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TELANGANA STATE PUBLIC SERVICE COMMISSION: HYDERABAD

PROHIBITION & EXCISE CONSTABLE IN EXCISE DEPARTMENT


(GENERAL RECRUITMENT)
NOTIFICATION NO: 06/2016
BASIC INFORMATION DATA
(CHECK LIST)

(To be filled by the candidate)

TSPSC ID :

Ref ID : PHOTO OF THE


CANDIDATE
HALL TICKET NO :

DATE OF VERIFICATION:

Signature
Name of the Candidate
01
( as per SSC)

02 Fathers Name

03 Mothers Name

04 Gender Male Female

Date of Birth D D M M Y Y Y Y
05
( as per SSC)

Years Months days

(Age as on 01/07/2016)
06

Date of Name of the


Qualification acquiring Board/Univer
qualification sity

Qualification
As per
(as on 30/04/2016)
07
Notification
Official use :
OC SC ST BC

A B C D E
Community(integrated
Community Certificate
Issued by M.R.O for
08
SC/ST/BC from
Telangana State Govt)
Official use :

Whether non-creamy
YES NO
layer certificate
produced
BC Candidates should
Submit Non Creamy
Official use :
Layer certificate as per
G.O.Ms.No:8 of 2014
09
&

MemoNo.3009/BCW/
OP/2011, Dt:18-12-2015.

Whether relevant Certificate


Years Produced
If age relaxation is
(No. of years claimed YES NO
claimed, specify
for relaxation)
.
1) Retrenched Census
Employee
2) Telangana State
10 Govt. Employee
3) N.C.C Official use :
4) Ex-Service Men
5) SC/ST and BC

Class Year District State

Indicate the evidence IV


(Original Study
Certificate to be
V
produced) OR
11
Residence certificate for
7 yrs. Prior to SSC if VI
private Study.
VII

VIII
IX

District you belong to


12
as per 4th class to 10th
class
Preference Name of the District
1st Preference

2nd Preference

3rd Preference

4th t Preference

5th Preference
13
District Preference
6th Preference

7th Preference

8th Preference

9th Preference

10th Preference

Yes

Are you applied for the No


post of Transport
14 Constables in Transport
department vide 1st Preference
Notification No.05/2016 If Yes
Preference
for the post 2nd preference

Official use:
Present Employment
details
15
(Government Employees
should submit NOC)
Declaration

I hereby declare that

i) All the columns filled in by me containing my biodata and other particulars, are true to the best of
my Knowledge.

ii) The certificates such as, my educational qualification, community certificate, date of birth (SSC),
study/residence in support of my claim for local candidature are genuine.

iii) I did not resort to any irregular or improper means in connection with my candidature for
selection.

iv) I am liable for permanent debarment from appearing for the recruitment to be conducted by
TSPSC and other PSCs and also criminal prosecution, if I am found involved in any unfair means
/ malpractice.

15
v) I further declare that the information furnished by me is correct and my candidature shall be
cancelled at any stage if it is found incorrect.

Address.

..

Mobile No

Place:
Date: Signature of the candidate.

TO BE USED FOR ADMISSION (OFFICIAL USE)

The Candidate Admitted for Oral Test.

Jr. ASST./A.S.O SECTION OFFICER ASST. SECRETARY

TO BE USED FOR REJECTION

The Candidate Rejected for Oral Test with the following reason.

A.S.O SECTION OFFICER ASST. SECRETARY DEPUTY SECRETARY SECRETARY

MEMBER CHAIRMAN