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APPLICATION FOR THE POST OF CONSTABLE (TECHNICAL/TRADE) IN

CENTRAL RESERVE POLICE FORCE


Recent passport
size photograph

FOR OFFICE USE ONLY

ACCEPTED/REJECTED
Reasons for Rejection
Applied post ------------

1.

Name of applicant in BLOCK LETTERS (As recorded in Matriculation Certificate)

2.

Fathers name (As recorded in Matriculation Certificate)

3.

Mothers name (As recorded in Matriculation Certificate)

4.

Caste/Category (Tick the correct one):


SC

5.

Nationality (State whether by birth or domicile)

6.

Name of State

7.

Date of Birth (in Christian era)


D
(Age as on 01/01/2015)

ST

M
Year

8. Permanent address:House
Name/No
Street
Village
PO
PS
Tehsil
District
State
Pin
9.
Present Postal Address:House
Name/ No.

Street
Village
PO
PS
Tehsil
District
State

24

OBC Genl

Month

Y
Days

Pin
10.

Religion (Tick the correct one)

11.

Educational qualification (Tick the correct one)

Hindu

Muslim Sikh Christian Budhist Others

Matric or
equivalent

12
13
14.

Name of Trade/Post applied for


(Each candidate is allowed to apply
for one trade only)
Trade qualification (if any)
Physical Standard
(a)
Height (in Cms)

Intermediate or Graduate
10+2

Post
Graduate

::
::
::
Cms

(b)
(c)

Chest Measurement
(For male candidates only)
Weight

Un-expanded :
Expanded
:
Kgs.

15.

Particulars of present employment ::


If any with post and service
Number/name of department etc.

16.

Are you Ex-servicemen

::

Yes/No

17.

Whether claiming age relaxation

::

Yes/No

18.

IPO/Bank Demand draft No date and


:: Issuing branch (Male Genl & OBC
categories candidates only)
Whether four self addressed envelopes::
duly affixing postage stamps for Rs.27/enclosed (By all candidates)
Whether Ward of Serving CRPF person::
If Ward of serving CRPF person,
::
details of serving Father/Mother be given

19.
20.
21.

Cms
Cms

Yes/No
Yes/No
Force No.______________ Rank______
Name ___________________________
Unit/Office _______________________

DECLARATION
I do hereby declare that all statements made in 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 ineligible being detected before or after the test, my candidature
will stand cancelled and all my claims of the recruitment will stand forfeited. I also understand that
if at any stage I am found by the selection board to have used unfair means in the
PET/PST/Written examination/trade test etc or to have violated any of the Rules/Regulations
governing in the conduct of selection process, my candidature can be cancelled or be declared to
have failed by the selection board at its sole discretion.

Place :

..

Date :

(_____________________)
Signature of the applicant
(Application not signed by the candidate will be rejected)

25

Appendix-B

FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING


TO SCHEDULED CASTE OR SCHEDULED TRIBE
This is to certify that Shri/Smt*/Kumari
son/daughter* of Shri . of village/town*
in District/Division* .. of State/Union
Territory*.belongs to the .Caste/Tribe*
which is recognized as Scheduled Caste/Schedules Tribe* under:The Constitution (Scheduled Caste) Order, 1950.
*The Constitution (Scheduled Tribes) Order, 1950.
*The Constitution (Scheduled Caste) (Union Territories) Order, 1951.
*The Constitution (Scheduled Tribes) (Union Territories) Order, 1951.
{As amended by the Scheduled Castes and Scheduled Tribes List (Modification Order)
1956, the Bombay, Reorganization Act, 1960, the Punjab Reorganization Act, 1966, the
State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganization Act,
1971) and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act,
1976}.
*The Constitution (Jammu & Kashmir) Scheduled Caste Order, 1956.
*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959, as
amended by the Scheduled Castes and Scheduled Tribes Order (Amendment) Act,
1976.
*The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.
*The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.
*The Constitution (Pondichery) Scheduled Castes Order, 1964.
*The Constitution (Utter Pradesh) Scheduled Tribes Order, 1967. *The
Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968. *The
Constitution (Goa, Daman & Diu) Scheduled Tribes Order, 1968. *The
Constitution (Nagaland) Scheduled Tribes Order, 1970.
*The Constitution (Sikkim) Scheduled Castes Order, 1978.
*The Constitution (Sikkim) Scheduled Tribes Order, 1978.
*The Constitution (Jammu & Kashmir) Scheduled Tribes Order, 1989.
*The Constitution (Scheduled Caste) Orders (Amendment) Act, 1990.
*The Constitution (Scheduled Tribes) Orders (Amendment) Act, 1991.
*The Constitution (Scheduled Tribes) Orders (Second Amendment) Act, 1991.
*The Constitution (ST) orders (Amendment) Ordinance 1996
*%2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have
migrated from one State/Union Territory Administration
Contd.P/2
26

P/2
2. **This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes
Certificate issued to Shri/Smt*/Kumari

son/daughter*
of
Shri
. of village/town* in
District/Division*
..
of
State/Union
Territory*.belongs to the .Caste/Tribe*
which is recognized as Scheduled Caste/Schedules Tribe* in the State/Union Territory*
issued by the . dated.
3. Shri/Smt*/Kumari and/or* family ordinarily reside
(s)
in
village/town*

in
District/Division*
.... of State/Union Territory* of .
Place
Date

:
:

..
..

Signature..
Designation.
(With seal of Office)

Note : (The terms Ordinarily resides used here will have the same meaning as in
Section 20 of the Representation of the Peoples Act, 1950)
*
**

Please delete the words which are not applicable.


Applicable in case of SCs, STs Persons who have migrated from one
State/UT.

AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE


1.

