KARNATAKA STATE POLICE DEPARTMENT

APPLICATION FOR THE POST OF CIVIL POLICE CONSTABLE ( MEN & WOMEN)- 2016
UjP Pm( g v ) zU Cf - 2016
Notification No /CZ

: 6709102

Application No

AS

: 30/Pw-4/2015-16,

Applying as a

01. Applicant's Full Name

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: SHASHIDHARA A

02. Mother's Name

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: GANGAMMA

03.

Fathers Name
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: ALKURAPPA

05.

Address

06. Native District

Av f

AP: 06.01.2016

: Direct Candidate

: Davangere

Unit Name

04. Gender
AU

: Male

NEAR THAYESHWARI TEMPLE BHOVI COLONY M K HATTI CHITRADURGA,M K

HATTI,CHITRADURGA,CHITRADURGA,Karnataka,577502
6a. If Others
Evg

: Chitradurga

: Nil

07

Mobile Number
AS

08. Email Id
E-

: shashidharag12@gmail.com

8a. Confirmation Email ID

E- jPgt

09. Height of the Candidate

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: 172

10. Weight of the Candidate (Only for Female)

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: 8792422232

: shashidharag12@gmail.com
: Nil

Reservation Details
11. Category
U

: SC

11a. Sub Caste

: BHOVI

11b. Date of issue of Certificate

it v vgu AP

: 04-Aug-2015

Do you belong to a family of an Ex-servicemen who while in service was permanently disabled or died in action ( Only for
12. Ex-servicemen Children )?
, Pvz vV zP Pv Cx gt Az if P PlAP jgg

: No

12a. Death while in service

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: No

Permanently disabled while in Service

12b. Pv U v Pv
Azg

: No

12c. Wife, Husband, Children, Step Children

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: No

12d. Select Family of an Ex-Servicemen

: Nil

Are you claiming PDP Reservation ?

13. Aid gv Csy w
Pgg ?

: No

Date of issue of Eligibility Certificate

13a. Cv it v vgu AP

: Nil

Are you claiming Kannada medium

Reservation ?
14. Pq izs Csy w
Pgg ?

: Yes

14a. Date of issue of Eligibility Certificate

Cv it v vgu AP

: 02-Nov-2015

: No

15a. Date of issue of Eligibility Certificate

Cv it v vgu AP

: Nil

: No

16a. If yes, to which District you belong to ? :

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17. Are you a Government Employee ?

Pj Pgg ?

: No

17a. Department
ES

17b. Designation
z

: Nil

17c. Service rendered : Years

z U

17d. Date of issue of NOC

gPu it v vgu AP

: Nil

18. Date of Birth

nz AP

Are you claiming Rural medium

15. Reservation ?
Ut izs Csy w
Pgg ?
Are you a candidate belonging to
16. Hyderabad-Karnataka Region ? /

zgz- PlP zz
CsyAi?

Nil

: Nil
: Nil

Months
wAU

: Nil

: 05-May-1990

Days
U

: Nill

18a. Age ,As On Date (05.02.2016 )

: 25 Years 9 Months 0 Days

Have you been involved in any Criminal

Case / Departmental Enquiry ?/
19. Aiizzg Cgzs Pgtz /
ES ZguAi zAiiVg ?

: No

Give details
19a. g qz

: Nil

Have you been convicted in a Criminal

Case ?
20. Cgzs PzAi PU
Mngg ?

: No

Give details
20a. g qz

: Nil

21. Have you submitted any application for the same post in any other units
zj zU Evg WlPU Cf g

: No

Educational Qualification Details

Are you a Degree holder or holder of a
Equivalent qualification from Recognized
University ?
22. zszg Cx CAVPv
zAiAz vvi zv
Agg?

: Yes

Educational Qualification
23. zv

24. If Equivalent, Please specify

vvi zv Azg .

: Nil

25. Year of passing

Gwtgz

: 2007

27. Maximum Marks

Uj CAPU

28. Secured Marks

Uz CAPU

29. Percentage
Pqg

: 64.83

: 600

: 389

:
PUC

Payment Details
30. Date of Challan Generation
Z fz AP

: 24-Jan-2016

31. Fee Paid

wz

: 100

32. Date of Payment

wz AP

: 28-Jan-2016

33. Journal No.

d AS

: 837773

34. Bank Branch Code

AP AZPq

: 40635

35. Bank
AP

: SBM

36. Bank Address

AP

: NO 120 I FLOOR

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Date

: 12 February-2016 6:58 PM

IP Address

: 103.231.218.158

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Applicants signature / Cfzg /-