ¸ÀA¨sÀ«¸ÀĪÀ AiÀiÁªÀÅzÉà jÃwAiÀÄ C£ÁºÀÄvÀ / vÉÆAzÀgÉUÀ½UÉ ¥Éưøï E¯ÁSÉ/
£ÉêÀÄPÁw ¸À«ÄwAiÀÄÄ dªÁ¨ÁÝgÀgÁVgÀĪÀÅ¢®è. £Á£ÀÄ £À£Àß ¸ÀéAvÀ »vÀ zÀȶ׬ÄAzÀ £À£Àß zÉúÀzÀ ªÉÊzÀåQÃAiÀÄ ¥ÀjÃPÉëAiÀÄ£ÀÄß ªÀiÁr¹PÉÆAqÀÄ, DgÉÆÃUÀåªÀÅ J®è jÃw¬ÄAzÀ®Æ
¸ÀzÀÈqsÀªÁVzÉ JAzÀÄ RavÀ ¥Àr¹PÉÆAqÀÄ E¯ÁSÉ £ÀqɸÀĪÀ ¸À»µÀÄÚvÉ ªÀÄvÀÄÛ zÉúÀzÁqsÀåðvÉ ¥ÀjÃPÉëUÉ J®è «zsÀ¢AzÀ®Æ CºÀð£ÉAzÀÄ/CºÀð¼ÉAzÀÄ ªÀÄÄAavÀªÁVAiÉÄà w½zÀÄPÉÆAqÀÄ
¨sÁUÀªÀ»¸À®Ä ¸ÀeÁÓVgÀÄvÉÛãÉAzÀÄ F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ.

Applicant Thumb Impression Applicant’s signature / CfðzÁgÀ£À ¸À»/- Applicant’s Identity Card / CfðzÁgÀ£À UÀÄgÀÄw£À aÃn

Date : 29 April 2021 7:03 PM IP : 157.45.182.44

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