vkuWykbu foLr`r vkosnu izi=k ds fy, vuqns'k

Guidelines for Online Detailed Application Form

bathfu;jh lsok ijh{kk] 2011

Engineering Services Examination, 2011

egRoiw.kZ
Important
1 - mEehnokjksa dks lykg nh tkrh gS fd os Hkkjr ljdkj ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kk
dh fu;ekoyh (iz f r la y Xu) ftles a ik=krk dh 'krks Z a vkfn dk mYYks [ k gS ] dks lko/kuh ls i<+ ys a A
1.
Candidates are advised to read carefully the Rules of the Examination, which include conditions of
eligibility etc. as published in the Gazette of India dated 08th January, 2011.

2. mEehnokj ;g lqfuf'pr dj ysa fd vkuWykbu vkosnu izi=k ds lHkh dkWyeksa dks Bhd izdkj ls Hkj fn;k gSaA vkosnu
izi=k esa dh xbZ izfof"V;ksa esa ifjorZu laca/h mEehnokjksa ds i=kkpkj ij vk;ksx }kjk fopkj ugha fd;k tk,xkA 'kqU; tkudkjh
dh fLFkfr ds ekeys esa mEehnokj lacf/r dkWye esa Li"V :i ls 'kwU; fy[ksaA dksbZ Hkh dkWye [kkyh u NksMk tk,A
2.
Candidates should ensure that all modules of the Online Application Form are filled in correctly . No
correspondence will be enteretained by the Commission from candidates to change any of the entries made in
the application form. In case of NIL information, candidates are advised to clearly write NIL or NA or "0" in
the relevant module. No module should be left blank.

3-

'kS f {kd ;ks X ;rk] vk;q ] tkfr bR;kfn ls la c a f /r lHkh la x r la y Xud iz i =k ds lkFk yxk fn, tk,a A

3.

All relevant enclosures relating to educational qualifications, age, community etc. should be enclosed with the Form.

4- iw.kZ :Ik ls Hkjk gqvk vkosnu izi=k v afre rkjh[k 29.12.2011 rd ;k mlls igys voj lfpo (i- 7)] la?k yksd lsok
vk;ksx] /kSyiqj gkmQl] 'kkgtgkWa jksM] ubZ fnYyh&110069 dks igqWap tkuk pkfg,A
vkosnu izi=k ds fyiQkiQs ij ^bathfu;jh lsok ijh{kk] 2011 ds fy, vkosnu izi=k* fy[ksaA vkosnu izi=k la?k yksd
lsok vk;ksx ds dkm.Vj ij nLrh :Ik ls Hkh tek fd;k tk ldrk gSA vk;ksx ds fdlh vU; inkf/dkjh dks tek djkus
ds fy, fn, x;s vkosnu izi=kksa ds fy, vk;ksx mRrjnk;h ugha gksxkA
4.
The completed application form must reach the Under Secretary (E.VII), Union Public Service Commission,
Dholpur House, Shahjahan Road, New Delhi-110069 on or before 29.12.2011
The envelope containing the application form should be superscribed Detailed Application Form Engineering
Services Examination, 2011. Application can also be delivered at the Union Public Service Commission counter by hand.
The Commission will not be responsible for the application forms delivered to any other functionary of the Commission.

5- mEehnokj vius vkosnu izi=k] mEehnokjh vkfn ds lac/

a esa fdlh izdkj ds ekxZn'kZu @lwpuk@Li"Vhdj.k ds lac/
a esa la?k yksd lsok
vk;ksx] ds ifjlj esa xsV lh ds fudV lqfo/k dkm.Vj ij Lo;a vkdj ;k nwjHkki la[;k 011&23385271@011&23381125@
011&23098543 ij dk;Zfnolksa esa izkr% 10-00 cts ls lk;a 17-00 cts ds e?; laidZ dj ldrs gSAa mEehnokj vius lk{kkRdkj
dk;Zdez ] ifj.kke vkfn ds foi; esa vk;ksx ds osCklkbZV ((Website)) http: //www.upsc.gov.in ls Hkh tkudkjh izkIr dj ldrs gSA
5.
In case of any guidance/information/clarification regarding their applications, candidature etc. candidates
can contact UPSC's Facilitation Counter near Gate C of its campus in person or over Telephone No. 01123385271/011-23381125/011-23098543 on working days between 10.00 hrs. and 17.00 hrs. CANDIDATES CAN
ALSO OBTAIN INFORMATION ABOUT THEIR APPLICATION, INTERVIEW PROGRAMME AND RESULTS
ETC. ON THE COMMISSIONS WEBSITE AT THE ADDRESS : http://www.upsc.gov.in

6-

la?k yksd lsok vk;ksx ds ijh{kk Hkouksa ds ifjlj esa eksckbZy iQksu ykus ij izfrca/ gSA

6.

The mobile phones are banned in the Campus of UPSC Examination Halls.

