-/ANNEEXUREI

STAFF SELECTI
S
ION COM
MMISSIO
ON
..
.
, ....
.. . .
-2011
EXAMIINATION FOR
F
RECR
RUITMEN
NT OF SUB
B INSPECT
TORS IN CPOs,
C
ASSIST
TANT SUB
B INSPECT
TORS IN CISF
C
& INT
TELLIGEN
NCE OFFIC
CER IN NC
CB-2011

/ (

Please read instruction in thee Notice of the Examination/Ann

E
nexure carefully
y. Use Blue or Bllack ball pen to write in the box (
1.

/ Naame of the Examin

nation Centre

2.
/ Center Cod
de

3. ( )
Candidate's Full Name (in English)). Write in Capita
al Letters exactly
y as in Matriculation Certificate. Leave
L
a box blan
nk between every
y two parts of the
e name.

4. (
) / Father's
F
Name (Write in Capita
al Letters in Eng
glish)

5. ( )/ Mother's Name
e (Write in Capital Letters in En
nglish)

6.

/ Date of Birth

/ Da
ay /Month

7. / Gen
nder

/Year

10. / Category

10.1
?

( 9 ,1,

2 6 )

Whether Ex-se
erviceman ?

(Write 3- Ex-S
Serviceman)
11.2

(24.06.2
2011)

12. [ A,B,C,D,E,F& G ]

Age as
s on normal clos
sing date (24.06
6.2011)

Preference forr Posts [ A,B,C,,D, E,F & G ]

/ Ye
ears

/ Mo
onths

/
Fee
(- 1 , 2- )
(Write 1-Fee paid & 2-- Exemption cla
aimed)
11.1 ,

11.
?
Whether se
eeking Age relaxxation ?
( 1 , 2- )
(Write -1-Ye
es, 2-No)

(Write 9-General,
9
1-SC, 2-ST, 6-OBC) (- 3- )

9.

8. /N
Nationality
(- 1 2- )
(Write 1-India
an & 2 - Others)

(- 1 2-)
(Write 1-Fem
male & 2- Male)

If yes, indica
ate code
( )
(Write two dig
git numeric code)
13.Wheth
her meeting height requirement for ?

/ Day
ys

?
( 1- , 2- .. )
Write 1-for all posts , 2-ffor NCB only)

13.1
For
F Ex-Servicem
man

14. ?

/ Length of Service

(- 1 , 2- )
Whether belong
b
to Minorrity Communitie
es
as per Gov
vt. Orders? (Write 1-Yes, 2-No
o)

/Date of Discharge

[ /Year]
/ Da
ay

/Month
/Year

15.
Educa
ational Qualifica
ation

Indic
cate Code

(%)
Percentage (%) of
o Marks

Subject Code
S

(-1, -2 --3)
Medium ( Engllish-1, Hindi-2, Otthers-3)

16. / Details of work

w
Experienc
ce / Govt. Servic
ce rendered

Name of
o the Organisation(s)

Name of the Du
uty(ies)

Des
signation

17. :



ss: Write your co
omplete Commu
unication Addres
ss including yourr
Addres

18. :
4 . .x 5 ..

(
)
Photograph
Paste here
h
firmly your recent
photograph
(4 cm.X 5 cm)
(Do not staple. Do not get
g the
Pho
otograph attested
d)

Name in
n English Capita
al Letters or Hind
di with Blue or Bla
ack Ball Pen.

Name_____________________________________________________

Addrress__________________________________________________
___________________________________________________________

/
/From

Period of Service
/ To

( )
R
Roll Number ( fo
or Office use onlyy)

____________________________________________________________
____________________________________________________________
PIN:
P
17.1
./ Mobille No. : .........................................................

- / Email :....................................................................

19. ( )
Signature off the Candidate in the
above Box (O
Only in running
g Hand)

Page 1 of 2

20. / Declaration

..


Space for cancellation
stamp by post office
after affixing CRF stamp

21. ..

Space for CRF Stamp

r 100.00 ..

( )

Paste here firmly CRF

Stamp of r 100.00
denomination and get
it cancelled from the

post office where

purchased.

