Sei sulla pagina 1di 8

N. B.

(i) Part IV(A) of the Gazette No. 2,019 of 12.05.2017 was not published.

YS% ,xld m%cd;dka;l%s iudcjd ckrcfha .ei m;%h


The Gazette of the Democratic Socialist Republic of Sri Lanka
wxl 2"020 2017 uehs ui 19 jeks isl=rdod 2017'05'19
No. 2,020 friday, may 19, 2017

(Published by Authority)

PART I: SECTION (IIA) Advertising


(Separate paging is given to each language of every Part in order that it may be filed separately)

Page Page

Post - Vacant Examinations, Results of Examinations &c. 1125

Note. (i) Sri Lanka Institute of Agriculture (Incorporation) Bill was published as a supplement to the Part II of the Gazette of the
Democratic Socialist Republic of Sri Lanka of May 05, 2017.
(ii) Nation Building Tax (Amendment) Bill was published as a supplement to the Part II of the Gazette of the Democratic
Socialist Republic of Sri Lanka of May 12, 2017.

Important Notice Regarding Acceptance of Notices


For Publication in the Weekly Gazette
Attention is drawn to the Notification appearing in the 1st week of every month, regarding the latest dates and times of acceptance of Notices
for publication in the weekly Gazettes, at the end of every weekly Gazette of Democratic Socialist Republic of Sri Lanka.

All notices to be published in the weekly Gazettes shall close at 12.00 noon of each Friday, two weeks before the date of publication.
All Government Departments, corporations, Boards, etc. are hereby advised that Notifications fixing closing dates and times of applications in
respect of Post-Vacancies, Examinations, Tender Notices and dates and times of Auction Sales, etc. should be prepared by giving adequate time
both from the date of despatch of notices to Govt. Press and from the date of publication, thereby enabling those interested in the contents of such
notices to actively and positively participate please note that inquiries and complaints made in respect of corrections pertaining to notification
will not be entertained after three months from the date of publication.
All Notices to be published in the weekly Gazette should reach Government Press two weeks before the date of publication i.e.
Notices for publication in the weekly Gazette of 09th June, 2017 should reach Government Press on or before 12.00 noon on 26th May, 2017.
Electronic Transactions Act, No. 19 of 2006 - Section 9
Where any Act or enactment provides that any proclamation, rule, regulation, order, by-law, notification or other matter shall be
published in the Gazette, then such requirement shall be deemed to have been satisfied if such rule, regulation, order, by-law, notification or
other matter is published in an electronic form of the Gazette.

Gangani Liyanage,
Government Printer (Acting)
Department of Govt. Printing,
Colombo 08,
01st January, 2017.
This Gazette can be downloaded from www.documents.gov.lk

1123-B 81171- 5,403(05/2017)


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PART I : SEC. (IIA) GAZETTE OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA 19.05.2017