2923 UPSC/2009

la?k yksd lsok vk;ksx

bathfu;jh lsok ijh{kk] 2011
mEehnokjksa dks vkosnu izi=k Hkjus ds ckjs esa vuqns'k
1- mEehnokjksa dks pkfg, fd os vkosnu izi=k Hkjus ls igys
bu vuqn'kksa dks ?;ku ls i<+ ysaA
2- mEehnokj ;g vo'; ?;ku j[ksa fd mUgsa vkosnu izi=k dks
Hkjus esa dsoy Hkkjrh; vadks ds varjkZ"V~+h; Lo:Ik dk iz;ksx djuk
gs tsls 1] 2] 3] 4] 5] 6 bR;kfnA os bl ckjs esa fo'ks"k lko/kuh cjrsa
fd vkosnu izi=k esa dh xbZ izfof"V;kWa Li"V vkSj lqikB~; gksaA ;fn
os izfof"V;ka i<+h ugha tk ldrh gSa ;k Hkzked gsa rks muds fuoZpu esa
gksus okyh Hkzkafr ;k lafnX/rk ds fy, mEehnokj gh ftEesnkj gksaxsa A
la'kks/u] ;fn dksbZ gks] Li"V gksus pkfg, rFkk mEehnokj }kjk
vuqizekf.kr gksus pkfg,A
3- mEehnokjksa ls vuqjks/ gS fd os vkosnu izi=k ds dkye 11
esa mu lsokvksa@inksa dks Li"V :i ls fy[k nsa ftuds fy, os
ojh;rke esa fopkj.k pkgrs gSa mUgsa lykg nh tkrh gS fd os ftruh
pkgsa mruh ojh;rkvksa dk mYys[k dj nsa rkfd ;ksx;rkdze esa muds
jSad dks ;ku esa j[krs gq, fu;qfDr djrs le; mudh ojh;rkvksa ij
Hkyh Hkkafr fopkj fd;k tk ldsA
o'ks"k ;ku 11% os foHkkxh; mEehnokj] ftUgsa vk;q lhek esa
fo'ks
NwV ds v/hu (nsf[k, fu;e 5 [k) ijh{kk esa Hkkx ysus dh vuqefr
nh xbZ gS vU; ea=kky;ksa@foHkkxksa ls lsokvksa@inksa ij fu;qDr fd, tkus
ds fy, Hkh viuh ojh;rk ns ldrs gSA
fo'ks"k ;ku 22% fu;e 6 ds mica/ ds varxZr ijh{kk esa izos'k
fn, x, mEehnokjksa dh dsoy mUgha ojh;rkvksa ij fopkj fd;k
tk,xk tks mDr mica/ esa fufnZ"V inks ads fy, gSa vkSj vU; lsokvksa
vkSj inks ads fy, mudh ojh;rkvksa] ;fn dksbZ gks ij fopkj ugha
fd;k tk,xkA
fo'ks"k ;ku 33% fdlh Hkh mEehnokj dk vius foLr`r
vkosnu izi=k esa igys ls fufnZ"V ojh;rkvksa dks c<kus @ifjorZu djus
ds ckjs esa dksbZ vuqjks/ vk;ksx }kjk Lohdkj ugha fd;k tk,xkA
4- mEehnokj }kjk bl vkosnu izi=k esa nh xbZ lwpuk dh
iM+rky bl ijh{kk ds ljyhd`r vkosnu izi=k esa nh xbZ lwpukvksa ls
dh tk,xhA xaHkhj folaxfr;kWa ikbZ tkus ij mudh mEehnokjh jn~n
dj nh tk,xhA
5- mEehnokj vkos n u iz i =k es a fn, x;s LFkku ij Bhd
iz d kj ls viuk gky gh dk ikliks V Z vkdkj dk ,d iQks V ks
fpidk,a A iQks V ks fdlh jktif=kr vf/dkjh vFkok ml
egkfo|ky;@ laLFkku tgkWa mEehnokj lcls ckn esa v;;ujr
jgk gks ds iz k pk;Z }kjk fof/or~ lR;kfir gks A
6- ;fn dksbZ mEehnokj fdlh vuqlwfpr tkfr @ vuqlwfpr
tutkfr ;k vU; fiNMh Js f .k;ks a dk gks u s dk nkok djrs gS a rks
mls vius nkos ds leFkZu esa ml ftys ds ftlesa mlds ekrk
firk (;k thfor ekrk ;k firk) vkerkSj ls jgrs gks a ] ftyk
vf/dkjh ;k mi eaM y vf/dkjh ;k ifjf'k"V&
ifjf'k"V&I esa n'kkZ, x,
,sls vU; vf/dkjh ls ftls laca/ jkT; ljdkj us ;g izek.k&i=k
tkjh djus ds fy, in ukfer fd;k gks ifjf'k"V&A es a

