REGIONAL OFFICE (HARYANA) EMPLOYEES' STATE INSURANCE CORPORATION (Under Union Ministry of Labour and Employment, Govt.

of India) PANCHDEEP BHAWAN, SECTOR 16, FARIDABAD-121002 Tel. 0129-2222980, 2222981, 2284728 Website : www.esicharyana.org, email : rd-haryana@esic.nic.in

Recruitment of UDC/MTS -2012

Under Meritorious Sports Persons (MSP) Quota in the ESIC, HARYANA REGION
Applications are invited from Indian Citizens (Meritorious Sports Persons) in the discipline of Football, Volleyball, Badminton & Table Tennis for recruitment to the following posts in the Employees State Insurance Corporation, Haryana Region, Faridabad under Meritorious Sports Person (MSP) Quota. No. of vacancies reserved for different Sports/Discipline Sl. No. Post Pay Band Football Men 01. UDC Volley Ball Men Badminton Men Women Table Tennis Men Women
3

Total

02.

PB-1, Rs5200Nil Nil Nil 1 1 1 20200 with Gr. Pay Rs2400/PB-1, Rs5200Nil 1 Nil NIL 1 1 20200 with Gr. MTS Pay Rs1800/The number of vacancies is provisional and may vary as per actual requirements. RESERVATION: Applicable for SC/ST/OBC as per rule. LAST DATE (normal closing date) FOR RECIEPT OF APPLICATIONS: 31-10-2012

1. Eligibility Criteria: (a). Age: Minimum 18 years as on normal closing date. Upper Age limit 27 years as on normal closing date 25 years as on normal closing date

For UDC For MTS

Relaxation in upper age limit is applicable upto a maximum of 5yrs for sports persons and to reserved category viz. SC/ST/OBC (Non-Creamy layer) in terms of Govt. of India rules, i.e., 10 yrs for SC/ST & 8 yrs for OBC. The concession in age relaxation will be available only to those sports persons who satisfy all other eligibility conditions relating to educational qualification etc. and furnish a certificate from the authorities in the form prescribed in ANNEXURE- III to this advertisement. b. Educational & Other requisite Qualifications:Post UDC MTS Degree of a recognized University or Equivalent. Matriculation or Equivalent Pass. E.Q. Essential Working knowledge of computer, including use of Office Suites and databases. -

Contd......2

:: 2 :: Note: 1. The Selected candidates on appointment will be on Probation for a period of two years. 2. During the Probation period, the candidates selected to the post of Upper Division Clerk shall be required to pass Computer Skill Test.
c. Sports Qualifications : For the above posts, the candidates should have represented the country in an International competition/State in a National Competition/University in an inter-University competition with distinction / State schools in the National Sports / games of Schools etc.. List of Authorities empowered to award Certificate as per Govt. Of India instruction: Sl. No. 1. 2. 3. 4. Competition International Competition National Competition Inter-University Tournaments National / Sports / Games for Schools Authority Awarding Certificate Secretary of the National Federation of game concerned Secretary of National Federation or Secretary of the State Association of the game concerned Dean of Sports or other Officer in overall charge of sports of the University concerned Director or Additional / Joint or Deputy Director in overall charge of sports/games for Schools in the Directorate of Public Instructions / Education of the state. Form in which certificate is to be awarded 1 2 3 4

5.

Secretary or other officer in overall charge of Physical Physical Efficiency in the Ministry of Education & Social Efficiency Drive Welfare, Govt. of India.

NOTE: Specimens of the forms 1, 2, 3, 4 & 5 referred to above are given in APPENDIX-III. 2. Selection Procedure: a. All eligible applicants should apply in the prescribed format through Speed Post/Regd. post only given (Annexure-I) on or before the last date for receipt of applications. So that applications must be recieved on or before last date. Applications received after the last date will not be considered. b. Selection will be made on the basis of the guidelines/instructions issued by Department of Personnel & Training, Govt. of India. The successful candidates will be posted initially in the offices of ESI Corporation in Haryana Region. They are liable to be transferred anywhere in India. 3. (i) Application Fee (Non refundable): For candidates belonging to a) Application Fee For UDC Application Fee For MTS Nil

