Annexure II A INSTRUCTIONS FOR FILLING UP THE APPLICATION I. The Commission uses standard application form for all its examinations. Therefore, please read the instructions given in the Notice of Examination and also given below carefully before filling up the application form, in your own interest. II. III. IV. Use only blue/black ball pen to write in the boxes, i.e., Instructions have been given for most items in the application itself which should be gone through carefully before filling up the boxes. For items for which instructions are not available, further instructions given below may be gone through carefully. Please go through the instructions given below for filling up each item numbered in the application form:- V. Request for change/correction in any particulars in the Application Form, once submitted, will not be entertained under any circumstances. 1. Name of the Examination Centre and 2. Centre Codes Refer to para-11 of the Notice of the Examination. 12.1. Code for seeking age relaxation. Refer to para 6 of the Notice of the Examination. 13. Preference for Posts P for Postal Assistant/Sorting Assistant Grade Pay Rs. 2400 Department of Post. D for Data Entry Operator Grade Pay Rs. 2400 E for Data Entry Operator Grade Pay Rs. 1900 L for Lower Division Clerk Grade Pay Rs. 1900 for You are advised to be careful in exercising your preference as in the event of your getting selected for both the posts, you will be considered for the posts in the order of your merit and preference for each post.you are also advised that you will not be considered for posts for which you have not excercised option. 15 VH candidates and such PH candidates as are entitled to scribes should specify the medium in which they desire to take the Written Examination. Scribes will be arranged by the Commission accordingly. 16. If a Candidate belongs to one of the minority communities notified by Govt. namely Muslims, Christians, Sikhs, Buddhists, or Zoroastrians (Parsis), Write Code-08. 17. Educational Qualification and Subject Code: See Annexure X Use Others if any particular Educational Qualification or Subject is not assigned a code. 19. Address for communication Write your complete communication address including your Name in English in capital letters or in Hindi with blue/black ball pen. Do not forget to write 6 digit PIN in the boxes.
20 IMPORTANT: It is in the interest of the candidate to furnish e-mail ID and/or mobile number to enable the Commission at its option, to send call letter and any other information. 20. Photograph Paste your recent photograph of size 4cmx5cm as per specification in Para 14 of the Notice. Do not staple and do not get the photo attested. Please note that your application shall be rejected summarily without photograph. Box for Roll Number to be left unfilled (blank) by the candidate. 21
Annexure-II B Procedure for Online Submission of Application Note: The facility of online Registration will be available from 13.06.2015 to 13.07.2015 (upto 5:00 PM). 1. Online submission of the application may be made at website http://ssconline.nic.in and http://ssconline2.gov.in Instructions are available at the site. Candidate should read the instructions carefully before making any entry or selecting options. Candidate should supply all the required details while filling up the online form. Mandatory fields are marked with * (asterisk) sign. 2. In registration, candidate will have to fill basic information. On submission of details, candidate will be prompted to check the details and make any correction in the application. 3. Candidate may press I agree button after declaration once he/she finds that information supplied by him/her is in order and no correction is required. Thereafter no correction/modification etc. will be allowed. 4. Then a page with Registration No. shall be generated. Note down registration number or take out the print out of the page. The application procedure is incomplete without payment, uploading of photograph and scanned signature. 5. Candidates who have to pay application fee can pay fee online through SBI Challan /Net banking and any credit and debit cards. 6. To pay fee in cash, candidate should take print out of challan generated online after completion of registration. Candidate may go to nearest SBI branch for depositing fees after 24 hours of submission of online form. 7. Those who want to pay online through SBI Challan /Net banking and any credit and debit cards, can go directly after submission of form. 8. Those who are exempted from payment of fee can skip steps 5 to 6. 9. Then upload a recently taken scanned photograph in 8 bit JPG format. The digital size of the file must be less than 12 kb and greater than 4 kb and of resolution 100 pixel widths by 120 pixels height. 10. Then upload your scanned signature in JPG format. The digital size of the file must be less than 12 kb and greater than 4 kb and of resolution 100X120 (Pixel).