Rules and Instructions for Candidates declare everything he has with him/her. Breach of this requirement shall
All candidates are bound to act in conformity with the provisions of be considered as an attempt to commit an act of dishonesty.
the Examinations Act, No. 25 of 1968. 13. Candidates are forbidden to copy or attempt to copy from the
All candidates are bound to abide by the rules given below. A candidate answer script of another candidate, a book, paper containing notes or
who violates any of these rules is liable to one or more of the following any other source. A candidate should not attempt to look at the answer
punishments at the discretion of the Commissioner of Examinations : script of any another candidate. A candidate should refrain from helping
(i) Suspension from the whole or part of the examination or one another Candidate and also from getting help from another candidate
subject or a part thereof; or a person. Every completed answer sheet should be kept underneath the
(ii) Disqualification from one subject or from the whole examination ; sheet on which the answer is being written. Sheets of writing paper should
(iii) Debarment from appearing for an examination for a period of not be strewn all over the desk.
one year or two years ; 14. A candidate will under no circumstance whatsoever be allowed to
(iv) Debarment for life ; leave the Examination Hall even for a brief period during the course of the
(v) Suspension of the certificate for a specified period ; paper. However in an emergency if a candidate needs to leave the hall, he/
(vi) Reporting the candidates conduct to his Superiors or handing over she shall be allowed to do under the surveillance of the supervisor or his
the candidate to the Police or making a complaint to the Police over assistant. He/she shall be subject to search before leaving the hall as well
his action. as before re-entering it.
The Commissioner reserves himself the right to take action at any time 15. Impersonation while answering a paper or before the commencement
before the Examination or at any stage of it or thereafter, and his decision of the Examination is a punishable offence. Tampering with identity cards,
presenting false identity cards or tampering with someones identity are
shall be deemed final. In the case of examinations for recruitment to the also such offences. Candidates are warned not to commit such offences.
Public Service, the decision of Commissioner of Examinations shall be 16. Assistance given to a candidate in a dishonest manner by a person
subject to the Supervision of the Public Service Commission. who is not a candidate, is considered a serious offence.
1. All candidates should conduct themselves in a quiet manner in Candidates should adhere to the following instructions for their own
and around the Examination Hall so as not to disturb or obstruct the safety :
Supervisor, his assistants or the other candidates. They should enter and (i) Be at the Examination Hall well in time. It is sufficient to be at the
leave the Examination Hall as quietly as possible. Examination Hall 10 or 15 minutes before the commencement of each
2. Candidates should obey the Supervisor. Therefore, when the paper. If you have any doubt as to the location of the Examination Hall,
Examination is in progress and before the commencement of the make inquiries on a day prior to the date of Examination and be sure of
Examination as well as immediately after the end of the Examination they its location.
should act in accordance with the instructions of the Supervisor and his (ii) In case of any doubt regarding your entry for a paper or eligibility
assistants. to sit a paper you should bring it to the notice of the Supervisor and get
3. Under no circumstances whatsoever will a candidate be allowed your doubts cleared. Failure to do so may result in your candidature for
into the Examination Hall after the lapse of half an hour after the the subject being cancelled.
commencement of a paper. No candidate will be permitted to leave the (iii) When appearing for the Examination, candidates should produce
hall till after half an hour from the time of commencement of the paper. their identity cards at every paper they sit. If a candidate fails to produce
Candidates who come late for Practical and Oral Examinations are liable identification documents at the Examination Hall, his candidature is
to be refused admission. liable to be cancelled. In case a candidate forgets to bring such documents
4. Every candidate should sit at the desk bearing his/her index number into the Examination Hall, it should be brought to the notice of the
and not at any other desk. Unless with the permission of the supervisor no Supervisor and arrangements should be made to produce them before the
candidate should change his/her seat. The occupation of a seat other than Examination concludes.
the one assigned to him by a candidate is liable to be considered as an act (iv) Standard stationery (i.e. writing paper, graph paper, ledger
with a dishonest intention. paper, precis paper) will be supplied. If you receive any stationery that is
5. Absolute silence should be maintained in the Examination Hall. A different from the kind generally distributed or distributed to the others it
candidate is forbidden to speak to, communicate with or have dealings should be promptly brought to the notice of the supervisor. No paper other
with any person within or outside the Examination Hall other than a than those issued at the Examination Hall should be used for answering
member of the Examination Hall Staff. If there is an urgent need for questions. Excess paper and other material should be left on the desk, in
a candidate to communicate with another, prior permission must be good condition. When log tables are supplied they should be used with
obtained from the supervisor. care and left on the desk when you leave.
6. A candidates answer script is identified only by the Index Number (v) Candidates should bring their own pens, pencils, bottles of ink,
and his/her name should not be written on the answer script. Another erasers, pieces of cloth, rulers, geometrical instruments, coloured pencils,
candidates index number appearing on the answer script of a candidate coloured chalk, etc.
is considered as an attempt to commit a dishonest act. Answer scripts (vi) When you start answering you should promptly write down your
bearing an index number that is difficult to decipher is liable to be rejected. Index Number and the name of the Examination on each sheet of paper
7. Candidates should write only on the paper provided and should used. Write neatly and legibly on both sides of the paper. Leave a blank
not write anything on the blotting paper, question paper, desk or any line after the answer to each part of a question. After the answer to a full
other place. Non conformity with this rule could be taken as an act with question leave one or several blank lines. Do not crowd in your work.
dishonest intentions. (vii) The left-hand margin of the answer sheet is set apart for you
8. Any paper or answer book supplied should not be torn up, crushed, to enter the number of the question you answer. The right hand margin
folded or erased. Each and every sheet of paper used for rough work is reserved for the examiners use and nothing should be written there.
should be tied up with the answer script. It should be a part of the answer Number your answers correctly as incorrect numbering leads to confusion.
script. (Such rough work should be neatly crossed out.) Anything written (viii) You should read carefully the instructions given at the head
inside the Examination Hall should not be taken out. If a question has of the question paper, with regard to the compulsory questions and the
been answered twice, the unnecessary answer should be neatly crossed manner in which the other questions should be selected. Disregard to
out. Failure to abide by these requirements may be considered as an these instructions is often liable to affect you adversely.
attempt to cheat. (ix) When Mathematics Questions are answered, give all details
9. When answering questions in Mathematics the submission of correct of calculations and any roughwork, in their serial order as part of the
answers with incorrect working or with no working at all and in art if working of the problem. Necessary sketches, diagrams and figures should
the work of art is similar or very close in resemblance to that of another be accurate and sufficiently large. In an answer running into serveral
candidate in concept, in form or in execution it is liable to be considered pages if reference must be made to a diagram drawn in an earlier page,
as a dishonest act. that diagram should be drawn repeatedly.
10. The removal of any paper or stationery supplied to candidates out of (x) At the end of each paper, arrange your answer sheets in the order
the Examination Hall is prohibited. All such material remains the property you answered the questions. Then using the piece of twine supplied, tie
of the Commissioner of Examinations. Breach of this rule shall be liable them up at the top left hand corner. Do not tie up at the top right hand
to be considered an act with dishonest intention. corner.
11. While in the Examination Hall a candidate should not have with (xi) You should personally handover your answer script to the
him or near him any book, note book, pocket note book, exercise book, Supervisor or to an Invigilator. Or else remain in your seat till it is
sheet of paper or pieces of paper other than the stationery supplied to collected. Failure to do so may result in the loss of your script and your
him. Nor should any handbag, travelling bag or parcel other than the being treated as an absentee for the paper. On no account should your
candidates boxes of colours and boxes of instruments where necessary or script be handed over to a peon or an attendant.
any file cover, card board pad, folded newspapers, brown papers should (xii) If it becomes necessary for you to speak to the Supervisor or an
be brought into the Examination Hall. Breach of this rule is a punishable Invigilator, or if you need stationery, remain in your seat and raise your
act. hand.
12. A candidate is strictly forbidden to keep with him any book, note Commissioner General of Examinations.
book or a sheet of paper with written notes once inside the Examination Department of Examinations,
Hall. Should the Supervisor so requires, each candidate is bound to Pelawatta, Battaramulla.
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Examinations, Results of Examinations & c.


