Beruflich Dokumente
Kultur Dokumente
, , -I
F.No.II/3-12/2013-Estt
FAX: 0265-2339271
Vadodara, Dated: 29.11.2013
To,
The Candidate
Dear Candidate,
Sub:
Estt: Appointment to the grade of Inspector/Tax Assistant (Central Excise and Customs) in
the Central Excise and Customs, Vadodara Zone selected by the Staff Selection
Commission on the basis of result of Combined Graduate Level Exam-2012.
You have been nominated by the Staff Selection Commission for appointment as INSPECTOR/TAX
ASSISTANT under the Central Board of Excise & Customs, Dept. of Revenue and allocated to Central Excise &
Customs, Vadodara Zone, for appointment in the State of Gujarat.
2.
You are directed to remain present for the certificates/documents verification as well as for physical test /
Test
Medical Test
2.
Physical Test
(only for
Inspectors )&
Document
verification (for
all candidates)
3.1.
Date/Time
.12.2013 at
8:30 AM Sharp.
As per Excel
List
.12.2013 at
10.30. A.M.
Sharp.
As per Excel
List
Venue
Civil Hospital, Near New High
Court, S.G. Highway Road, Sola,
Ahmedabad
Recreation Hall, Ground Floor,
Central Excise Building, Race
Course, Vadodara
Person to be contacted
Official representative -Shri M.P. Makwana,
who will facilitate you at
Hospital.
Shri M. D. Mehta,
Superintendent,
Establishment Section.
You are directed to bring following documents in original along with their attested copies (of one
each)
3.2.
1.
2.
Degree Certificates
3.
Mark-Sheets of SSC/HSC/Degree.
4.
SC/ST/OBC/PH Category).
2.
3.
4.
Character certificate (to be obtained from 2 different Gazetted Officers and also attested by
the
The candidates are required to make their own arrangement of Bicycle for Cycling, which is a part of
Physical test.
2
4.
The following physical tests/ physical standards are prescribed for the post of Inspectors
Physical Test
(i)
5.
Physical Test
(a) Walking 0 1 km. in 20 min.
(b) Cycling 3 kms. In 25 min.
(ii)
No Traveling Allowance/ Daily Allowance will be paid in this regard. It is also further informed that
candidate will have to make their own arrangements regarding travel and stay in Ahmedabad/Vadodara.
6.
This letter is only for the purpose of consideration for appointment to the post of Inspector and shall not
confer any right for appointment to the said post. Appointment Orders shall be issued only after verification of the
documents in Para 3.1 above and if you qualify in the physical standard test and Medical Examination.
7.
Any request for change of the date mentioned above will not be entertained. No further extension will be
granted.
Encl.As above
(Dr.Ashir Tyagi)
Additional Commissioner (P&V),
Central Excise & Customs,
Vadodara-I
ATTESTATION FORM
:WARNING:
1.
2.
3.
If the fact that false information has been furnished of that there
has been suppression of any factual information in the attestation
form comes to notice at any time during the service of a person his
service would be liable to be terminated.
---------------------------------------------------------------------------------------------------------------------------1.
Contd.2/-
4
4.
Particulars of places (with periods of residence) where you have resided for more than one year
at time during the preceding five years. In case of stay abroad (including Pakistan) particulars of all
places where you have resided for more than one year after attaining the age of 21 years should be
given.
From
5 (a)
ii
To
Name
Nationality Place of
(by birth & Birth
or by
domicile)
Occupation
if employed
give
designation
& official
address
Present
postal
address if
dead give
last
Address
Permanent
Home
Address
Father
(Name
in full,
Aliases
if any)
Mother
iii
Wife/
Husband
iv
Brother
(s)
Sister (s)
5 (b). Information to be furnished with regard to son (s) & for daughter (s) in cases they are studying/
living in a foreign country:Name
Country
in
which studying
living with full
address.
Date
from
which studying
living in the
country
mentioned in
previous col.
5
Contd.3/-
6
6.
Nationality
7. (a)
Date of Birth
(b)
Present Age
(c)
Age of Matriculation
8. (a)
(b)
(c)
9. (a)
(b)
Your religion
10.
Educational qualification showing places of education with year in Schools & College since 15
years of age.
Name of School/College with full
Address
Date of
entering
Date of
leaving
Examination passed
11. (a) Are you holding or have any time hold an appointment under the Central or State Government
or Semi Govt., or a Quasi Govt. body, or an autonomous body, or a Public Undertaking, or a
private firm or Institution. If so, give full particulars with dates of employment, up-to-date.
