ARUNACHAL PRADESH PUBLIC SERVICE COMMISSION ITANAGAR APPLICATION FORM FOR ADMISSION TO THE RECRUITMENT EXAMINATION FOR THE POST OF JUNIOR SECRETARIAT ASSISTANT/ LOWER DIVISION CLERK-2017-18 PASTE here firmly

Roll No. _______________

your recent self-attested passport size photograph . (NB: Do not pin or staple )

Important instructions

(a) Write NEATLY in CAPITAL LETTERS ONLY WITH BALL PEN IN THE SQUARES. (b) Leave one box blank between any two parts of the name. (b) Candidates are required to submit all supporting documents as claimed and declared under the Column No.6,7, 10,11,12 of this application form, otherwise your application will be Rejected. (c) All documents should be self-attested. (d) Your one self-attested photographs should be pasted on the space provided in the application form and another on the attendance sheet. Both photographs should be self-attested on the front side. (e) Enclose all relevant certificates/ Mark sheets . (f) Applications of those candidates shall be summarily rejected if they fail to follow the above instructions.

1. NAME OF APPLICANT (Give one BOX gap between First/Middle/Surname)

2. FATHER’S/HUSBAND’S NAME

3. POSTAL ADDRESS FOR COMMUNICATION (With State PIN )

4.

PERMANENT HOME ADDRESS (With District Headquarter)

_______________________________________

_____________________________________________

_______________________________________

_____________________________________________

_______________________________________

_____________________________________________

_______________PIN_____________________

____________PIN______________________________

Tel/Mobile No.___________________________

Tel/Mobile No.________________________________

5. NATIONALITY:_______________________

6.CASTE/TRIBE:_______________________ (enclose APST certificate )

7. Date of Birth: Day

Month

Year

(enclose Matriculation certificate issued from Board)

8. SEX (Male / Female) : ________________

9.

HAVE YOU EVER BEEN DEBARRED BY UNION / STATE PUBLIC SERVICE COMMISSION. IF YES, (a) Date of Debarment : (b) Period of Debarment : Contd. Page…02/-

// 02 //

10. EDUCATIONAL QUALIFICATION

: ....................................................................................

(Attach certificates & Marksheets from Class-X onwards issued by the Board/Registrar/Asstt. Registrar/Controller of examination/ViceChancellor of the concerned University)

11. APPLICATION FEE : “ Deposited in the form of ____________________(Demand draft/Indian Postal Order whichever is applicable) to the tune of Rs___________(in figures)_____________________________ ___________________________________________________(in words) vide Demand draft /IPO no.___________________dated_______________Bank/Post Office____________________________”.

:-

12. (a) ADDRESS OF DEPARTMENT (in case of candidate already in service)

(b) Intimation letter applied to His/Her HoD or NOC from his /her HoD (Enclose Copy)

:-

13. LIST OF ENCLOSURE :(1) ____________________________________ (2) _____________________________________ (3) ____________________________________ (4) _____________________________________ (5) ____________________________________ (6) _____________________________________ (7) ____________________________________ (8) _____________________________________ (9) ____________________________________ (10) ____________________________________

DECLARATION I hereby declare that, the statement made by me in this application is complete and correct to the best of my knowledge and belief. I have carefully gone through the advertisement and conditions laid down there of and also hereby undertake to abide by them. In the event of any information being found false or incorrect before, during and after this examination, the Commission can take action leading to cancellation of my candidature at any stage. Place: Date:

Signature of the Candidate with date.

N.B.- Ensure and confirm that the following documents are self-attested and enclosed with the application form. 1. 2 (two) photographs Self-attested by the Candidate (paste one on the application from and another on the space provided in the attendance sheet. 2. Self-Attested copy Class-X Passed Certificate (CBSE/State Board). 3. Self-Attested copy Class-XII Passed Certificate and Marksheet or equivalent issued from a recognized Board or equivalent. 4. Self-Attested copy of Basic Computer Application Course Certificate (Microsoft Office). 5. Self-Attested copy of APST Certificate. 6. Enclose original copy of DD/IPO of Rs.100.

ARUNACHAL PRADESH PUBLIC SERVICE COMMISSION ITANAGAR

ATTENDANCE SHEET FOR THE POST OF JUNIOR SECRETARIAT ASSISTANT/ LOWER DIVISION CLERK2017-18 Name of the Candidate_________________________________ Roll No._____________________ ( For official use). PASTE here firmly your recent passport size photograph duly self-attested on the front side

Specimen Signature of the Candidate with Date (sign in the box before submission of application form)

TO BE FILLED UP IN THE EXAMINATION HALL

(Do not pin or staple)

Sl. No.

1

Subject

Answerscript/OMR Sheet Bar Code No.

Candidate’s Signature with date

Invigilator’s Signature

Recruitment Test ( if conducted)

Signature of the Centre Superintendent Subject

Sl. No.

Answer-script /OMR Sheet Bar Code No.

1

GENERAL ENGLISH

2

GENERAL KNOWLEDGE

3

TYPING SPEED TEST

4

VIVA VOCE TEST

Candidate’s Signature with date

Invigilator’s Signature

N.B: Candidates signature on attendance sheet in the examination hall must be an identical one with his specimen signature already appended above.

Signature of the Centre Superintendent

(For use during interview) Viva-Voce/Personality 1

Candidate’s Signature with date

Duty Officer’s Signature

Test

N.B: Candidates signature on attendance sheet during interview/Viva-voce must be an identical one with his specimen signature already appended above