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APPLICATION FORM FOR THE RECRUITMENT OF TEMPORARY WOMAN CONSTABLE (EXECUTIVE) IN DELHI POLICE -2013 WARNING: (i)Furnishing of false information or supperssion of any factual information in the application form would be a disqualification for the job. Note: 1. For item No. 7,8,9,10,11,12,14,17 & 18 please tick the right choice 2. You must write your Name and Fathers Name in BLOCK Letters as written in your 10th pass certificate. 1. Name of Applicant : SEEMA BISHT 2. Father's Name: LATE SHRI SURENDER SINGH BISHT 3. Husband'sName 4. Complete Mailing Address of the Applicant with Name (IN BLOCK LETTERS) Name: SEEMA BISHT Address: A-8/1 DAYALPUR DELHI-110094 District : DELHI , State DELHI , Pin: 110094 Registration No. :2550832 (For office use only) 25-02-2013 11:01 am
5. Photograph

Do not Pin or Staple. Paste one recent clear Passport size with name plate Photograph should be taken in red background (without attestation) Photograph must not be larger than the box size of the Photograph 35mm x 45mm

Mobile No.:+91 9891192734 Landline with STD Code: Email ID (if any): SEEMA.BISHT1988@GMAIL.COM 7.Category SC ST OBC GENL 10. Educational Qualification XI Pass XII Pass Graduate Post Graduate 11. NCC 'C' Certificate Yes No 12. Sportswoman Yes No 13. Date of Birth 8.Other Category 1. Widow 2. Divorced Woman

6. Applicant's Signature

9.Religion 3. Judicially Separated Woman Hindu Muslim Date of Enlistment Christian Sikh Other 14. Whether belongs to Hill areas Yes No

4.Daughter's of Delhi Police Personnel 5. Departmental Candidate (Delhi Police)

30-07-1988

15. Name of The PE & MT Center Delhi Center Code 01 16. Bank Demand Draft Details DD No.: 171164 Bank Name: STATE BANK OF INDIA Date of Issue: 22-02-2013 17. Have you ever been debarred by Union Public Service Commission, SSC or State Public Service Commission or any Yes No recruitment board from appearing in any exam? 18. Criminal Proceeding details, if any: (a) Whether any FIR or criminal case has ever been registered against you? Yes No ((b) Whether any criminal Complaint Case(s) or FIR or criminal case(s) is pending against you in Court of Law, or with Yes No police at the time of submitting the application form? (c) Have you ever been arrested / detained in any criminal case (s) Yes No (d) Have you ever been tried & convicted or acquitted by a Court of Law in any criminal case (s) Yes No (e) Have you ever been tried and convicted by the court by filling any bond for good behavior, etc. Yes No 19. Case Reference: If the answer to any of the above mentioned questions is YES then give full particulars of the criminal complaint case, FIR No.& Date Under Sections, Police Stations, District, and present status of the case at time of filling up this application form. -> 20. If after submission of this application form, any criminal case is registered against you or arrested/detained by police in any criminal case relevant details regarding the same should be communicated by you immediately to the DCP/Recruitment Cell, New Police Lines Kingsway Camp. Delhi110009, failing which it shall be deemed to be suppression of factual information. 21. DECLARATION: I hereby declare and confirm that all the entries in this application form are correct. I undertake that, in case any information furnished by me is found to be false or incomplete or any material information concealed by me, my candidature may be cancelled . Place: DELHI Date: 25-02-2013 Applicant Signature: ___________________

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