( Do not Staple)

(i ) BE
S
BEn
bBEP
uq BE
Vx
B

ci lx
/
. .
BE]BE]
{BEx
]BE]

for
cancellation
stamp

office
after

CRF stamp
Space
by post
affixing
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 by the Commission.
(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.
(iv) / /
/

I also declare that I do not stand debarred by SSC/UPSC as on date and have never been
convicted by any court of law. I also declare that no charge sheet is pending against me in any
court of law. Further declare that I have never been dismissed or removed from Govt. Service or
my service been terminated during probation.
(v) *
/ 3
,
* For Central Govt. Civilian Employee seeking age relaxation.
I declare that I am a Central Govt. Civilian Employee and completed 3 years of regular service or
regular length of service stipulated in the Notice of the examination on or before date of closing
of submitting application form given in the Notice.
(vi) *
/ 8.9.1993
36012/22/93- ( )

, . 3 / ( )
/
*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 in Deptt. 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 the schedule of
the OM mentioned above and modified vide Govt. of India DOPT OMs mentioned in the Notice. I
further declare that I am in possession of OBC Certificate in the prescribed format given in the
Notice of the examination.
(vii)
/ /
For Candidate belonging Ex-Serviceman
I declare that I fulfill all the eligibility condition relating to Ex-Serviceman as per notice of
examination.
(viii) /
, / /
/
I hereby declare that all statements made in this 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 suppressed/false or incorrect or ineligibility being detected before or after the
examination, my candidature/appointment is liable to be cancelled.

( )
Signature of candidate ( only in running hand)

/Place: .............................................

/Date:

*
* Strike off this sentence if not applicable

Unsigned application will be rejected

(Page 2 of 2)

-IIA/Annexure- IIA
INSTRUCTIONS FOR FILLING UP THE APPLICATION
1.0 Please read the instructions given in the Notice of Examination carefully before filling up the
application form, in your own interest.
2.0 Use only blue/black ball pen to write in the boxes. i.e.
3.0 Instructions have been given for most items in the application itself which should be gone
through carefully before filling up the boxes. For items for which instructions are not available,
further instructions given below may be gone through carefully.
4.0 Please go through the instructions given below for filling up each item numbered in the
Application Form:Column 1 and 2: Name of the Examination Centre and Centre Code
Refer to para-7 of the Notice of the Examination.
Column 11.1: Code for seeking age relaxation.
Refer to para 4 B of the Notice of the examination.
Column 12: Preference for Posts
Candidates should carefully indicate preference for Posts
A
B
C
D
E
F
G

Sub-Inspector in Central Industrial Security Force (CISF)

Assistant Sub-Inspector in Central Industrial Security Force (CISF)
Sub-Inspector in Border Security Force (BSF)
Sub-Inspector in Central Reserve Police Force (CRPF)
Sub-Inspector in Indo-Tibetan Border Police Force (ITBPF)
Sub-Inspector in Sashastra Seema Bal (SSB)
Intelligence Officer in Narcotics Control Bureau (NCB)

Column 13: If you meet height requirement for all the posts including the post of Intelligence Officer
in NCB, write-1, if for NCB only write-2.
Column 14: Candidates may indicate whether they belong to one of the minority communities
notified by Govt. namely, Muslims, Christians, Sikhs, Buddhists or Zoroastrians (Parsees).
Column 15: Educational Qualification from Degree or Equivalent onwards:
See Annexure X for Codes. Use OTHERS for any other qualification.
Subject Code : See Annexure-XI for codes. Use OTHERS (Code No.48) for other subjects. If marks
are not available (some universities use grades), equivalent marks may be filled or marks column
may be left blank.
Column 17: Address for Communication:
Write your complete communication address including your Name in English in capital letters or in
Hindi with blue/black ball pen. Do not forget to write 6 digits PIN Code in the boxes. All the
correspondence will be made to this address.
Column 17.1: E-mail ID / Mobile Nos. Are used for communicating with the candidates in
emergencies. Commission is also examining whether Admission Certificates for Written
Examination, PET/ME and Interview / Personality Test can be sent through E-mail/SMS. It is in the
interest of the candidate to furnish these details.
Column 18: Photograph:
(i)Paste your recent photograph of size 4cmx5cm. Do not staple and do not get the photo attested.
Please note that your application shall be rejected summarily without photograph or with mutilated /
defaced photograph.
(ii)Box in the Application Form for Roll Number to be left unfilled (blank) by the candidate.
Column 19&20: Signature of the Candidate
Please sign in running hand only. Signature in capital letters of English or unsigned application shall
not be accepted and your application shall be summarily rejected.