CENTRAL INDUSTRIAL SECURITY FORCE

APPLICATION FORM FOR RECRUITMENT OF

CONSTABLE/FIRE(MALE)-2017
Application Number FIRE1700250673
Post Applied for CONSTABLE/FIRE
Candidate Name SONU CHALAK
Fathers's Name MILAN CHALAK

Date of Birth 20-06-1997

Gender Male
Nationality INDIAN
Religion HINDU
Category SC
Whether belong to Militancy/Naxal
NO
affected district?
Minority NO
Belongs to Hill Area NO
Are you Child / dependent of victims
KILLED in the 1984 riots/2002 communal NO
riots in Gujarat ?
Were you domiciled in the State of J &
K during the period from 1st Jan 1980 NO
to 31st Dec 1989?
Whether you are a ward of West
Pakistani Refugee(WPR) settled in J & NO
K?
Have you ever been convicted by any
court of law or any other judicial NO
Institution?
Is there any case pending against you
NO
in any court of law?
Has any FIR been lodged and case is
NO
pending against you?
Was any FIR ever lodged against you in
NO
the past?
Have you ever been dismissed from
any service under the Central or State NO
Govt.?

Have your services ever been

NO
terminated while on probation?
Domicile State JHARKHAND
Communication Address: Permanent Address:
H.No: 89 H.No: 89
Village: 6 Village: 6
Post: DUMKA Post: DUMKA
PS: DUMKA PS: DUMKA
District: DUMKA District: DUMKA
State: JHARKHAND State: JHARKHAND
Pincode:814101 Pincode:814101
(a)A MOLE ON RIGHT EAR
Identification Marks:
(b)A MOLE ON RIGHT LEG
Civil:12TH(with Science subject only)
Educational Details:
Army:N/A
Fee Details: Fee Exempted
EX-SERVICEMEN: N/A
CISF PERSON: N/A
CISF SON/SPOUSE: N/A
GOVERNMENT EMPLOYEE: N/A
DECLARATION

(i) 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.

(ii) I have read the provisions in the notice of the examination carefully and hereby undertake to abide by
them.

(iii) 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 CISF as on date and have never been convicted by any
court of law. I also declare that no criminal case is pending against me. Further declare that I have never
been dismissed or removed from Govt. Service or my service been terminated during probation.

(v) * For Employees of CISF seeking age relaxation.

  I declare that I am serving in CISF and completed 3 years regular service or regular length of service
stipulated in the Notice of the examination on or before date of closing submitting application form given in the
notice.

(vi) * 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-Servicemen.

  I declare that I fulfill all the eligibility conditions relating to Ex-Servicemen 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.

Singnature