Ministry of Health, Nutrition and such registration invalidated by 01.01.2017.
Indigenous Medicine Even when you are a person registered in a
University and still has not participated or
Recruitment for Ayurveda Student Nurse is not participating in lectures, you will be
Training - 2017 deemed a registered student of a University
and therefore, such applicants should also get
Applications are invited from applicants with their registration invalidated. You should keep
following qualifications to be recruited for Student Nurse sufficient written documents in proof of the
Training under the Ministry of Health, Nutrition and same as and when required.
Indigenous Medicine. (Recruitment of male applicants 2.2 Even when you are not a person registered in a
will be made based on requirements of institutions coming course of study conducted under any University
under the Ministry subject to provisions of the Nurses' or the Ministry of Health, Nutrition and
Service Minute) : Indigenous Medicine by the date of 01.01.2017
01. The qualified persons will be selected as 30% on all stated above, you will still be disqualified for
Island skill and 70% on provincial skill by preparing this course if you had in any way remained
skills registeres based on Z-score received at the G. registered by the date of interview for
C. E. (Advanced Level). The number of trainees to recruitment of trainees to the relevant course.
be recruited from those Provinces for the training
course will be selected based on the number of 2.3 If you are a person who has completed a degree
vacancies available in hospitals and institutions in any University, the effective date of such
coming under the Line Ministry of the Province and degree should be a date falling on or before the
the Provincial Council. final date of entertaining applications.
When applications are called for a training course
out of those who have passed the Advanced Level Important :
Examination in a number of years based on their
z-score, the number to be recruited is divided in 1. You should strictly keep in your mind that no
proportion to the number of applicants from each section of this Gazette notification means that
year. Thereafter, the number to be recruited for each you will be given definite admission for the
such year is divided in proportion to the number of course applied for even when you have satisfied
students applied under the streams of Bio Science, conditions 2.1 to 2.3 mentioned above.
Mathematics and Agriculture in that year, and
2. You should be aware that even when you
thereafter the qualified persons will be selected
on District basis out of the applicants who have have satisfied said conditions from 2.1 to 2.3,
obtained the highest z-score. you are in no way qualified for these courses
if you have not obtained the required z-score
02. These courses are full-time courses. Therefore, the considered to be qualified or have not satisfied
students following any other type of full time course any other condition mentioned herein.
on the five week days and Saturday morning in a
University or under the Ministry of Health or in any 3. You should be further aware that you will by no
other Government institution should not apply for means be qualified for these courses if you have
this. In case any person is later found to have so not satisfied conditions mentioned from 2.1 to
applied, he will be removed out of the course/post 2.3 even when you have obtained a sufficient
and all expenses borne by the Government so far for z-score and completed all other conditions
him/her will be recovered. If a person following a mentioned herein.
full-time course in a University expects to so apply,
the provisions under 2.1 to 2.3 below should be 03. Educational qualifications :
adhered to. Applications of those who have been
registered in full-time courses under the Ministry of (a) Passing General Certificate of Education
Health, Nutrition and Indigenous Medicine will be (Advanced Level) Examination in one sitting
rejected : in all subjects under the Science stream of Bio
2.1 If you have been or are registered any time in a Science/Mathematics/ Agriculture (Excluding
full-time course in any University or any other the Common General Test),
Government institution, you should have taken and,
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(b) Passing the G. C. E. (O/L) Examination in six Note : In case the mother or father of any candidate
(06) subjects in no more than two sittings with has been serving in a transferable service under
Credit Passes for the 04 subjects of Sinhala/ Government, a Provincial Council or a Corporation,
Tamil language, Mathematics, Science and such candidate may select the district of birth of his
English. mother or father as the district to which he belongs
(for which the Certificate of Birth of his mother or
Certified photocopies of certificates of the father should be submitted).
above two Examinations should be sent to prove
educational qualifications. 05. Method of application :

