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Application for Assistant Central Intelligence Officer Grade-II (Executive)

Examination-2009-
PART-I
1. Code and Name of center for written test For office use only
(Refer table ‘A’. Application shall be rejected if
boxes left unfilled) Roll No.

Center Code Center Name Candidate should


affix his/ her
2. a) Date of Birth recent self attested
passport size
photograph
Date Month Year
b) Age (As on closing date)

Years Months Days Signature of the candidate


in box above preferably in
Black ink/ Black ball pen

3. Male/ Female (Write ‘M’ for Male, ‘F’ for female)


4. a) Whether SC/ ST/ OBC

(Write ‘Y’ for Yes, ‘N’ for No)


Category with Code
1 for SC
2 for ST
3 for OBC
5. i) Whether Ex-serviceman: Yes/No
ii) Total Service rendered as Ex-serviceman

Years Months Days


6. Whether the resident of J&K and seeking age relaxation
(Write ‘Y’ for Yes, ‘N’ for No)

7. Home State:
8. Nationality:
9. Educational Qualification (Graduation Onwards)
SI Exam Passed Subjects of study Maximum Marks %age of
No. marks obtained marks

10. Are you prepared to service anywhere in India (Write Yes/No)

11. Name in Full:


12. Father’s Name:

13. Mailing Address

Pin Code

14. Permanent Address:

Pin Code

I hereby declare that I satisfy the conditions of the eligibility advertised for admission for the
examination. All the information made in this application are true to the best of my
knowledge and belief. I am aware that if at any time, it is found that any information given
above is false or incorrect then my candidature is liable to be cancelled apart from any other
legal action deemed fit.
Date:
Place: Signature of the Applicant

PART-II
To be filled by the Head of Office in which the candidate is serving.
(Only for Government Employees)
It is certified that:
i) There are no circumstances rendering Shri/Ms………………. unsuitable for
appointment as Assistant Central Intelligence Officer Grade-II /Executive
ii) He/ She is regularly appointed as ………………………… with effect from
………….. and continues to be so employed
iii) He/ She is permanent (state designation) ……………………….. of the (Name of the
Department etc.)……… with effect from ……………. and continues to be so
employed
iv) The information given be Shri/Ms…………. in the application has been verified with
reference to his/ her service record and is correct
v) No disciplinary proceeding is pending or contemplated against Shri/Ms……………

OFFICE SEAL:…………………………. SIGNATURE:…………………..


NAME:………………………….
DESIGNATION:……………….
DEPARTMENT/ OFFICE…….
Admission card
IB’s Assistant Central Intelligence Officer Grade II (Executive) Examination-2009

1. Name of the Candidate :………………………………………….. Candidate


should affix
(To be filled in by the Candidate) his/her
2. Roll Number:……………………………………………………… recent self-
(For Office Use Only) attested
3. Date, Time and Center of Examination- See Annexure passport size
(For office use only) photograph

Assistant Director
Subsidiary Intelligence Bureau
(Ministry of Home Affairs)
Government of India

To
Name:……………………………………..
Address:………………………………….
(To be filled in by the candidate)

Note:
1. Please attach a self-addressed un-stamped envelop of 10x23 cm size
2. This admission card should be of the size of 30x21cms. No deviation from the size
indicated will be accepted
3. You will not be allowed admission in the examination hall if you fail to bring this
admission card.

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