STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH,

MANGALAGIRI.
FILLED IN ONLINE APPLICATION FORM
For the posts of SCT SIs (Civil) (Men & Women),
SCT RSI (APSP) (Men) in Police Dept.
Vide Notification Rc.No.163/SLPRB/Rect.1/2022, dt: 28.11.2022.

Basic Details
Registration No. 5005293
1. Name of the Candidate
REYYA BHARGAV
(as per SSC or Equivalent Certificate)

2. Father's/ Husband's Name R JANAKIRAM

3. Gender Male
4. Date of Birth
07-Aug-1995
(as per SSC or Equivalent certificate)

5. SSC/Equivalent Roll No 1005203298

6. Community BC-A

7. Mobile No. 7799535328

8. e-Mail Id reyyabhargav@gmail.com

Age Relaxation Details

9. As per the information you provided in Column Nos. 9 & 10 in Online Application Form (Stage 1), do you
BC-A
come under the Reservation Quota?
a) Do You come under Creamylayer or Non-Creamylayer I belong to Creamy Layer
b) Sub Caste(BC-E Candidates) NA
10. Do you claim benefit of Physical Measurements and age Relaxtion under category of ABO-ST? (Please
NA
go through the Notification)
What is your Native Scheduled Area NA
11. Do you claim age relaxation under category Employee of the A.P. Government? (Please go through the
No
Notification)
i) Date of Joining in Service NA
ii) Length of Service as on 28.11.2022 NA

iii) Are you still in Service NA

12. Do you claim age relaxation under Ex-servicemen and also relaxation in Physical Efficiency Test under
No
Ex-servicemen Category? (Please go through the Notification)
i) Ex-servicemen Joining Date NA
ii) Ex-servicemen Date Of Discharge NA
iii) Total Service rendered NA

13. Are you still working in Army,Navy or Airforce of the Union as on date of notification (28-11-2022)? NA
i) Date of Entry in Service NA
ii) Likely date of discharge NA
14. Do you claim age relaxation for having worked as an instructor in NCC? (Please go through the
No
Notification)
i) Date of Entry NA
ii) Date of Discharge NA

iii) Total Service rendered NA

15. Do you claim age relaxation for having Employed in the State Census Department during 1991? (Please
No
go through the Notification)

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If yes, Length of Service in Census Department during 1991 (in Days) NA

16. Do you claim age relaxation and Reservation under EWS Category? (Please go through the Notification) NA
Date of issuing the EWS certificate NA
Special Representation Details
17. Do you claim benefit of Special Representation for the post code nos. 11 & 13 No

I) If yes, furnish the applicable category NA

a). Furnish details of your parent if you claim Special Representation under Police Executive (PE) Quota?
i) Date of enrollment (Eligible to the post of SI to ASI) NA
ii) Name of the present post NA
iii) Name of the Unit where you are working NA
iv) Date of declaration of Probation as on date of Notification
NA
(28.11.2022)
v) Are you still working as on date of Notification (28.11.2022) NA
b). Furnish details of your parent if you claim Special Representation under Police Ministerial (PM) Quota?
i) Date of entry into service (Eligible Post Jr.Asst. or Sr.Asst) NA
ii) Name of the present post NA
iii) Name of the Unit where you are working NA
iv) Date of declaration of Probation as on date of Notification
NA
(28.11.2022)
v) Are you still working as on date of Notification (28.11.2022) NA
c). Furnish the details if you claim Special Representation under the Meritorious Sports Person Quota? (You should satisfy the
conditions as given in the Notification)
Meritorious Sports Persons-1 NA Name of the Sport / Game-1 NA
Meritorious Sports Persons-2 NA Name of the Sport / Game-2 NA
Meritorious Sports Persons-3 NA Name of the Sport / Game-3 NA
d). Furnish details of your parent if you claim Special Representation under Children of Police Personnel (CPP) Quota?
i) Date of enrollment of your parent NA
ii) Name of the post NA
iii) Name of the Unit NA
iv) Was your parent 'working' or 'retired' or 'dead' as on 28.11.2022 NA
e). For Children of Deceased & Incapacitated (CDI) Police Personnels due to violent action of extremists/Criminals/ Anti-Social
elements & retired on medical invalidation while on duty only. Furnish details of your parent if you claim Special Representation
under CDI Quota?
i) Date of enrollment of your parent NA
ii) Name of the post NA
iii) Name of the Unit NA
iv) Is your parent dead or retired on medical invalidation as on
NA
28.11.2022
f). Furnish the details if you claim Special Representation under NCC ( NCC-A, NCC-B, NCC-C) Quota?
Date on which the Certificate was
NCC-A NA NA
obtained
Date on which the Certificate was
NCC-B NA NA
obtained
Date on which the Certificate was
NCC-C NA NA
obtained

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 Other Details
18. Which is your preferred place for writing Final Written Test?
1st Preference Visakhapatnam
2nd Preference Eluru

3rd Preference Guntur

19. Have you been involved in any Criminal case till today? No

Number of Criminal cases you were involved.