04. Other qualifications : (a) Application should be prepared by using both


sides of an A4 size paper in keeping with the
(a) Should be a citizen of Sri Lanka. specimen given at the end of this notification.

(b) Should serve a minimum period of 10 years Applications should be prepared to contain
in the Province for which training based Sections 01 to 09 given in the specimen
recruitment is made. Officers recruited for the application on page 01, Section 10 on page 02
Central Government should serve for a period of and Sections 11 to 13 on page 03.
10 years in the Department.
(b) ''Recruitment to Ayurveda Student Nurses'
(c) Should be not below 18 years of age and above Training - 2017" should be written on the left
28 years of age by 01.01.2017.
hand corner of the envelope containing duly
filled applications and be sent by registered post
(d) Should be not below 04 feet and 10 inches in
height. to reach Chief Secretary of the Province of your
permanent residence by 30.06.2017. Addresses
(e) Should be unmarried. of Chief Secretaries of each Province are given
below.
(f) Should be willing to serve in any area in the
Island and should be of sound physical health. 1. Chief Secretary, Western Province, Chief
Secretary's Office, Shrawasthi Mandiraya,
(g) Should have a continuous period of residence Colombo 07,
within the district of application for 03 years
immediately prior to the closing date of 2. Chief Secretary, Central Province, Chief
entertaining applications. One of the following Secretary's Office, Kandy,
should be satisfied to prove residence :
3. Chief Secretary, Uva Province, Chief
(i) The candidate recruited for Provincial Secretary's Office, King's Street, Badulla,
Service being a person born in the relevant
District, 4. Chief Secretary, North-Western Province,
Chief Secretary's Office, Provincial Council
(ii) Should have a continuous record of Office Complex, Kurunegala,
residence for a period of at least 03 years
out of the 05 years immediately preceding 5. Chief Secretary, North-Central Province,
the date mentioned in the Gazette (in Chief Secretary's Office, Maithripala
proof of which either the Grama Niladhari Senanayake Mawatha, Anuradhapura,
Certificate countersigned by the Divisional
Secretary or the Voter Register for 03 6. Chief Secretary, Southern Province, Chief
years immediately preceding should be Secretary's Office, S. H. Dahanayake
submitted), Mawatha, Galle,

(iii) Should have received the secondary school 7. Chief Secretary, Sabaragamuwa Province,
education in the relevant district for a Chief Secretary's Office, Provincial Council
continuous period of 05 years. Office Complex, New Town, Ratnapura,
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8. Chief Secretary, Eastern Province, (d) National Identity Card or valid passport or valid
Chief Secretary's Office, Kandy Road, Driving License (of which a certified copy should
Kappalthurei, Trincomalee. be sent annexed to the application).

