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WEST BENGAL POLICE RECRUITMENT BOARD
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APPLICATION FORM FOR THE POST OF WARDER / FEMALE WARDER, CORRECTIONAL SERVICES 2019
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D8C407D1449920121DD61DB5D2D9DB58F9510FDD95FFC13635104235DC749234
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60593778MG000814A
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Application RG000814NY
Sl. No. 60593778

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To RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
The Chairman
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West BengalRG000814NY RG000814NY
Police Recruitment Board RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
POLICE RECORDS BHAVAN, ARAKSHA BHAVAN, BLOCK -DJ , SECTOR -II,
SALTLAKE, KOLKATA-700091
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Sir,
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I hereby apply for the post of Warder / Female Warder, Correctional Services 2019. Necessary particulars
are furnished
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Post appliedRG000814NY
for RG000814NY RG000814NY
: Warder / Female RG000814NY
Warder, Correctional RG000814NY
Services 2019 RG000814NY RG000814NY RG000814NY

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Name in FullRG000814NY RG000814NY
RG000814NY : RAKESH ROY
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Gender : Male Category : UR Date of Birth : 14/08/2000
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Father's Name : RAGHUNATH ROY Mother's Name : RINKU ROY
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Marital Status : Un-Married Husband Name :
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Computer Literacy : Yes RG000814NY
Name ofRG000814NY
Computer CouseRG000814NY
Name : RG000814NY RG000814NY
DIPLOMA IN COMPUTER RG000814NY
ONE YEAR
Certificate Issuing
RG000814NY Authority RG000814NY
RG000814NY : MIIT CourseRG000814NY
RG000814NY RG000814NY RG000814NY Duration (In Months)
RG000814NY: 12
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Ex-Srv : Not Applicable Service Experience Details : Year Month Days
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00 00 00
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Mobile RG000814NY RG000814NY
: 6295473658RG000814NY RG000814NY
Email RG000814NY RG000814NY RG000814NY RG000814NY
: somroy62661@gmail.com
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Complete Mailing Address :
VILL+POST-KIABONI,P.S-GARHBETA,DIST-PASCHIM MEDINIPUR,PIN-721253
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PO : KIABONI
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POLICE STATION : GARBETA
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DISTRICT : PASCHIM MEDINIPUR PIN : 721253
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STATE : WEST BENGAL
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NEAREST RAILWAY STATION : CHANDRAKONA RD (CDGR)
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Permanent Address : RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
VILL+POST-KIABONI,P.S-GARHBETA,DIST-PASCHIM MEDINIPUR,PIN-721253
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PO : KIABONI
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POLICE STATION : GARBETARG000814NY RG000814NY RG000814NY RG000814NY RG000814NY

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DISTRICT : PASCHIM RG000814NY
MEDINIPUR RG000814NY RG000814NY RG000814NY RG000814NY
PIN : 721253

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STATE : WEST BENGAL RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
NEAREST RAILWAY
RG000814NY RG000814NY RG000814NY STATIONRG000814NY
RG000814NY : CHANDRAKONA RD (CDGR) RG000814NY RG000814NY RG000814NY
RG000814NY
Educational RG000814NY
RG000814NY Qualification RG000814NY
: Class X PassRG000814NY
: Yes RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
Name of Examination Year of Passing (YYYY) Name of the Board / Council / University
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Madhyamik (Class X) 2016 WEST BENGAL BOARD OF SECONDARY EDUCATION
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Higher Secondary (10+2) RG000814NY RG000814NY RG000814NY
2018 RG000814NY
WEST BENGAL RG000814NY
COUNCIL OF HIGHER RG000814NY
SECONDARY EDUCATION RG000814NY

RG000814NYGraduation
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Post Graduation
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D8C407D1449920121DD61DB5D2D9DB58F9510FDD95FFC13635104235DC749234
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Application Sl. No. 60593778RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
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60593778MG000814B
Name : RAKESH ROY D8C407D1449920121DD61DB5D2D9DB58F9510FDD95FFC13635104235DC749234
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Do you belong to exempted category? : NO Registration & NCO No. issued by the
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Your Community : Religion : HINDUISM
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Employed in any Government : NO Organization Name :
OrganisationRG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
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Have you ever been subjected to a criminal : NO
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investigation asRG000814NY RG000814NY
an accused involving moral RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
turpitude?
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Details RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY: RG000814NY

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Police Station RG000814NY
Name in Full RG000814NY RG000814NY
FIR No. RG000814NY RG000814NY RG000814NY
FIR Date Sections of LawRG000814NY

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Application Fees RG000814NY
: Rs. 200.00 RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY
Bank Charge : Rs. 0.00
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Processing Charge : Rs. 20.00
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Total Fees paid RG000814NY
: Rs. 220.00 RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY

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RG000814NY RG000814NY Transaction


RG000814NY ID : RG000814NY
QHMP7299802125 [ Online Payment
RG000814NY through
RG000814NY Bill Desk ] RG000814NY RG000814NY
RG000814NY
Transaction Date
RG000814NY RG000814NY RG000814NY RG000814NY : 08/03/2019
RG000814NY 09:38:01 RG000814NY RG000814NY RG000814NY
RG000814NY
(Rupees Two Hundred Twenty only)
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Declaration :
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(i) I possess all the Essential Qualifications for the Post.
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(ii) I solemnly declare that RG000814NY RG000814NY
all statements made RG000814NY
in this application form areRG000814NY RG000814NY
true, complete and RG000814NY
correct to the RG000814NY
best of my knowledge
and belief. In the event of any information being found suppressed / false or incorrect, or if my ineligibility is detected before,
during or
RG000814NY after the tests RG000814NY
RG000814NY and medical examination,
RG000814NY my candidature
RG000814NY / appointment will stand
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RG000814NY my claim to recruitment
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will stand forfeited. I also declare that I have submitted no other application form for this examination.
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(iii) I have never been debarredRG000814NY RG000814NY
from any examination RG000814NY
conducted RG000814NY
by any Service CommissionRG000814NY RG000814NY
/ Recruitment Board RG000814NY
of the Government
of West Bengal.
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(iv) I have not been subjected RG000814NY RG000814NY
to a criminal investigation RG000814NY
involving RG000814NY RG000814NY RG000814NY RG000814NY
moral turpitude.
(v) I shall submit the No Objection Certificate from the Head of the Office/ Disciplinary Authority if shortlisted for Personality Test.
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Place : KIABONI
RG000814NY Yours faithfully,
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Date : 08 Mar 2019 09:38:01RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY RG000814NY

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Full signature of the candidate (only in Long Hand)
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