SC/ST/PWD/Women Candidates/ Govt./ESIC Nil employees/Ex-Servicemen For all other categories 125/b) Rs. 225/(ii) Mode of payment: - The requisite Demand Draft / Bankers Cheque (as applicable) in favour of The Regional Director, E.S.I. Corporation, Faridabad drawn on any scheduled bank payable at Faridabad has to be submitted along-with the application. Note:i. Fees once paid will not be refunded under any circumstances. ii. Only Demand Draft/Bankers Cheque drawn on any scheduled bank will be accepted. Application Fee paid by any other mode will not be accepted. iii. The Demand Draft / Bankers Cheque must be drawn only after the publication of the advertisement. Contd. .......3 :: 3 ::

4. How to apply: Application in an envelope super scribed Application for the post of UDC /MTS under MSP Quota mentioning discipline of sports/games, as the case may be, should be sent by Speed/Registered post at the following address: Regional Office, Employees' State Insurance Corporation, Panchdeep Bhavan, Sector - 16, Faridabad-121002 (Haryana) The following testimonials should be attached with duly filled-up application form in all respects: a) Two copies of recent passport size photographs duly attested by a Group A/Group BGazetted Officer with one photograph firmly pasted on the application form. Applicants should write their name on the reverse of the other copy of photograph to be enclosed. b) Attested copies of certificates and testimonials in support of proof of age, Educational qualification, Sports Qualification, Experience (if any) etc. c) Participation certificate in the Sports event as prescribed by DOPT, Govt. of India. (Specimens of the form-1,2,3,4 & 5 referred to above are given in ANNEXURE-III d) Attested copy of Community Status Certificate in the prescribed format in case of candidates belonging to SC/ST/ OBC (Non-creamy layer) category in the proforma enclosed in ANNEXURE-II. The OBC candidates will also ensure that their caste is listed in the State-wise Central List of OBC as notified by Govt. of India, Ministry of Social Justice & Empowerment. Those candidates who are working under Govt. should send their applications Through Proper Channel in such a way that the application must reach the given address on or before the closing date. However, an advance copy of application along-with all requisite documents can be sent before the last date. Note 1:- The application and other documents should be arranged in the following order, one below the other and tightly tagged or stapled on the left hand side top corner. 1. Application Fees (If required) 2. Additional Photograph. 3. Application Form. 4. Attested copies of certificates. 5. Participation certificates in Sports events in prescribed format. 6. Two self addressed envelope of sizes 23cms x 10 cms. Note 2:- The Demand Draft should not be tagged or stapled, but should be clipped at the top of the Application form. The name and address of the candidates should be written on the reverse side of the Demand Draft. General Conditions:1. The crucial date for determining the age limit and other eligibility criteria shall be the closing date for receipt of applications from candidates i.e. 31-10-2012 and not the closing date prescribed for those in Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division of Jammu and Kashmir State, Lahul and Spiti District and Pangi Sub-Division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands or Lakshsdweep 2. Mere submission of application does not confer/guarantee any right to be called for field trial/selection. 3. A candidate should submit one application for one post only. Submission of more than one application for the same post shall lead to rejection of all the applications submitted. 4. Application should be submitted in the prescribed format only, annexed to this advertisement, which may be downloaded from the official website of ESIC. Any other format of application shall summarily be rejected. The application form should be filled up in his/her own handwriting by the candidates. LTI & RTI both imputes on the application form should be complete & Clear otherwise the candidature will be treated as cancelled. 5. Application should be sent in a cover super-scribed Application for the post of UDC/MTS under MSP Quota, mentioning discipline of sports/games as the case may be by Registered Post/Speed Post so as to reach at the address mentioned above on or before the stipulated date i.e. till 07-11-2012 (upto 5 pm). Contd......4 :: 4 :: 6. Incomplete or unsigned application, or applications received without certified/attested copies of marksheets, certificates of educational qualification, proof of age, Sports Qualification/participation certificate in sports, caste certificates and photographs and those received after the last date of receipt of application will summarily be rejected without any