District Magistrate / Additional District Magistrate / Collector / Deputy

st

Commissioner / Additional Deputy Commissioner / Dy. Collector / 1


Class Stipendiary Magistrate / Sub Divisional Magistrate / Taluka
Magistrate / Executive Magistrate / Extra Assistant Commissioner.
2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency
Magistrate.
3.
Revenue Officers not below the rank of Tehsildar.
4.
Sub Divisional Officers of the area where the candidate and / or his
family normally resides.
NOTE: ST candidates belonging to Tamil Nadu state should submit caste
certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.

27

APPENDIX-C
FORM OF CERTIFICATE TO BE PRODUCED BY CANDIDATES BELONGING TO
OTHER BACKWARD CLASSES APPLYING TO POSTS UNDER THE GOVERNMENT
OF INDIA
This is to certify that Shri/Smt/Kumari ____________________son/daughter of
____________________________

of

village/town

_________________

in

District/Division_________________________________ in the State/Union Territory


_____________________belongs to the ________________________community which is
recognised as a backward class under the Government of India, Ministry of Social Justice
and Empowerments Resolution No. __________________________dated _______*.
Shri/Smt/Kumari __________________________________and/or his/her family ordinarily
reside(s) in the ____________________________________District/Division of the
____________________State/Union Territory. This is also to certify that he/she does not
belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to
the Government of India, Department of Personnel & Training O.M.No. 36012/22/93Estt.(SCT) dated 08/09/1993**.
District Magistrate
Deputy Commissioner etc
Dated:

Seal
________________________________________________________________________

*of -Government
The authority issuing the certificate may have to mentioned the details of Resolution
of India, in which the caste of the candidate is mentioned as OBC.
** -As amended from time to time.
Note:- The term Ordinarily used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.

28

Appendix-D
FORM OF CERTIFICATE TO BE SUBMITTED BY THOSE CANDIDATES WHO INTEND
TO AVAIL RELAXATION IN HEIGHT OR CHEST MEASUREMENT

Certified
that
Shri/Smt/Kumari
__________________________________
Son/Daughter of Shri ________________________ is permanent resident of village
______________________,
Tehsil/Taluka_____________________________
District_____________________ of ________________________________ State.
2.

It is further certified that:*


Residents of entire area mentioned above are considered as Garhwali/
Kumaoni/Dogras/ Marathas for relaxation in height and chest
measurement for recruitment in the Para Military forces of the Union of
India.
*

He/ She belongs to the States of Sikkim/Himachal Pradesh/(Jammu &


Kashmir) / North-Eastern States/candidates hailing from Gorkha
Territorial Administration (GTA) comprising of the three sub-Divisions
of Darjeeling District namely Darjeeling, Kalimpong and Kurseong and
including the following Mouzas sub Division of these districts, which is
considered for relaxation in height and chest measurement for
recruitment in the Para Military forces of Union of India.
(1) Lohagarh Tea Garden (2) Lohagarh Forest (3) Rangmohan (4)
Barachenga (5) Panighata (6) Chota Adalpur (7) Paharu (8) Sukna
Forest (9) Sukna Part-I (10) Pantapati Forest I (11) Mahanadi Forest
(12) Champasari Forest (13) Salbari Chhat Part-II (14) Sitong Forest
(15) Sivoke Hill Forest (16) Sivoke Forest (17) Chhota Chenga (18)
Nipania

Date:
Place:

He/she hailing from LWE affected areas/districts (i.e. Gadchiroli,


Chandrapur, Gondia Districts of Maharashtra State,
Warrangal,
Karimnagar, Adilabad, Khammam, Medak, Nalgonda, Guntur,
Nizamabad,
Mahboobnagar,
Prakasam,
Anantapur,
Kurnool,
Vizianagaram, Vishakhapatam, East Godavari and Srikakulam Districts
of Andhra Pradesh) which is considered for relaxation in height and
chest measurement for recruitment in the Para Military forces of Union
of India.

He/She belongs to Scheduled Tribe.

Signature
District Magistrate/ Sub-Division Magistrate/ Tehsildar
With Seal

* Delete whichever is not applicable


29

APPENDIX-E

CERTIFICATE FOR SONS/DAUGHTERS OF SERVING CRPF PERSONNEL


Certified

that

_______________________________________

is

son/

daughter of No._________________________________ Rank ______________ Name


____________________________________,

who

is

posted

in

_____________________________________________________ (Name of Bn/Office with


location). It is also certified that the above ward is residing with the serving Force person.
The name of the above Son/Daughter has been verified from the service records of the
serving Force personnel.

Signature of Head of office


Name of H.O.O __________________________
Rank___________________________
Unit____________________________
Note : One copy of the certificate is to be kept in the Service record of the
serving personnel.

30

Appendix-F

MEDICAL FITNESS CERTIFICATE


Certified that Mr./Ms. Age years, a
candidates of recruitment of Constable (Tech/Trade) in CRPF was examined by me at
Hospitalon date.
2.
I, the undersigned have the knowledge that Mr./Ms.

has been declared Medically Unfit by the Medical Officer during recruitment of
Constable(Tech/Trade) in CRPF due to :-

In my opinion this is an error of judgement due to following reasons :-

3.

After due examination, I declare him/her medically fit for the said post.
Signature & Name with seal
of Medical Practitioner
Registration
No
(MCI/State Medical Council)
Address

Dated: .

...
Signature of the Candidate
Attested by
The Medical Practitioner
Signature & seal
Note : The findings of the Medical Practitioner should be supported by Medical reports/
documents wherever applicable.
Details of the Full Notification click here- privatejobshub.blogspot.in/2012/10/crpfrecruitment-2012-13-crpfnicin.html