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ASC CENTRE (South)-2 ATC

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Civilian Direct Recruitment Board
CHQ, ASC Centre (South) –2 ATC ljdkjh oSdsU'kh gsrq okV~li xzqi ls tqMsa
Agram Post, Bangalore -560007
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09457117382
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 PERFORMA FOR APPLICATION
Recent
To, Passport size
The Presiding Officer, photo duly
Civilian Direct Recruitment Board, self-attested
CHQ, ASC Centre (South)-2 ATC
Agram Post, Bangalore -07
====================================================================================================

1. Post applied for :____________________________________________________________________

2. Name of the Candidate (Full Name) :____________________________________________________________________
3. Mobile Number (Functional) :____________________________________________________________________
4. E-Mail ID (Functional) :____________________________________________________________________
5. Aadhar No :____________________________________________________________________
6. Father`s Name :____________________________________________________________________
7. Date of Birth (As per Matriculation certificate) :____________________________________________________________________

(DD/MM/YYYY)
8. Correspondence Address:-
House No/ Street/ Village :____________________________________________________________________
Post Office :____________________________________________________________________
District :____________________________________________________________________
State :____________________________________________________________________
Pin Code :____________________________________________________________________
9. Permanent Address:-
House No/ Street/ Village :____________________________________________________________________
Post Office :____________________________________________________________________
District :____________________________________________________________________
State :____________________________________________________________________
Pin Code :____________________________________________________________________
10. Educational Qualification : ____________________________________________________________________
(Matric/ITI/Diploma/12th/
Graduation/Post Graduation)
11. Educational Qualification
Ser Qualification Name of Name of % of Marks Obtained Remarks
No School/ College Board/ University

12. Gender (Male/Female/ Other) : ____________________________________________________________________

13. Category (UR/ SC/ ST/ OBC/ : ____________________________________________________________________
EWS/ PH/ ESM/ MSP)
14. If applied for the Post of Ex Serviceman : ____________________________________________________________________
(Date of enrolment in Army/ Navy/ Air Force
and date of retirement and attach copy of
Discharge Book/ certificate/ NOC)
15 If applied for the post in PH category:-

Type of Disability Percentage of Disability Remarks

(OH/ HH/ VH/ Mental illness/ Disability (O Pop-up-menu for
Multiple disability) 40% and above)
Enclose Disability
certificate issued by
CMO/ Civil surgeon of
Govt hospital certifying
the disability.

16. Whether registered with any employment exchange : _____________________________________________________

(If yes, mention registration No and Name of employment exchange)
17. Whether employed in Central Govt Services : Yes/ No
(If yes, give details as per following format &
attach serving certificate duly signed by HoD)
Name of employer Name of Post Date of Appointment Serving since Office Address

18. Name of the stations, a candidate wishes to be posted, if selected in the order of preference:-

(a) 1st Choice :________________________

(b) 2nd Choice :________________________

(c) 3rd Choice :________________________

===================================================================================================

DECLARATION
I hereby certify that above particulars mentioned in the application form are correct and true to the best of my knowledge and
belief. I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility criteria
according to the requirements of the advertisement, my candidature/ appointment is liable to be cancelled/ terminated. I am willing to
serve anywhere. I agree that department has the right to transfer me to anywhere in India.

Dated : ______________________
(Signature of the Candidate)
Place :

===================================================================================================

Enclosures:-
(i) Two Self-Attested Photographs (Name & father’s name on the back side of photo).
(ii) One self-addressed registered envelope duly affixed with appropriate postal stamps.
(iii) Self-Attested copies of certificates (_______ ) Sheets.
(vi) Admit Card in duplicate.
 ADMIT CARD (IN DUPLICATE)
(Applicable wherever Physical/ Skill Test is mandatory)

1. Roll No _____________________________________ Recent

Passport size
(Not to be filled by candidate)
attested
2. Name of candidate ___________________________________________________________________________
photograph
2 Father’s/Husband’s Name______________________________________________________________________of the
applicant
3. Date of Birth _________________________________________________________________________________
4. Application Registration No _____________________________________________________________________
(Not to be filled by candidate)
5. Exam Centre Allotted __________________________________________________________________________
(Not to be filled by candidate)
6. Category (UR/SC/ST/OBC/EWS/PH) _____________________________________________________________
7. Schedule of Exam Physical/ Skill Test - ___________________________________________________________

(Date & Time of reporting at Examination Centre)

8. Candidates will report for written test as applicable along with original documents. Only after verification of original
documents and Biometric Attendance, candidate will be allowed to appear for test.

__________________
Signature of Candidate

-----------------------------------------------------------------------------------------------------------------------

ADMIT CARD (IN DUPLICATE)

(Applicable wherever Physical/ Skill Test is mandatory)

Recent
1. Roll No _____________________________________ Passport size
attested
(Not to be filled by candidate) photograph
2. Name of candidate ___________________________________________________________________________
of the
applicant
2 Father’s/Husband’s Name______________________________________________________________________
3. Date of Birth _________________________________________________________________________________
4. Application Registration No _____________________________________________________________________
(Not to be filled by candidate)
5. Exam Centre Allotted __________________________________________________________________________
(Not to be filled by candidate)
6. Category (UR/SC/ST/OBC/EWS/PH) _____________________________________________________________
7. Schedule of Exam Physical/ Skill Test - _____________________________________________________________

(Date & Time of reporting at Examination Centre)

8. Candidates will report for written test as applicable along with original documents. Only after verification of original
documents and Biometric Attendance, candidate will be allowed to appear for test.

__________________
Signature of Candidate
 ADMIT CARD (IN DUPLICATE)
Written Test

1. Roll No _____________________________________ Recent

Passport size
(Not to be filled by candidate) attested
photograph
2. Name of candidate ___________________________________________________________________________
of the
2 Father’s/Husband’s Name______________________________________________________________________
applicant
3. Date of Birth _________________________________________________________________________________
4. Application Registration No _____________________________________________________________________
(Not to be filled by candidate)
5. Exam Centre Allotted __________________________________________________________________________
(Not to be filled by candidate)
6. Category (UR/SC/ST/OBC/EWS/PH) _____________________________________________________________
7. Schedule of Exam Written Test -__________________________________________________________________

(Date & Time of reporting at Examination Centre)

8. Candidates will report for written test as applicable along with original documents. Only after verification of original
documents and Biometric Attendance, candidate will be allowed to appear for test.

__________________
Signature of Candidate

-----------------------------------------------------------------------------------------------------------------------

ADMIT CARD (IN DUPLICATE)

Written Test

Recent
Passport size
1. Roll No _____________________________________ attested
(Not to be filled by candidate) photograph
2. of the
Name of candidate ___________________________________________________________________________
applicant
2 Father’s/Husband’s Name______________________________________________________________________
3. Date of Birth _________________________________________________________________________________
4. Application Registration No _____________________________________________________________________
(Not to be filled by candidate)
5. Exam Centre Allotted __________________________________________________________________________
(Not to be filled by candidate)
6. Category (UR/SC/ST/OBC/EWS/PH) _____________________________________________________________
7. Schedule of Exam Written Test -__________________________________________________________________

(Date & Time of reporting at Examination Centre)

8. Candidates will report for written test as applicable along with original documents. Only after verification of original
documents and Biometric Attendance, candidate will be allowed to appear for test.

__________________
Signature of Candidate