9. Chief Secretary, Northern Province, Chief (e) Grama Niladhari Certificate as countersigned
Secretary's Office, No. 187, Adiyapatham by the Divisional Secretary or a certified copy
Road, Thirunelvel, Jaffna. of Voter Registers for 03 immediately preceding
years in proof of residence as per 4 (g) above.
10. For vacancies (in Central Government)
existing under the Department of Ayurveda,
(f) An affidavit signed before a Justice of Pease in
applications should be sent to the address of
proof of marital status.
Commissioner of Ayurveda, Department of
Ayurveda, Nawinna, Maharagama.
08. Training Procedure :
(c) Signature of the applicant should be certified
by an Officer of the Sri Lanka Administrative (a) Selected applicants will be admitted to Nurses'
Service Educational Administrative Service/ Training Schools as Student Nurses and they
Government Accountants' Service/Principal of a should follow a 03 year training course.
government school/a Justice of Peace or a Public
Officer holding a post with an initial salary of not (b) A code of rules and regulations pertaining to
less than Rs. 240,360. Nurses Training Schools will be provided to
trainees at the time of admission for training.
(d) Stamps to the value of Rs. 300/- should be They will be subject to these rules and regulations
pasted on the stamp cage on the Application and and other rules and regulations to be imposed
invalidated by putting your signature. from time to time.

06. Applications of workers in a Governement or Semi- (c) Training of the trainees may be terminated any
Governmental Institution should be sent through their time without compensation with respect to
Head of the Department. It should also be kept in mind that those who fail in due examinations during the
this is an external recruitment. period of training or whose work and conduct
are unsatisfactory or those who fail to follow
07. Only a number twice as much as the number conditions of examination and leave or if their
of vacancies will be called for the interview with a educational and other qualifications submitted for
representation of Staff Officers in the Ministry of Health, recruitment to the training are later revealed to
Nutrition and Indigenous Medicine and Provincial be false. Trainees are entitled to no leave during
Government Services based on a priority list prepared their period of training and a fee in proportion
on the z-score of applicants who have satisfied above to their allowance will be deducted in respect of
qualifications. Originals of the following documents days of absence from training. However, 80%
should be presented by the applicants at the Interview. attendance is compulsory every year to sit for the
examination.
This general Board of Interview is appointed to check
whether the qualifications mentioned in the Scheme of (d) A monthly allowance will be paid to trainees
Recruitment and Gazette notification published accordingly as follows during their period of training in a
are met and to check the physical fitness and no marks will Nursing School:
be given at the interview. 1. First year - Rs. 18,728/-
(a) Birth certificate ; 2. Second year - Rs. 18,935/-
3. Third year - Rs. 19,142/-
(b) Original of the certificate containing G. C. E.
(A/Level) Examination and the z-score (of which
(e) If one is to vacate training during the period of
a cretified copy should be sent annexed to the
training without successful completion of the
application).
training or is removed or leaves the training,
(c) Original of the certificate of G. C. E. (O/Level) he/she should repay the amount spent on him/
Examinations results (of which a certified copy her during the period of training as his training
should be sent annexed to the application). expenses by the government to the Provincial
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Council/ Department of Ayurveda, Or else, due 11. Conditions of Service and Salary Scale :-
steps will be taken to recover such amount.
(a) It is required for all trainees to appear for a
09. Conditions and Agreement for Non-marriage : medical test prior to commencement of training.

