6/28/22, 10:32 AM CISF | Central Industrial Security Force

CENTRAL INDUSTRIAL SECURITY FORCE

APPLICATION FORM FOR RECRUITMENT OF CT/FIRE-2021

1.)Application Number FIREN2200434572

2.)Post Applied for CT/FIRE

3.)Candidate Name DEEPAK KUMAR PANDEY

4.)Fathers's Name RAGHUBIR PANDEY

4.)Mothers's Name BINDU DEVI

5.)Date of Birth 05-12-2002
6.)Gender male
7.)Nationality INDIAN
8.)Religion HINDU
9.)Category General
10.)State/UT of Domicile UTTAR PRADESH
11.)District of Domicile DEORIA
12.)Highest Educational Qualification 12TH
13.)Qualifing Educational Qualification 12TH
14.)Whether seeking age relaxation NO
15.)Whether belong to Naxal affected
NO
district?
16.)Belongs to Hill Area NO
17.)(A)Communication Address: (B)Permanent Address:
H.No: 130 H.No: 130
Village: sugar mill colony Village: sugar mill colony
Post: meham Post: meham
PS: meham PS: meham
District: ROHTAK District: ROHTAK
State: HARYANA State: HARYANA
Pincode:124112 Pincode:124112
18.)Identification Marks: (a)small cut on forhead

(b)a small cut on head

19.)Fee Details: Reference Number CPABKIUQK8
Amount 100.00
Status Success
21.)EX-SERVICEMEN: NO
22.)Have you ever been convicted by any
court of law or any other judicial NO
Institution?
23.)Is there any case pending against you in
NO
any court of law?
24.)Has any FIR been lodged and case is
NO
pending against you?
25.)Was any FIR ever lodged against you in
NO
the past?

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6/28/22, 10:32 AM CISF | Central Industrial Security Force

26.)Have you ever been dismissed from any

NO
service under the Central or State Govt.?
27.)Have your services ever been
NO
terminated while on probation?
28.)Have you migrated from the State/UT of
NO
your origin to another State/UT?
29.)Mobile No 7206237949
30.)Email ID? deepak822082@gmail.com
31.)Date on which Photograph has been
05-01-2022
taken
32.)Whether the Date mentioned in the
YES
photo is clearly printed on the photograph?
DECLARATION

(i) I have read the Notice of Examination and accept all the Terms & Conditions mentioned therein.

(i)  I hereby declare that all the statements made in the application are true, complete and correct to the best of my
knowledge and belief. I understand that in the event of any information being found supressed/false or incorrect at any
stage or ineligibility being detected before or after the Examination, my candidature/appointment is liable to be
cancelled. i am willing to serve anywhere in india.

       

Singnature       

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