communication to the candidate. 7. Wrong declaration/submission of false information or any other action contrary to law shall lead to cancellation of the candidature at any stage. 8. The E.S.I. Corporation has the discretion not to fill any vacancies and the vacancy position shown may also increase or decrease. 9. Applicants are required to attach recent (not taken before three months) coloured photograph with the application and the same photograph should be used through out the process of recruitment. 10. Candidates selected shall be liable to be posted anywhere in India. However, presently, they will be posted in Haryana Region. 11. The Corporation takes no responsibility for any delay in receipt or losses in postal transit of any application or communication. Applicants are advised to Intimate their Mobile No. and E-mail ID for correspondence. 12. Before applying for the post the candidate should ensure that he/she has fulfilled the eligibility criteria mentioned above. The Corporation would be free to reject any application at any stage of selection process if the candidate is found ineligible for the post for which he has applied. The decision of the Corporation regarding eligibility of the candidates at the stage at which scrutiny of eligibility is to be undertaken, qualifications, experience and other eligibility norms, the documents to be produced for the purpose of conduct of selection/interview and any other matter relating to recruitment of players will be final and binding on the candidates. No correspondence or personal enquiries shall be entertained by the Corporation in this behalf. 13. Canvassing in any form will be considered as disqualification. NOTE: Application without signature, without thumb impression, without handwritten declaration, incomplete applications or the applications or the applications received without the supporting documents, Participation certificate in prescribed format, application fee, caste certificate, without photographs and those received after the last date of receipt of applications will summarily be rejected without any communication to the candidate. DISQUALIFICATON - No Person:1. 2. who has entered into or contracted a marriage with a person having a spouse living; or who, having a spouse living, has entered into or contracted a marriage with any person; shall be

eligible for appointment to the said posts.

Provided that the Director General may, if satisfied that such marriage is permissible under the personal law applicable to such person and the other party to the marriage and that there are other grounds for so doing, exempt any person from the operation of this Regulation. Last date of receipt of application is 31-10-2012. For candidates from Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division of Jammu and Kashmir State, Lahul and Spiti District and Pangi Sub-Division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands or Lakshsdweep, the last date of receipt of application will be 07-11-2012

Contd. .........5 :: 5 :: The application form can be downloaded from the website www.esicharyana.org/www.esic.nic.in See ANNEXURE I for application format,II- proforma for community certificates & III-for sports certificates. N.B.:

No such appointment can be made unless the candidate is, in all respects, eligible for appointments to the post applied for and in particular in regard to age, educational or experience, qualification referred under 1 (a) (b) (c) except to the extent to which relaxation thereof have been permitted in r/o class, category of persons to which the applicant belongs. Centre of Examination /Selection will be FARIDABAD or 'CHANDIGARH'

REGIONAL DIRECTOR Disclaimer: The contents of this page are informatory in nature. Kindly verify the same from the Corporation Office.

SPEED POST/REGD. POST

APPLICATION FOR RECRUITMENT OF MERITORIOUS SPORTS PERSON UNDER SPORTS QUOTA IN ESIC, Haryana Region.
Name of the post : Sports Discipline : Category of candidate : From, Name of candidate: ______________________ Address of candidate: ____________________ ______________________________________ ______________________________________ Pin Code: ______________________________ To Regional Office, Employees' State Insurance Corporation Panchdeep Bhawan, Sector 16 Faridabad-121002 (Haryana)

ANNEXURE-I APPLICATION FORM FOR RECRUITMENT TO THE POST OF UDC/MTS-2012 in E.S.I. Corporation in Haryana Region

under Meritorious Sports Person (MSP)Quota

(To be filled in ENGLISH) 01.
(I)

Post applied for [Mark a 'tick' () in the appropriate box]

U.D.C. (Upper Division Clerk)

(ii) MTS(Multi Tasking Staff)

Paste your recent passport size photograph attested by a Group -A/ B/ Gazetted Officer

02. (a) Discipline / Sports applied for ['tick' () appropriate box]

Volleyball (Men)

Badminton (women)

T.T (men)

T.T (women

(b) 3

Gender: Indicate [Tick () mark)]in the Box

MALE

FEMALE

Mode of Payment : Demand Draft No. Date and amount Name of issuing Bank

............................................................... ............ ............................................................... ............ ............................................................... ............

4 Name in full (in Block Capital letter 5

Fathers/Husbands Name:

(in Block Capital letter D M M Y 1 Y 9 Y Y

6(i) Date of Birth in Christian era(in figures D

(In words) ------------------------------------------------------------------------------------------------(ii) Age as on ................. Permanent Address (In Block Capital Letter) With PIN Code number ...........years ............months ...........days .................................................................................. ............... ..................................................................................

............... ............................................................PIN CODE..................... .................................................................................. ............... 8 Mailing Address (in Clock Capital .................................................................................. Letters) with PIN Code number ............... .............................................................PIN CODE....................

------- :: 2 :: -----9 Mobile No. .................................................................................. ............... .................................................................................. ...............

Email Id

10

Are you a citizen of India by birth and/or domicile?

................................................................ .........

