Beruflich Dokumente
Kultur Dokumente
-01 CEPTAM
*DECLARATION TO BE SIGNED BY OBC CANDIDATES ONLY I.Son/daughter/wife of Shri resident of village/town/city ...... district .state .... hereby declare that I belong to the community which is recognized as a backward class by the Govt. of India for the purpose of reservation in services as per orders contained in Deptt. of Personnel and Training Office Memorandum No. 36102/22/93-Estt (SCT) dated 8.9.1993. It is also declared that I do not belong to the persons/sections (creamy layer) mentioned in Column 3 of the schedule to the OM No-36102/22/93-Estt (SCT) dated 08.09.1993 and modified vide Govt. of India Deptt. of Personnel and Training OM No. 36033/3/2004-Estt (Res) dated 09.03.2004. Place: Date (Signature of candidate) (In running handwriting)
NOTE: The closing date for receipt of application will be treated as the date of reckoning for OBC status of the candidate and also, for assuming that the candidate does not fall in the creamy layer. The candidate should furnish the relevant OBC Certificate in the format prescribed for Central Government jobs as per Form-04 issued by the competent authority on or before the Closing Date as stipulated in the Notice.
e) If serving, the date of discharge is within one year from the date of publication of CEPTAM 04 Advertisement.
Place: Date:
Resolution No. 12011/68/93-BCC dated the 10th September, 1993, published in the Gazette of India Extraordinary-Part I , Section I, No. 186 dated 13th September, 1993. Resolution No. 12011/9/94-BCC, dated 19.10.1994 published in Gazette of India extraordinary Part I Section I No. 163, dated 20th October 1994 Resolution No. 12011/7/95-BCC, dated the 24th May 1995 published in the Gazette of India extraordinary Part I Section I No. 88, dated 25th May, 1995. Resolution No. 12011/96/94-BCC dated 9th March, 1996 Resolution No. 12011/44/96-BCC, dated the 6th December, 1996 published in the Gazette of India extraordinary Part I Section I No. 210, dated the 11th December 1996. Resolution No. 12011/13/97-BCC dated 3rd December, 1997 Resolution No. 12011/99/94-BCC dated 11th December, 1997 Resolution No. 12011/68/98-BCC dated 27th October, 1999 Resolution No. 12011/88/98-BCC, dated the 6th December, 1999 published in the Gazette of India extraordinary Part- I Section I No. 270 dated 6th December 1999 Resolution No. 12011/36/99-BCC, dated 4th April ,2000 published in the Gazette of India extraordinary Part- I Section I No.71 dated 4th April 2000. Resolution No. 12011/44/99-BCC, dated 21.9.2000 published in the Gazette of India extraordinary Part- I Section I No. 210 dated 21.09.2000.
Shri_/Smt/Km__________________________________and/or his/ her family ordinarily reside(s) in the _______________District/ Division of the __________________State. 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 and Training O.M. No. 36012/22/93-Estt. (SCT) dated 08.09.1993. and modified vide Government of India, Department of Personnel & Training OM No. 36033/3/2004- Estt(Res) dated 14.10.2008.
Dated: Seal :
*Strike out whichever is not applicable Note-1: (a) The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of the people act 1950 (b) The authorities competent to issue caste certificates are indicated below: (i) District Magistrate/additional Magistrate /Collector/Deputy Commissioner/additional deputy Commissioner/Deputy Collector/first Class Stipendiary Magistrate/Sub-Divisional Magistrate/Taluka Magistrate /Executive Magistrate /Extra Assistant Commissioner (not below the rank of First Class Stipendiary Magistrate) (ii) Chief Presidency Magistrate /additional Chief Presidency Magistrate /Presidency Magistrate (iii) Revenue Officer not below the rank of Tehsildar; and (iv) Sub Divisional Officer of the area where the candidate and/or his family resides. Note-2: The closing date of receipt of application will be treated as the date of reckoning for OBC status of the candidate and also, for assuming that the candidate does not fall in the creamy layer The candidate should furnish the relevant OBC certificate in the format prescribed for Central Government jobs as per Form-05 issued by the competent authority on or before the Closing date as stipulated in the Notice
Affix here recent photograph of candidate clearly showing face with affected portion of the body duly attested by the Chairperson of the Medical Board
(v)
(vi) (vii)
BH- Stiff back and hips (Cannot sit or stoop) MW-Muscular weakness and limited physical endurance. (i) B-Blind (ii) PB-Partially Blind
C. Hearing Impairment
(i) D-Deaf (ii) PD-Partially Deaf (DELETE THE CATEGORY WHICHEVER IS NOT APPLICABLE) 2. This condition is progressive/non-progressive/likely to improve/not likely to improve. Reassessment of this case is not recommended /is recommended after of period of..years.months. 3. Percentage of disability in his/her case is..Percent. 4. Shri/Smt/Kmmeets the following physical requirements for discharge of his/her duties:(i) F-can perform work by manipulating with fingers (ii) PP-can perform work by pulling and pushing (iii) L-can perform work by lifting (iv) KC-can perform work by kneeling and crouching (v) B can perform work by bending (vi) S-can perform work by sitting (vii) ST-can perform work by standing (viii)W-can perform work by walking (ix) SE-can perform work by seeing (x) H-can perform work by hearing/speaking (xi) RW-can perform work by reading and writing (Dr) Member, Medical Board (Dr) Member, Medical Board Yes/No. Yes/No Yes/No. Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No (Dr) Chairperson, Medical Board
Note-1: Application without the thumb impression and not signed by Candidate will be rejected. All signatures affixed on the Application Form must be in running script (not in Block letters), in the same language and in the same manner. Note-II: Please ensure that the Application Form filled up by you is identical in format/size to the one appearing in the advertisement in the Employment News/Rozgar Samachar and the paper on which your Application Form is printed/photocopied, is white in colour and of good quality so that it can be scanned easily.
It is certified that Shri/Smt/Km.*_____________ is a central Government Civilian employees and is holding the post of _________________________ Non-technical post of_______________________ in the pay scale of Rs._____________________________ with 3 years regular service in the grade as on closing date of CEPTAM -04 Advertisement. The detailed nature of duties performed by him/.her during the last three years duly certified is enclosed.
Place: Date :
Official Seal
Date: Place: