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ANDHRA PRADESH PUBLIC SERVICE COMMISSION # VIJAYAWADA


GROUP-I SERVICES (NOTIFICATION NOs. 15/2011 (LIMITED) & 18/2011 (GENERAL) RECRUITMENT
CHECK LIST FOR VERIFICATION OF ORIGINAL CERTIFICATES
(To be filled by the candidate)

REGISTER NO. : AFFIX PHOTO

DATE OF VERIFICATON & ORAL TEST (INTERVIEW) :

01 Name of the Candidate


(as per SSC)
02
Father’s Name
03
Gender Male/Female
04 Date of Birth D D M M Y Y Y Y
Age : Years____ Months ___Days_____
(as per SSC)
05
If age relaxation is claimed, specify code

01. A.P. State Govt. Employee 02. SC/ST OR BC 03. Ex-Service Man
04 .N.C.C 05 PH persons 06. Retrenched Census Employee

06 If BC(a) mention category


(b) Whether non-
Community creamy layer certificate
OC SC ST BC
(integrated community issued by M.R.O produced As per G.O.M.s.No:3
for SC/ST/BC) (BCW)dept, dt:04.04.2006
YES NO

Date of acquiring
Degree
07 Qualification details Subjects qualification
a ) For the Posts Codes.
01 to 04, 06 to 08, 10 to 12,
14 to 16 and 19.

b) For Post Code No.05


Whether you posses a Bachelor’s
degree in B.E. (Fire). If B.E. (Fire)
candidates are not available, degree YES/NO
in any discipline will be Considered.

c) For Post Code No: 13


whether you posses degree in Social
work or Sociology. Preference shall
be given to persons who possesses a YES/NO
Degree in Sociology or Social Work.

d) For Post Code No: 09


whether you posses a degree in
Commerce Or Economics Or
Mathematics with at least Second
Class in the subjects Or CA of the YES/NO if Yes, _________ % of marks &
U.K. OR INDIA OR an incorporated
Accountant (LONDON) __________ Division

08 Local Zone to which you belong ZONE


For Post Code No: 19

Indicate the evidence (original study


certificate for regular study OR Class Year District State
Residence certificate for 7 yrs prior to IV
SSC if private Study) to be produced. V
VI
VII
VIII
IX
X
09 PH (Disability) Percentage
In case of PH candidates VH ________% HH _________% OH ___________%
2

10 Physical Fitness
Height(In Cms): Weight(In Kgs):
For PC No.3 to 5:
Male: Must not be less than 167.6Cms in
Height, and Must be not less than Inspiration(In Cms only):
86.3Cms round the chest on full
inspiration and has a chest expansion
of not less than 5Cm. on full inspiration
Expiration(In Cms only):
(As per special Rules),
ST: Must not be not less than 164Cms in
Height, and Must be not less than Chest
83.8Cms round the chest with a (For Men only)
minimum expansion of not less than
5Cm .on full inspiration .
For PC No.3:
Difference(In Cms
Female: not less than 152.5cms in Height, not only):
less than 45.5Kgs in Weight.
(As per G.O Ms No.137 HOME (Police –
E), dt.01.06.1998)
(a) Right Eye: Distant Vision V-6/6 _______ (b) Left Eye: Distant Vision (V-6/6) __________
Near Vision- Reads ( 0.6) _______ Near Vision- Reads (0.6) __________

11 Details of the Present Employment.


(Persons who are Government Servant/
Employees of State / Central/ PSU and
Autonomous Bodies/ Public Autonomous
Bodies / Constitutional Bodies are
required to produce letter of permission /
intimation (with acknowledgement) to
appear in the examination if He/ She was
in Service while applying.)

Signature of the candidate


Mobile no:
Email :

CANDIDATE’S STATEMENT

The Original certificates produced by me have been verified in my presence and returned to me.
All relevant columns filled in by me and they are true and correct.

I am also informed to attend Physical fitness examination before the Medical Board constituted by
K.G Hospital, Vishakhapatnam even though I brought Physical Fitness Certificate.

I could not produced the following Original Certificates/documents as they are not available with
me. I am aware of the all missing documents. (If not applicable, strike of the Para)

Signature of the Candidate

TO BE USED FOR ADMISSION (OFFICIAL USE)


The Candidate is eligible for the following post codes.

The candidate may be admitted for Interview Finally / Provisionally.

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

TO BE USED FOR REJECTION

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

Member

CHAIRMAN
Copy to: D.S. (Confdl.)