11

Category you belong to Code of Category (UR-01, SC-02, ST-03, OBC04)

12
Sl. No

Educational qualification (from Matriculation onwards including computer knowledge)

Qualification University/Board Subject studied %age of Marks obtained Remarks

13. (a)Sports Qualification/Achievements: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------(b) Sports Representation

Certificate attached: Write Yes/No in the appropriate Box. ( In case of non submission of certificate in proper format, candidature shall lead to be canceled) ( as per specimen of forms at Annexure-III):
FORM-1 FORM-2 FORM-3 FORM-4

International Competition

National Competition

Inter-University Competition

National Games for School

------- :: 3 :: -----14
Sl. No

Experience/particulars of previous and present employment Name & full address of Employer Designation Scale of pay Period of employment

From 1 2 3 4

To

15. DECLARATION

I hereby declare that the information furnished in the application are true, complete and correct to best of my knowledge and belief. I understand that in the event of any information being found false or incorrect at any stage, my candidature/appointment is liable to summary cancellation/termination without notice or any compensation in lieu thereof. 16. List of enclosures :1. .............................................. 2 ............................................... 3.

.............................................. 5. ..............................................

4.

............................................... 6. ................................................

Candidates Thumb Impression (LTI )

Candidates Thumb Impression (RTI )

Date : ........................... Place : ........................

Signature of Candidate : ...................................... Name : .................................................................

ANNEXURE-II FORMAT FOR SC/ST CERTIFICATE A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should submit in support of his claim an attested/certified copy of a certificate in the form given below, from the District Officer or the sub-Divisional Officer or any other officer as indicated below of the District in which his parents (or surviving parent) ordinarily reside who has been designated by the State Government concerned as competent to issue such a certificate. If both his parents are dead, the officer signing the certificate should be of the district in which the candidate himself ordinarily resides otherwise than for the purpose of his own education. Wherever photograph is an integral part of the certificate, the Commission would accept only attested photocopies of such certificates and not any other attested or true copy.
(The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates applying for appointment to posts under Government of India) This is to certify that Shri/Shrimati/Kumari* ________________________________________ son/daughter of ____________________________________________ of village/town/* in District/Division *_______________________ of the State/Union Territory* ________belongs to the Caste/Tribes_______________ which is recognized as a Scheduled Castes/Scheduled Tribes* under:The Constitution (Scheduled Castes) order, 1950 ___________________ The Constitution (Scheduled Tribes) order, 1950 ________________ The Constitution (Scheduled Castes) Union Territories order, 1951 * _______________ The Constitution (Scheduled Tribes) Union Territories Order, 1951*______________ As amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) order, 1956, the Bombay Reorganization Act, 1960 & the Punjab Reorganization Act, 1966, the State of Himachal Pradesh Act 1970, the North-Eastern Area(Reorganization) Act, 1971 and the Scheduled Castes and Scheduled Tribes Order(Amendment) Act, 1976. The Constitution (Jammu & Kashmir) Scheduled Castes Order, 1956___________ The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by the Scheduled Castes and Scheduled Tribes order (Amendment Act), 1976*. The Constitution (Dadra and Nagar Haveli) Scheduled Castes order 1962. The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order 1962@. The Constitution (Pondicherry) Scheduled Castes Order 1964@ The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967 @ The Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968@ The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @ The Constitution (Nagaland) Scheduled Tribes Order, 1970 @ The Constitution (Sikkim) Scheduled Castes Order 1978@ The Constitution (Sikkim) Scheduled Tribes Order 1978@ The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@ The Constitution (SC) orders (Amendment) Act, 1990@ The Constitution (ST) orders (Amendment) Ordinance 1991@ The Constitution (ST) orders (Second Amendment) Act, 1991@ The Constitution (ST) orders (Amendment) Ordinance 1996 %2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from one State/Union Territory Administration. This certificate is issued on the basis of the Scheduled Castes/ Scheduled tribes certificate issued to Shri/Shrimati ______________________Father/mother ____________________________________ of Shri/Srimati/Kumari*___________________________ of village/town*____________ ___________________ in District/Division* ______________________of the State/Union Territory*______________________________ who belong to the _________________________________ Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe in the State/Union Territory* issued by

