Page No. 1/8
UNION PUBLIC SERVICE COMMISSION DETAILED APPLICATION FORM FOR CISF AC(EXE) LIMITED DEPARTMENTAL COMPETITIVE EXAMINATION, 2022
CISF No : 150200587 Rank : Sub Inspector(GD) CISF Unit : DMRC DELHI
1. Name
| RADHA RAMAN SINGH
2. (a) Address for correspondence to which communication is to be sent Post Office: District: State : Pin Code :
| | | | | |
(b) Telephone No. with STD Code (c) Mobile No. (d) Fax No. (e) E-mail address (f) Permanent Postal Address Post Office: District: State : Pin Code :
CIW OFFICE, CISF UNIT DMRC, SHASHTRI PARK
NORTH EAST DELHI DELHI 110053 | | 7382548053 | | | | | | |
[email protected] BANGAON, BAJPATTI
BANGAON SITAMARHI BIHAR | 843314
3. Gender :
| MALE
4. Marital Status :
| UNMARRIED
5. Citizenship :
| A CITIZEN OF INDIA(1)
6. State of Domicile :
| BIHAR
| GENERAL (4) 7. (a) Community Note 1: Candidates belonging to neither SC nor ST should write 'General' Category(Others) Code No.4' against the column of community and not leave it blank.'. Note 2: No change in the community status already indicated by a candidate in his / her application form for this examination will ordinarily be allowed by the Commission. 8. Date of Birth
CISF No. :- 150200587
| 19-01-92
|
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 2/8 9. Place of Birth : Town/Village District State
| BANGAON | SITAMARHI | BIHAR
10. Mother tongue :
| MAITHILI
11. Choice of Centre for Examination :
| DELHI
12. (a) Language Medium of Examination for Essay and General Studies in Paper I and II: (b) Language Medium for Interview Test :
| HINDI | HINDI
13. (a) Have you passed the requisite qualifying | YES examination, as specified in Rule-6 (b). Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination Passed
Class/ Percentage CGPA Year of Division of Score Out of /Grade Marks(%) Passing
10th or Equivalent
2nd
55
12th or Equivalent
1st
60
Graduation or Equivalent
1st
62.62
Name of Board/University
Hindi math science SRPN HIGH BSEB, PATNA sanskrit social science SCHOOL, BAJPATTI 2009 Commerce SRKG COLLEGE, BSEB, PATNA SITAMARHI 2012 Commerce SRKG COLLEGE, BRABU, SITAMARHI MUZAFFARPUR
| DMRC DELHI
15. No of Displeasures :
|0
16. No of Warnings :
|0
17. (a) Name of Father (b) Name of Mother (c) Nationality of Father (d) Nationality of Mother (e) Father's present postal Address (If deceased give last address) Post Office: District: State : Pin Code : (f) Mother's present postal Address (If deceased give last address) Post Office: District: State : Pin Code :
| | | | | | | | | | | | | | | |
|
Name of School/College /Institution
2007
14. Present Unit Where Posted :
CISF No. :- 150200587
Subject(s)
SHAMBHU SINGH DEZI DEVI A CITIZEN OF INDIA A CITIZEN OF INDIA BANGAON BAJPATTI SITAMARHI BIHAR 843314 BANGAON BAJPATTI SITAMARHI BIHAR 843314
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 3/8 (g) Father's Profession: | (h) Mother's Profession: | (i) If your Father is in service,the post held by him (if retired, indicate the post held by him at the time of his retirement) | (j) If your Mother is in service,the post held by her (if retired, indicate the post held by her at the time of her retirement) | (k) Annual income of your Father | (l) Annual income of your Mother | (m) District to which your Father originally| belongs (n) State to which your Father originally | belongs (o) District to which your Mother originally| belongs (p) State to which your Mother originally | belongs
FARMER HOUSE MAKER
NO
NO RS.60000 RS.0 SITAMARHI BIHAR DARBHANGA BIHAR
18. (a) How many times have you appeared in written examinations of CISF AC-LDCE so far, including the current Examination in ,2022.(Write 1,2,3 in the opposite box as the case may be) | 3 (b) Appeared during the vacancy Year | 2020, 2021, 2022 Appeared during the vacancy Roll no. | 0800683, 0800002, 0 19. Were you ever Employed :
| YES
Details of your employment(in chronological order -till date):Designation/ Position
Monthly remuneration (Total) in Rs.
Whether Permanent/ Temporary/ Ad hoc etc.
SUB INSPECTOR
74000
PERMANENT
20. Have you ever been debarred by any Public Service Commission or SSC from any of their Examinations/Selections? 21. Please give Particulars of:(a) Particulars of prizes,medals scholarships,etc. (b) Team/Games/Sports/N.C.C. /Hitchhiking/Mountaineering etc. (c) Position(s) of distinction Leadership held in School/College (d) Other extra curricular activities and interests (Such as hobbies etc.)
Period From To 03-10-2015
Till date
Name of Place of employment employer/ (Address) Organisation/ Firm/Individual CISF
DELHI
| NO
| | | | WATCHING MOVIES
22. Whether you have been selected or CISF No. :- 150200587
|
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 4/8 appeared for U.P.S.C. Examination /Recruitment:-
| NO
23. List of Enclosures sent by the candidate:--->Self-Attested/Certified Copy of certificate of Age. --->Self-Attested/Certified Copy of the certificate of educational qualifications. --->Certificate from Head of Department / Cadre Controlling Authority, Signed and Verified by it verifying their eligiblity. --->Annexure Regarding Details of punishment etc.
CISF No. :- 150200587
|
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 5/8 DECLARATION TO BE SIGNED BY THE CANDIDATE I, hereby declare that all statements and entries made in columns 1 to 23 of this application are true, complete and correct to the best of my knowledge and belief.In the event of any information being found false or incorrect or ineligibility being detected before or after the examination,action can be taken against me by the commission under Rule 12 of the Rules of the examination. Further certified that I have not availed three chances so far in competing in this examination and information furnished by me against column 18 is correct.In case at any stage,even after my appointment (If I am selected to the post) this information is found false or incorrect, my candidature may be rejected/I may be reverted back to my substantive post, as the case may be, by the competent authority, without assigning any reason thereof and also competent authority may take any appropriate discipilinary action against me for furnishing false and incorrect information. I have read provisions in the Rules and Notice of the Commission carefully and hereby undertake to abide. Application not signed by the candidate will be rejected. Incomplete application will be also rejected .
* Signature of the Candidate Place: Date: * Application not signed by candidate is liable to rejection.
CISF No. :- 150200587
|
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 6/8 UNION PUBLIC SERVICE COMMISSION Certificate to be forwarded for CISF AC(EXE) Limited Departmental Competitive Examination , 2022 Roll No. ______________ (to be given by the UPSC)
1. CISF No :| 150200587 2. Rank :| SUB INSPECTOR(GD) 3. Name :| RADHA RAMAN SINGH 4. Present Unit Where Posted :| DMRC DELHI 5. Father's Name :| SHAMBHU SINGH 6. Date of Birth :| 19-01-92 7. Age as on 01.08.2022 :| 30 Years 8. Date Of Appointment :| 03102015 9. Educational Qualification :| B.COM 10. Category(Gen./SC/ST) :| GENERAL 11. No of Cash Rewards :| 0 12. No of Commendations :| 0 13. No of Punishments :| As per ANNEXURE 14. No of Displeasures :| 0 15. No of Warnings :| 0 *16. No. of Chances of LDCE appeared in writted exam /availed and details thereof : S.N.
Roll No. allotted
1
Appeared during vacancy year 2020
2
2021
0800002
3
2022
Remarks
0800683
I, hereby declare that all entries/statements made in columns 1 to 16 of this application are true,complete and correct to the best of my knowledge and belief. In the event of any information being found false or ineligibility being detected before or after the examination,action can be taken against me by the Commission as per provisions contained under the Rules of the Examination . Further certified that I have not availed three chances so far in competing in this examination and information furnished by me against column 16 is correct. In case at any stage,even after my appointment (if I am selected to the post) this information is found false or incorrect, my candidature may be rejected/I may be reverted back to my substantive post, as the case may be, by the competent authority , without assigning any reason thereof and also competent authority may take any appropriate disciplinary action against me for furnishing false and incorrect information. I have read provisions in the Rules and the Notice of the Commission carefully and I hereby undertake to abide. Note 1 : Application not signed by the candidate will be rejected. Note 2 : Incomplete application will also be rejected. Signature of the Applicant
* To be filled by candidate.
CISF No. :- 150200587
|
This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
Page No. 7/8 CERTIFICATE FROM THE CONTROLLING OFFICER 1. The details like CISF No,Rank, Name, Date of Birth, Date of Appointment, Category, Reward & Punishment, mentioned in the application have been verified with reference to his/her service record and found correct. 2. He/She has completed 04 years of service as on 01.01.2022 in Rank of SI(GD)/Inspector(GD). 3. No criminal case or DE or other enquiry including sexual harassment is pending. 4. Certified that the Department/Office has no objection in permitting Shri/Smt._____________________ . for applying to the Post of _______ in CISF.It is further certified that Shri/Smt.____________________ . has not been awarded / any punishment during his entire service career. 5. His medical categorization for the year 2021 (should be valid upto August 2022) is ____________________ as specified in CISF circular no (145) dated 28.01.2009. Xerox copy duly self-attested is enclosed. Place: Date: TO BE SIGNED BY HEAD OF OFFICE ( With Stamp )
CISF No. :- 150200587
|
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Page No. 8/8 ANNEXURE RECRUITMENT OF ACs (GD) IN CISF THROUGH LDCE-2022 Details of Punishments (Major/Minor) in entire service CISF No :Rank :Name :CISF Unit :-
| | | |
S/No
Date of Issue of Charge sheet.
01
02
150200587 SUB INSPECTOR(GD) RADHA RAMAN SINGH DMRC DELHI
Penalty Date of appeal, Outcome of Date of Penalty awarded by if any. apppeal with Revision awarded by Disciplinary date. Wheather Petition, if any. Revisioning Authority with exonerated Authority with date of award. enhanced, or date. reduced. 03 04 05 06 07
Signature of the Candidate
Verified by Commander
Signature of the Unit Commander
CISF No. :- 150200587
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This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by Commission.May take a printout after FINAL SUBMISSION only.