(a) All applicants should be unmarried by the closing (b) Appointments will be made for vacancies
date for application and it is also compulsory to available in the posts of Nurse, Grade III on the
remain unmarried during the three year period salary scale Rs. 32,525-445x10-660x11-730x10-
of training. All applicants should present at the 750x10- Rs. 59,035 of MT 7-2016 of Public
interview an affidavit signed before a Justice of Administration Circular 03/2016.
Peace to confirm their unmarried status.
(c) All officers of the Nurses Service should perform
(b) Student Nurses should come to an agreement their duties and obligations in keeping with all
with the relevant Appointing Authority at the rules, regulations, orders and procedures to be
time of their admission to the School of training imposed on Public Service by the Public Service
that they will successfully complete training and Cmmission. Further, they should also be subject
no completion of such training that they will to the Establishments Code of the Democratic
serve a minimum period of 10 years in a hospital Socialist Republic of Sri Lanka, Financial
coming under the Ministry of Health, Nutrition
Regulations of the government other regulations,
and Indigenous Medicine and Provincial Council/
circulars and instructions of the government and
Department of Ayurveda. This period of time will
be specified from time to time. to amendments issued for them from time to time.
They will be subject to conditions contained in the
10. Conditions of engagement in service :- Ayurveda Nurses Service Minute and Ayurveda
Act and also to transfers made according to
(a) Government is not committed to offer permanent
policies stipulated by the Provincial Department
appointments on conclusion of training. However,
of Ayurveda.
candidates will be considered for appointment to
a post of Grade III Nurse on vacancies available (d) Particulars of educational and other qualifications
in the Province and conditions of the Scheme of should be very carefully and accurately included
Recruitment for the course of their training. It is in filling applications. If the above said certificates
compulsory to serve in the service station of one's
are found to be false after recruitment for training
first appointment for a period of 10 years from
or receiving appointment, action will be taken to
the date of appointment.
refer to the Criminal Investigations Department
Based on the merit list prepared on the final for legal action, to dismiss from training/the post
written examination conducted on termination by invalidation of posts so offered and to take
of each course and also the 70% percentage disciplinary action on it and to include his/her
recruited at provincial level and 30% percentage
name to the black list of persons not to be taken
recruited on merit as mentioned above, it will be
back into Public Service. Further, action will
considered to grant appoitments to institutions
where vacancies exist. be taken to recover from him/her the allowance
made to him/her during the period of training,
Appointments will be granted subject to policy expenses made by the Government and the
decision to be taken in future by the government amounrt pertaining to the Security.
so as to create vacancies in posts on relevant
salary scales. (e) This Ministry is not bound to provide residential
facilities in Training Schools for applicants
(b) You should be subject to the policy decision to
recruited for training.
be taken in due course by the government on the
Pension Scheme entitled to the post of Nurse (f) There is no right whatsover during this period
Grade III to which appointments are to be made of training to be engaged in union activities or
on results of the final examination conducted on private practice. Further, if you are appointed to
termination of training as stated above. the relevant post after the training, you have no
(c) Appointments will be made to the posts of right whatsoever even thereafter to be engaged in
Nurse, Grade III subject to a probation period of private practice. Steps will be taken to take legal
03 years. action if such an action is to be revealed.
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(g) In case any problematic situation is to be arisen 10. (a) General Certificate of Education Advanced Level
on recruitment for training which is not covered Examination (Science stream)
by this Gazette notification, the decision of the (attach a certified copy of the certificate)
Secretary to the Ministry of Health, Nutrition
and Indigenous Medicine on the same will be the Year :. Index No. :.
final decision. In the event of any inconsistency
between the Sinhala and Tamil texts of this Subject Grade For Subject Grade For
Gazette notification, the Sinhala text shall prevail. office office
use use
Anura Jayawickrama,
Secretary, 1. 3.
Ministry of Health, Nutrition and 2. 4.
Indigenous Medicine.
(b) General Certificate of Education Ordinary Level
Examination (attach a certified copy of the
Specimen Application Form certificate)

Recruitment of Student Nurses for Training Year :. Index No. :.



Index No. : Subject Grade For Subject Grade For
(for office use only) office office
use use
Medium in which you appeared for the Examination 1. 7.
8.
2.
Sinhala -S Tamil- T
3. 9.
(write the relevant letter in the box)
4. 10.
Basis of application
5. 11,
Central Government - 1 6. 12.
Provincial Councils -2
(write the relevant number in the box) Year :. Index No. :.

01. (a) Last name with initials :. Subject Grade For Subject Grade For
(in block capital letters) office office
(b) Full name (in Sinhala) :. use use
1. 7.
02. Postal address :. 8.
(in block capital letters) 2.
3. 9.
03. Permanent address (in Sinhala) :. 10.
4.
District (in English) :.
5. 11,
04. Date of Birth : 6. 12.
Year :. Month :. Date :.
11. Have you been convicted of any offence before a court
05. Age as at the date of application : of law? Yes/No :.
Years :. Months :. Days :.
If yes, give particulars :.
06. Gender :. Marital status :.
12. Stamp cage :
07. Whether you are a Sri Lankan : Yes/No :.

08. National Identity Card No. :.

09. Height : feet :. inches :.


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PART I : SEC. (IIA) GAZETTE OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA 19.05.2017

13. Certification by the applicant :- 14. Attestation of signature of the applicant :

(a) I respectfully state that the particulars furnished I certify that Mr/Miss ...................... submitting this
by me in this application are true and correct to application is known to me personally and that he/she put
the best of my knowledge. his/her signature before me on ................. 2017.

(b) I am aware that, if this statement I have made ,


is proven to be false I will be disqualified to Signature of the attester.
be recruited to the Service and if proven so
after receiving appoitment I will be subject to Date :.
dismissal from service. Official stamp :.
Full name of the attester :.
, Post :.
Signature of the applicant. Address :.

Date :. 05-479

Printed at the Department of Government Printing, Sri Lanka.

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