the_______________________________ ____dated____________________________. %3. Shri/Shrimati/Kumari and /or * his/her family ordinarily reside(s) in village/town*________________________________________ of ________________ District/Division* _________________of the State/Union Territory of ____________________________ Signature__________________________ ** Designation________________________ (with seal of office) Place______________ Date_______________ * Please delete the words which are not applicable @ Please quote specific presidential order % Delete the paragraph which is not applicable. NOTE: The term ordinarily reside(s) used here will have the same meaning as in section 20 of the Representation of the People Act, 1950. ** List of authorities empowered to issue Caste/Tribe Certificates: (i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Dy. Collector/Ist Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra-Assistant Commissioner/Taluka Magistrate/Executive Magistrate. (ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. (iii) Revenue Officers not below the rank of Tehsildar. (iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides. NOTE: ST candidates belonging to Tamil Nadu state should submit caste certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA This is to certify that Shri/Smt./Km. _________________________ son/daughter of Shri/Smt. _____ _____ ____ ______ ______ ____ ___ ____ ____ ___________ of village/town _____ ____________ ____ ___ _____________ ______ _________ _____ ___________ _______ District/Division ______ _______ ________in the ___________________ community which is recognized as a backward class under : i) Resolution No.12011/68/93-BCC dated the 10th September, 1993, published in the Gazette of India Extraordinary Part I, Section I, No.186 dated 13th September, 1993. ii) Resolution No.12011/9/94-BCC dated the 19.10.1994 published in the Gazette of India Extraordinary Part I Section I No.163 dated 20th October, 1994. iii) Resolution No.12011/7/95-BCC dated the 24th May 1995, published in the Gazette of India Extraordinary Part I, Section I No. 88 dated 25th May, 1995. iv) Resolution No.12011/96/94-BCC dated the 9th March, 1996. v) Resolution No.12011/44/96-BCC, dated the 6th December, 1996, published in the Gazette of India Extraordinary Part I, Section I, No.210 dated 11th December, 1993. vi) Resolution No.12011/13/97-BCC dated the 3rd December, 1997 vii) Resolution No.12011/99/94-BCC dated the 11th December. 1997.. viii) Resolution No.12011/68/98-BCC dated the 27th October, 1999.. ix) Resolution No.12011/88/98-BCC dated the 6th December, 1999, published in the Gazette of India Extraordinary Part I, Section I, No.270 dated 6th December, 1999. x) Resolution No.12011/36/99-BCC dated the 4th April, 2000, published in the Gazette of India Extraordinary Part I, Section I, No.71 dated 4th April, 2000. xi) Resolution No.12011/44/99-BCC dated the 21.9.2000, published in the Gazette of India Extraordinary Part I, Section I, No.210 dated 21.9.2000 Shri/Smt./Km__ ________ ___________ ______ ___and/or his family ordinarily reside(s)____________ ____________ _____________ __________________ in the____ ______ _____ _____ ____ ______ District/ Division __________ ______ _____of the ______ _______ ______ State. This is also to certify that he / she does not belong to the persons/section ( Creamy Layer) mentioned in column 3 of the Scheduled to the Government of India, Department of Personnel & Training OM No 36033/3/2004 Estt. (Res.) dated 09.03.2004 & OM No.36033/3/2004-Estt.(Res.) dated 14.10.2008. Dated: District Magistrate or Deputy Commissioner etc. Seal Note :( a) The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of the people Act, 1950. (b) The authorities competent to issue Caste Certificate are indicated below:(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Deputy Collector / I st Class Stipendiary Magistrate/ Sub-Divisional Magistrate/ Taluka Magistrate /Executive Magistrate./Extra-Assistant Commissioner (not below the rank of Ist class stipendary Magistrate) (ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. (iii) Revenue Officers not below the rank of Tehsildar (iv) Sub-Divisional Officers of the area where the candidate and/or his family resides.

ANNEXURE-III List of authorities empowered to award certificate as per Govt. of India.

Sr. No. 1 2

Competition

Authority awarding Certificate

Form in which certificate is to be awarded 1

International Competition National Competition

Secretary of the National Federation of game concerned

Secretary of National Federation or 2 Secretary of the State Association of the game Dean of sports of other officer in overall 3 charge of sports of the University concerned 4

Inter-University Tournament

National/Sports/Games for Director or Additional/Joint or Deputy Schools Director in overall charge of sports/games for Schools in the Directorate of Public Instructions/Education of the State. Physical Efficiency Drive Secretary or other officer in overall charge of Physical Efficiency in the Ministry of Education & Social Welfare, Govt. of India.