Period
From
To
Designation
Full name & Address Reasons for leaving
employments & nature of employer
previous service
of employment
Contd.4/-
7
11. (b) If the previous employment was under the Govt. of India, a State Govt./ an Undertaking owned
or controlled by the Govt. of India or a State Govt./an autonomous body/University Local Body.
If you had left service on giving a Months notice under Rule 5 of the Central Civil Services
(Temporary Service) Rules, 1965, or any similar corresponding Rules were any disciplinary
proceedings framed against you, or had you been called upon to explain your conduct in any
matter at the time you gave notice of termination of service, or at a subsequent date, before
service actually terminated.
12. (a)
(b)
(c)
(d)
(e)
(f)
(g)
NOTE: i.
ii
Please also see the Warning at the top of this Attestation Form.
Specific answer to each of the question should be given by striking out YES or NO as
the case may be.
14.
I certify that the foregoing information is correct and complete to the best of my knowledge &
belief. I am not aware of any circumstance which might impair my fitness for employment
under Government.
Date :
Signature of the Candidate.
Place :
Grade
Place of posting.
8
::IDENTIFICATION FORM::
(Certificate to be signed by any of the following)
1. Gazetted Officers of Central or State Government.
2. Member of Parliament or State Legislative belonging to the constituency where the candidate or
his Parent/Guardian is ordinarily residents.
3. Sub-Divisional Magistrate/Officers.
4. Tehsildars or Naib/Deputy Tehsildars authorized to exercise Magisterial Powers.
5. Principals/Head Master of the recognized school/College/Institution where the candidate
studied last.
6. Block Development Officers.
7. Post Masters.
8. Panchayat Inspectors.
Certified
that
__________________
have
known
Son/Daughter
Shri/Smt./Kum.
of
Shri
________________________________
_______________________________
_____________________ for the last _______________ years ______________ months and that to the
best of my knowledge and belief the particulars furnished by him/her are correct.
Date :
Signature
with stamp
Place :
Designation or:
status and
Address.
1.
2.
3.
Or
(b) Any other disease or accident
Requiring confinement to bed and
Medical or surgical treatment ?
4.
5.
6.
7.
8.
Fathers age if
Living and state
Of health
No. of brothers
living, their ages
and state of health
10
::2::
Mothers age if
Living and state
Of health
I declare all the above answers to be, to the best of my belief, true and correct.
I also solemnly affirm that I have not received disability certificate / pension on account of any
disease or other condition.
Candidates Signature ...
Signed in my presence
Signature of Medical Officer .
NOTE.The candidate shall be held responsible for the accuracy of the above statement. By willfully
suppressing any information he will incur the risk of losing the appointment and , if appointed, of
forfeiting all claim to superannuation allowance or gratuity.
[ G.I., M.H., O.M. No. F.5(11)-55-M-II, dated the 27th September, 1957.]
11
: CERTIFICATE OF CHARACTER:
Certified
that
have
known
Shri/Smt./Kum.
___________________________________________________
_____________
Son/Daughter
______________________________________________________________
for
of
the
Shri
last
__________ years and ________________ months and that to the best of my knowledge and
belief he/she bears reputable character and has no antecedents which render him/her unsuitable
for Government employment.
Shri/Smt./Kum.________________________________________________
is
not
related to me.
Place :
Date :
* Signature
Name
:
:
Designation :
(* To be signed by the Gazetted Officer of Central or
State Government)
ATTESTED
Place :
Date :
@ Signature
Name
Designation :
(Attesting Authority)
(@ To be attested by Stipendiary Ist class Executive
Magistrate/District Magistrate or Sub-divisional Magistrate.)
NOTE: Two certificates to be signed by two different Gazetted Officers of the Central or State
Government attested by Stipendiary Ist class Executive Magistrate/District Magistrate
or Sub-Divisional Magistrate.
12
APPENDIX 3
AUTHORITIES EMPOWERED TO ISSUE CASTE CERTIFICATES
[G.I., Dept. of Per. & Training O.M. No. 36012/6/88-Estt. (SCT), (SRD.III), dated 1-44-1990.]
The under mentioned authorities have been empowered to issue Caste Certificates of
verification
1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional
Deputy Commissioner/Deputy Collector/1st 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 Officer not below the rank of Tehsildar,
4. Sub-Divisional Officer of the area where the candidate and/or his family normally resides.