1.Crime No. & Year NA & NA

Name of the Police Station NA

Name of the District NA

Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

2.Crime No. & Year NA & NA

Name of the Police Station NA

Name of the District NA

Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

3.Crime No. & Year NA &NA

Name of the Police Station NA

Name of the District NA

Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

4.Crime No. & Year NA &NA

Name of the Police Station NA

Name of the District NA

Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

5.Crime No. & Year NA & NA

Name of the Police Station NA

Name of the District NA

Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

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Furnish the present stage of the case. NA

20. Were you at any time employed and dismissed from service of the State or Central Government or
from the Service of any Central or State Government undertaking or local body or other authority ? No
(whether during training or later)

Name of the Post NA

Name of the Department NA

Date of declaration of Probation NA

Date of Dismissal NA

Office Address NA

Post Preference Details

21. As per information provided by you in Column no. 22 In online application form (stage 1), Post Preferences
Preference Order Name of the Post

1st Preference SCT SI (Civil) (Men & Women)

2nd Preference SCT RSI (APSP) (Men)

22. Indicate the Zones you prefer in the event of selection for posts of SCT SI (Civil)- Post Code-11 (Please mention Code No. of
the Zone in the order of preference mentioned below)
Preference Order Name of the Zone
1st Preference Zone-I
2nd Preference Zone-IV
3rd Preference Zone-II
4th Preference Zone-III
Study details
23. Are you a Local or Non-Local Candidate? Local If Yes, which is your Local District? Srikakulam
24. Did you migrate from the State of Telangana to
No You have Migrated to which District? NA
Andhra Pradesh?
Date of Issue of Migration Certificate. NA
25. To Justify column 44 i.e Local status furnish the Whether Regular Study / Residence Details? Regular studies
(a)To Justify your claim, furnish your Study/Residence details as applicable from 4th to 10th Class:
Sno Class Month Year School Name / Residential Address Name of the District
1 4th Class 6 2004 Sri neelakanteswara school Srikakulam

2 5th Class 6 2005 Sri neelakanteswara school Srikakulam

3 6th Class 6 2006 Sri neelakanteswara school Srikakulam

4 7th Class 6 2007 Sri neelakanteswara school Srikakulam

5 8th Class 6 2008 Sri Satya Sai high school Srikakulam

6 9th Class 6 2009 Sri Satya Sai high school Srikakulam

7 10th Class 6 2010 Sri Satya Sai high school Srikakulam

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The following relevant ORIGINAL DOCUMENTS along with one set of Xerox copies will be submitted by me when I appear for
PMT/PET. I understood the instructions given in the Notification

a) Secondary School/Matriculation certificate or equivalent certificate in support of the date of birth.

b) Educational qualification: The candidate must have passed, as on 1st July, 2022, Intermediate or its equivalent examination
recognised by the State Government.
In the case of a candidate belonging to Scheduled Caste or Scheduled Tribe, as on 1st July, 2022, he/she must have passed
Intermediate or its equivalent Examination and studied Degree and appeared for the Degree Examinations of 1st, 2nd and 3rd year.

c) A candidate belonging to Scheduled Caste or Scheduled Tribe, who did not pass the Degree or its equivalent examination but
passed Intermediate or its equivalent examination and studied Degree and appeared for the Degree Examination, must submit the
Memorandum of Marks of both the 1st ,2nd and 3rd year Degree Examinations.

d) A candidate belonging to the Open Category (OC), who wish to claim concession in age and reservation specified for the EWS
category, should submit the said Certificate issued by the competent authority as specified (Para no. 11 in the Notifiation).

e) A candidate belonging to the Backward Class, who wish to claim concession in age and also reservation specified for the Backward
Classes, must submit the LATEST Community & Date of Birth Certificate and Certificate of Non Creamy Layer issued by the
competent revenue authority as specified.

f) A candidate belonging to Scheduled Caste or Scheduled Tribe, who wish to claim concession in age and also reservation specified
for the SCs/STs, must submit the LATEST Community & Date of Birth Certificate issued by the competent authority as specified.

g) Certificate from the competent authority in respect of State Government employees/those who worked in the Army, Navy or Air
Force of the Indian Union/NCC Instructors/ retrenched temporary employees in the State Census Department during 1991 for
claiming age relaxation.

h) Residence certificate in the agency area from the competent authority in respect of candidates belonging to Scheduled Tribes and
Aboriginal Tribes in the agency area who claim relaxation in Physical Measurements or reservation.

i) Study certificate issued by the School authorities or Residence certificate (in case the candidate has not studied in any Educational
Institution preceding to SSC/Matriculation or equivalent (Private study)) issued by Tahasildar of the concerned Mandal, for
determining local status.
j) Police Executive / Police Ministerial Service Certificate/Certificate of CPP/Certificate of CDI issued on or after the
date of notification, wherever applicable.
k) Ex-servicemen certificate / Meritorious Sports Persons Category (a), (b) or (c) Certificate / NCC ‘A’, ‘B’ or ‘C’ certificate etc.,
wherever applicable.

i) Migration certificate i.e. candidate who migrated to any part of the State of Andhra Pradesh from the State of Telangana within a
period of seven years from the 2nd day of June, 2014 shall submit relevant certificate in order to claim local candidate status (Para
No. 21 in the Notification).

Application submitted on : 31-07-2023 09:22:26

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