22 11. Emails will be received by the candidates on completion of Registration. Copy of email may be retained to produce before the Regional Office in the event of any discrepancy. 12. Candidates are advised to go through the instructions carefully before filling up the application form. 13. Request for change/correction in any particulars in the Application Form (both Online/Offline) shall not be entertained under any circumstances. The Staff Selection Commission will not be responsible for any consequences arising out of non acceptance of any correction/addition/deletion in any particular filled in application form whatever the reasons may be. 23
ANNEXURE-III FORM OF CERTIFICATE TO BE SUBMITTED BY CENTRAL GOVERNMENT CIVILIAN EMPLOYEES SEEKING AGE- RELAXATION (To be filled by the Head of the Office or Department in which the candidate is working). (Please see Para 6 of the Notice) It is certified that *Shri/Smt./Km. is a Central Government Civilian employee holding the post of in the pay scale Of with 3 years regular service in the grade as on closing date (i.e. 13.07.2015). Signature : Name: Place: Date : (*Please delete the words which are not applicable.) Office seal 24
ANNEXURE- IV Form of Certificate for serving Defence Personnel (Please see Para-6 of Notice for the Examination) I hereby certify that, according to the information available with me (No.) (Rank) (Name) is due to complete the specified term of his engagement with the Armed Forces on the (Date). Place: Date: (Signature of Commanding Officer) Office Seal:
25 ANNEXURE-V UNDERTAKING TO BE GIVEN BY THE CANDIDATE COVERED UNDER PARA 6 OF NOTICE. I understand that, if selected on the basis of the recruitment/examination to which the application relates, my appointment will be subject to my producing documentary evidence to the satisfaction of the Appointing Authority that I have been duly released/retired/discharged from the Armed Forces and that I am entitled to the benefits admissible to Ex- Servicemen in terms of the Ex-Servicemen Re-employment in Central Civil Services and Posts rules, 1979, as amended from time to time. I also understand that I shall not be eligible to be appointed to a vacancy reserved for Ex-S in regard to the recruitment covered by this examination, if I have at any time prior to such appointment, secured any employment on the civil side (including Public Sector Undertakings, Autonomous Bodies/Statutory Bodies, Nationalized Banks, etc.) by availing of the concession of reservation of vacancies admissible to Ex-S. I further submit the following information: a) Date of appointment in Armed Forces b) Date of discharge c) Length of service in Armed Forces d) My last Unit / Corps (Signature of the Candidate) Place: Date:
26 FORMAT FOR SC/ST CERTIFICATE ANNEXURE-VI A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should submit in support of his claim an attested/certified copy of a certificate in the form given below, from the District Officer or the sub-divisional Officer or any other officer as indicated below of the District in which his parents(or surviving parent) ordinarily reside who has been designated by the State Government concerned as competent to issue such a certificate. If both his parents are dead, the officer signing the certificate should be of the district in which the candidate himself ordinarily resides otherwise than for the purpose of his own education. Wherever photograph is an integral part of the certificate, the Commission would accept only attested photocopies of such certificates and not any other attested or true copy. (The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates applying for appointment to posts under Government of India) This is to certify that Shri/Shrimati/Kumari* son/daughter of of village/town/* in District/Division * of the State/Union Territory* belongs to the Caste/Tribes which is recognized as a Scheduled Castes/Scheduled Tribes* under:- The Constitution (Scheduled Castes) order, 1950 The Constitution (Scheduled Tribes) order, 1950 The Constitution (Scheduled Castes) Union Territories order, 1951 * The Constitution (Scheduled Tribes) Union Territories Order, 1951* As amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) order, 1956, the Bombay Reorganization Act, 1960 & the Punjab Reorganization Act, 1966, the State of Himachal Pradesh Act 1970, the North-Eastern Area(Reorganization) Act, 1971 and the Scheduled Castes and Scheduled Tribes Order(Amendment) Act, 1976. The Constitution (Jammu & Kashmir) Scheduled Castes 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*.
27 The Constitution (Dadra and Nagar Haveli) Scheduled Castes order 1962. The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order 1962@. The Constitution (Pondicherry) Scheduled Castes Order 1964@ The Constitution (Scheduled Tribes) (Uttar Pradesh) 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 (SC) orders (Amendment) Act, 1990@ The Constitution (ST) orders (Amendment) Ordinance 1991@ The Constitution (ST) orders (Second Amendment) Act, 1991@ The Constitution (ST) orders (Amendment) Ordinance 1996 The Scheduled Caste and Scheduled Tribes Orders(Amendment)Act,2002 The Constitution (Scheduled Caste) Orders (Amendment) Act,2002 The Constitution (Scheduled Cas te and Scheduled Tribes) Orders(Amendment)Act,2002 The Constitution (Scheduled Caste) Order (Amendment) Act,2007 %2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from one State/Union Territory Administration. This certificate is issued on the basis of the Scheduled Castes/ Scheduled tribes certificate issued to Shri/Shrimati Father/mother of Shri/Srimati/Kumari* of village/town* in District/Division* of the State/Union Territory* who belong to the Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe in the State/Union Territory* issued by the dated. Shri/Shrimati/Kumari and /or * his/her family ordinarily reside(s) in village/town* of District/Division* of the State/Union Territory of Signature ** Designation (with seal of office) Place Date
28 * Please delete the words which are not applicable @ Please quote specific presidential order % Delete the paragraph which is not applicable. NOTE: The term ordinarily reside(s) used here will have the same meaning as in section 20 of the Representation of the People Act, 1950. ** List of authorities empowered to issue Caste/Tribe Certificates: (i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Dy.Collector/Ist Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra-Assistant Commissioner/Taluka Magistrate/Executive Magistrate. (ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. (iii) Revenue Officers not below the rank of Tehsildar. (iv) 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.