NOTE : Specimen of the forms 1,2,3,4 & 5 referred to above are given in Appendix-III

Appendix-III (FORM 1 TO FORM 4)

FORM 1
(For representing India in an International

Competition in one of the recognized Games/ Sports)

NATIONAL FEDERATION/NATIONAL ASSOCIATION OF -----------------------Certificate to meritorious sportsman for employment to

Group C and D services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri_________ resident of _________________________________ _______ _______ _______ ______ ______ ___ (complete address) represented the country in the game /event of ___________________ in________ ____________________ _____________ ____competition/Tournament held at _________________ _________________ ___________ _____ from ________________ to_____________________.

The position obtained by the individual /team in the above-said Competition/Tournament was________.

The Certificate is being given on the basis of record available in the Office of National Federation/ National Association of _________________.

Signature: _________________________ Place:________________ Name:____________________________ Date: __________________ Designation:_______________________ Name of National Federation/Association ________________________________________ Address:-______________________________________________________ ______________________________________________________ Seal: ____________________________

NOTE: This Certificate will be valid only when signed personally by the Secretary, National Federation/ National Association.

FORM 2
(For representing State in India in a National Competition in one of the recognized Games/ Sports)

STATE ASSOCIATION OF _____________ IN THE GAME OF ______________________ Certificate to meritorious sportsman for employment to

Group C and D services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri_________
resident of ________________________________ _________________________________________(complete address) represented the State of _________ ____________ in the game /event of ________ ______________ in National competition/Tournament held at__________________________________________________________ from________________ to_____________________

The position obtained by the individual /team in the above-said Competition/Tournament was ___________.

The Certificate is being given on the basis of record available in the Office of State Association of ___________.

Signature: _________________________ Place:________________ Name:____________________________ Date: __________________ Designation:_______________________ Name of State Association ________________________________________ Address:-______________________________________________________ ______________________________________________________ Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally by the Secretary of the State Association.

FORM 3
(For representing a University in the Inter-University Competition in one of the recognized Games/Sports) UNIVERSITY OF_______________________ Certificate to meritorious sportsman for employment to

Group C and D services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________ __________-resident of __________ _________ ________________ ____________ (complete address) student of_________________________________________represented the University of _____________ in the game /event of __________________ in Inter-University competition/Tournament held at _____________ __________ from ________________ to_____________________ .

The position obtained by the individual /team in the above-said Competition/Tournament was ________________.

The Certificate is being given on the basis of record available in the Office of Dean of Sports or Officer in Overall charge of sports in the University of _______________________.

Signature: _________________________ Place:________________ Name:____________________________ Date: __________________ Designation:_______________________ Name of University ________________________________________ Address:-______________________________________________________ ______________________________________________________ Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally by Dean/director or other Officer in overall charge of sports in the University.

FORM 4
(For representing a State School Team in the National Games for School in one of the recognized Games/Sports. ) DIRECTORATE OF PUBLIC INSTRUCTIONS/EDUCATION OF THE STATE OF __________ Certificate to meritorious sportsman for employment to

Group C and D services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________ ________ ______________-resident of ____ ________________ _____________________________________ (complete address), student of _____________________________________________________ represented the _____________________State School team in the game /event of ___________________ in National Games for Schools held at _________ __________ _______________________________________________________ from ________________ to_____________________ .

The position obtained by the individual /team in the above-said Competition/Tournament was ______________

The Certificate is being given on the basis of record available in the Office of Directorate of Public Instructions/ Education of ________________________________.

Signature: _________________________ Place:________________ Name:____________________________ Date: __________________ Designation:_______________________ Name of State Association ________________________________________ Address:-______________________________________________________ ______________________________________________________ Seal: ____________________________ NOTE : This Certificate will be valid only when signed personally Director or Additional/Joint or Deputy Director in overall charge of sports/games for schools in the Directorate of public Instruction/Education of the State.

FORM 5
(For the awardees in Physical Efficiency performances conducted by the Ministry of Education and Social Welfare ) GOVERNMENT OF INDIA/MINISTRY OF EDUCATION AND SOCIAL WELFARE Certificate to meritorious sportsman for employment to

Group C and D services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________ ________ ______________-resident of ____ ________________ _____________________________________ (complete address), represented the__________________________________________________ School team in the game/event of _____________________ in National Competition held at _________ __________ _______________________________________________________ from ________________ to_____________________ .

The Certificate is being given on the basis of record available in the Ministry of Education and Social Welfare .

Signature: _________________________ Place:________________ Name:____________________________ Date: __________________ Designation:_______________________

Address:-______________________________________________________ ______________________________________________________ Seal: ____________________________ NOTE : This Certificate will be valid only when signed personally by the Secretary or other officers in overall charge of sports/games for schools in the Directorate of public Instruction/Education of the State.