29 ANNEXURE-VII (FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA) This is to certify that Shri /Smt./Kumari son/daughter of village/town in District/Division in the State/Union Territory the belongs to Community which is recognized as a backward class under the Government of India, Ministry of Social Justice and Empowerment s 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 Scheduled to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt (SCT) dated 8.9.1993**. District Magistrate Deputy Commissioner etc. Dated: Seal: of * The authority issuing the certificate may have to mention the details of Resolution of Government of India, in which the caste of the candidate s 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.
30 Annexure-VIII (FORM-II) DISABILITY CERTIFICATE (IN CASE OF AMPUTATION OR COMPLETE PERMANENT PARALYSIS OF LIMBS AND IN CASES OF BLINDNESS) (See rule 4) Recent PP size Attested Photograph (showing face only) of the person with disability (NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THE CERTIFICATE) Certificate No. Date: This is to certify that I have carefully examined Shri/Smt/Kum Son/wife/daughter of Shri Date of Birth Age years, male/female (DD/MM/YY) Registration No. permanent resident of Home No. Ward/Village/Street Post Office District State. Whose photograph is affixed above, and an satisfied that : (A) he/she is a case of: locomotor disability blindness (Please tick as applicable) the diagnosis in his/her case (A) He/She has % (in figure) percent(in words) permanent physical impairment/blindness in relation to his/her (part of body) as per guidelines(to be specified). 31
2. The applicant has submitted the following document as proof of residence:- Nature of Document Date of Issue Details of authority issuing certificate. Signature/Thumb impression of the person in whose favour disability certificate is issued. (Signature and Seal of Authorised Signatory of notified Medical Authority)
32 DISABILITY CERTIFICATE (In Case of Multiple disabilities) Annexure-VIII (FORM-III) (NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THE CERTIFICATE) (See rule 4) Recent PP size Attested Photograph (showing face only) of the person with disability Certificate No. Date: This is to certify that I have carefully examined Shri/Smt/Kum Son/wife/daughter of Shri Date of Birth Age years, male/female (DD/MM/YY) Registration No. permanent resident of Home No. Ward/Village/Street Post Office District State affixed above, and are satisfied that : (A) whose photograph is He/She is a Case of Multiple Disability. His/her extent of permanent physical impairment/disability has been evaluated as per guidelines(to be specified) for the disabilities ticked below, and shown against the relevant disability in the table below: S.N Disability Affected o. part of the body 1. Locomotor disability @ 2 Low vision # 3. Blindness Both Eyes 4. Hearing impairment $ 5. Mental retardation X 6. Mental-illness X Diagnosis Permanent physical impairment/mental disabilities(in %)
33 (B) In the light of the above, his/her over all permanent physical impairment as per guidelines ( to be specified) is as follows:- In figure percent. In words: percent. 2. This condition is progressive/non progressive/likely to improve/not likely to improve. 3. Reassessment of disability is: (i) not necessary Or (ii) is recommended/after years months, and therefore this certificate shall be valid till (DD) (MM) (YY) @ e.g. Left/Right/both arms/legs # e.g. Single eye/both eyes $ e.g. Left/Right/both ears. 4. The applicant has submitted the following document as proof of residence. Nature of Document Date of issue Details of authority issuing certificate 5. Signature and seal of the Medical Authority Name and seal of Member Name and seal of Member Name and seal of the Chairperson Signature/Thumb impression of the person in whose favour disability certificate is issued.
34 Annexure-VIII (FORM-IV) DISABILITY CERTIFICATE (In case other than those mentioned in Forms II and III) (NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THE CERTIFICATE) (See rule 4) Recent PP size Attested Photograph (showing face only) of the person with disability Certificate No. Date: This is to certify that I have carefully examined Shri/Smt/Kum Son/wife/daughter of Shri Date of Birth (DD/MM/YY) Age years, male/female Registration No. permanent resident of House No. Ward/Village/Street Post Office District State Whose photograph is affixed above, and an satisfied that he/she is a Case of disability. His/her extent of percentage physical impairment/disability has been evaluated as per guidelines(to be specified) for the disabilities (to be specified) and is shown against the relevant disability in the table below:- S.N Disability Affected o. part of the body 1. Locomotor disability @ 2 Low vision # 3. Blindness Both Eyes 4. Hearing impairment $ 5. Mental retardation X 6. Mental-illness X (Please strike out the disabilities which are not applicable) 35 Diagnosis Permanent physical impairment/mental disabilities(in %)
2. The above condition is progress/non progress/likely to improve/not likely to improve. 3. Reassessment of disability is: (i) not necessary Or (ii) is recommended/after years on ths, and therefore this certificate shall be valid till (DD) (MM) (YY) @ e.g. Left/Right/both arms/legs # e.g. Single eye/both eyes $ e.g. Left/Right/both ears. 4. The applicant has submitted the following document as proof of residence. Nature of Document Date of issue Details of authority issuing certificate Signature/Thumb impression of the person in whose favour disability certificate is issued. Medical Authority (Authorised Signatory of notified (Name and Seal) (Countersignature and seal of the CMO/Medical Superintendent/Head of Government Hospital, in case the certificates issued by a medical authority who is not a permanent servant(with seal) Note: In case this certificate is issued by a medical authority who is not a government servant, it shall be valid only if countersigned by the Chief Medical Officer on the District.
36 ANNEXURE-IX GOVERNMENT OF INDIA FORM OF MEDICAL CERTIFICATE TO BE PRODUCED BY THE PHYSICALLY HANDICAPPED CANDIDATES WHO SEEK EXEMPTION FROM APPEARING IN THE TYPEWRITING TEST FOR LOWER DIVISION CLERK. This is to certify that Sh/Smt/Kum son/daughter/wife of Shri is suffering from. Clinical diagnosis as a result of which he/she has the following disabilities. (Brief description of his/her disabilities) --------------------------------------- --------------------------------------- --------------------------------------- --------------------------------------- --------------------------------------- Photograph of candidate clearly showing Face with affected portion of the body This is a permanent disability and the extent of his/her disability works to % of disability. This disability is likely to interfere with Typewriting (specify) ---------------------------------------------------------------------------------------------------------------- ---------------------------- Signature of candidate Signature of Civil Surgeon Name: Place: Official Stamp:
37 ANNEXURE - X Essential Educational Qualification Code Educational Qualification Code Matriculation 01 Intermediate/Higher Secondary 02 Certificate 03 Diploma 04 BA 05 BA (Hons.) 06 B. Com. 07 B.Com. (Hons.) 08 B.Sc. 09 B.Sc. (Hons.) 10 B. Ed. 11 LLB 12 BE 13 B. Tech 14 AMIE (Part A & Part B) 15 B.Sc. (Engg.) 16 BCA 17 BBA 18 Graduation issued by Defence (Indian Army, Air Force, 19 Navy) B. Lib. 20 B. Pharm. 21 ICWA 22 CA 23 PG Diploma 24 MA 25 M.Com. 26 M. Sc. 27 M.Ed. 28 LLM 29 ME 30 M. Tech. 31 M. Sc. (Engg.) 32 MCA 33 MBA 34 Others 35
38 Subject Code for Educational Qualification Subject of Educational Qualification Code History 01 Political Science 02 Economics 03 English Literature 04 Hindi Literature 05 Geography 06 Commerce 07 Law 08 Physics 09 Chemistry 10 Mathematics 11 Statistics 12 Botany 13 Zoology 14 Agriculture Science 15 Civil Engineering 16 Electrical Engineering 17 Mechanical Engineering 18 Electronics Engineering 19 Electronics & Power Engineering 20 Electronics & Communication Engineering 21 Electronics & Instrumentation Engineering 22 Agriculture Engineering 23 Computer Science 24 Computer Application 25 Information Technology 26 Library Science 27 Accountancy 28 Work Accountancy 29 Business Administration 30 Mass Communication 31 Journalism 32 Mass Communication & Journalism 33 Pharmacy 34 Photography 35 Printing Technology 36 Nursing 37 Assamese 38 Bengali 39 Malyalam 40 Telgu 41 Kannada 42 Tamil 43 Marathi 44 Gujrati 45 Urdu 46 Sanskrit 47 Others 48
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