fn, x;s iQkeZ esa izek.k i=k ysdj mldh vuqizekf.kr@ izekf.kr
izfrfyfi izLrqr djuh pkfg,A ;fn mEehnokj ds ekrk vkSj firk nksuksa
dh e`R;q gks xbZ gks rks ;g izek.k i=k ml ftys ds vf/dkjh ls fy;k
tkuk pkfg, tgkWa mEehnokj viuh f'k{kk ls fHkUu fdlh vU; iz;kstu
ls vkerkSj ij jgrk gSA
7- mEehnokj dks bl izi=k ds lkFk ,d ,sls izek.ki=k dh
vuqizekf.kr@ izekf.kr izfrfyfi vo'; Hkstuh pkfg, ftlls bl ckr
dk izek.k fey lds fd ^^jkstxkj lekpkj** fnukad 08 tuojh
2011 esa izdkf'kr mDr ijh{kk ds uksfVl ds iSjk 4(3) esa vksj Hkkjr
ds jkti=k fnukad 08 tuojh 2011 esa izdkf'kr mDr ijh{kk dh
fu;ekoyh ds fu;e 6 esa izdkf'kr fu/kZfjr 'kSf{kd ;ksx;rk mlds
ikl gSaA Hkstk x;k izek.k i=k ml vf/dkjh (vFkkZr fo'ofo|ky;
;k vU; fdlh ijh{kk fudk;) dk gksuk pkfg, ftlus mls ;ksx;rk
fo'ks"k iznku dh gSA
8- mEehnokj dks vk;q izek.k i=k dh ftlesa tUe dh rkjh[k
crkbZ xbZ gks] vuqizekf.kr@izekf.kr izfr vius vkosnu ds lkFk Hkstuh
pkfg,A vk;ksx tUe dh og rkjh[k Lohdkj djrk gS tks eSfV~+dqys'ku
;k ek;fed fo|ky; NksMus ds izek.k i=k ;k fdlh Hkkjrh;
fo'ofo|ky; }kjk eSfV~+dqys'ku ds led{k ekus x, izek.k i=k ;k
fdlh fo'ofo|ky; }kjk vuqjf{kr eSfV~+dqys'ku ds led{k ekus x,
izek.k i=k ;k fdlh fo'ofo|ky; }kjk vuqjf{kr eSfV~+dqys'ku ds
jftLVj esa ntZ dh xbZ gks vkSj og mn~/j.k fo'ofo|ky; ds leqfpr
izkf/dkjh }kjk izekf.kr gksaA tks mEehnokj mPPkrj ek;fed ijh{kk
;k mldh led{k ijh{kk mRrh.kZ dj pqdk gS og mPprj ek;fed
ijh{kk ;k led{k ijh{kk ds izek.k i=k dh vuqizekf.kr@izekf.kr
izfrfyfi izLrqr dj ldrk gSA
vk;q ds laca/ esa dksbZ vU; nLrkost tsls tUe dq.Myh] 'kiFk
i=k uxj fuxe ls rFkk lsok vfHkys[k ls tUe laca/h mn~/j.k rFkk
,sls gh vU; izek.k i=k Lohdkj ugha fd, tk,axsA
vuqns'kksa ds bl Hkkx esa vk, ^eSfV~+dqys'ku@ mPprj ek;fed
ijh{kk izek.k i=k* okD;ka'k ds varxZr mi;qZDr oSdfYid izek.k i=k
lfEefyr gSA
dHkh dHkh eSfV~+dqys'ku@mPprj ek?;fed ijh{kk izek.k i=k esa
tUe dh rkjh[k ugha gksrh gS ;k vk;q ds dsoy iwjs o"kZ ;k@vkSj eghus
gh fn, tkrs gSA ,sls ekeyksa esa mEehnokjksa dks eSfV~+dqys'ku@mPprj
ek;fed ijh{kk izek.k i=k ds vfrfjDr ml LkaLFkk ds gSMekLVj@fizfa liy
lss fy, x, izek.k i=k dh vuqizekf.kr@izekf.kr izfrfyfi Hkstuh
pkfg, tgkWa ls mlus eSfV~+dqys'ku@mPprj ek;fed ijh{kk mRrh.kZ dh
gksaA bl izek.k i=k esa ml laLFkk ds nkf[kyk jftLVj esa ntZ dh xbZ
mldh tUe dh rkjh[k ;k okLrfod vk;q fy[kh gksuh pkfg,A
mEehnokjksa dks psrkouh nh tkrh gS fd ;fn vkosnu
izi=k ds lkFk bu vuqns'kksa esa ;Fkkfu/kZfjr vk;q dk iwjk izek.k
ugha Hkstk x;k rks mEehnokj dh mEehnokjh jj dj nh tk,xha
fVIi.kh 11& ftl mEehnokj ds ikl i<kbZ iwjh djus ds ckn izkIr
ek;fed fo|ky; izek.k i=k gks mls dsoy vk;q ls
lac
a izfof"V okys i`"B dh vuqiez kf.kr@izekf.kr izfrfyfi
Hkstuh pkfg,A

Union Public Service Commission

ENGINEERING SERVICES EXAMINATION, 2011
Instructions to Candidates for filling in the
Application Form
1. The candidates should read these instructions
carefully before filling in the application form.
2. Candidates must use only International form of
Indian numerals in filling in the application form, e.g.
1, 2, 3, 4, 5, 6 etc. They should take special care that the
entries made in the application form should be clear and
legible. In case there are any illegible or misleading
entries, the candidates will be responsible for the
confusion and the ambiguity caused in interpreting such
entries. Corrections, if any, should be legible and attested
by the candidates.
3. Candidates are required to specify clearly in
Column 11 of the application form the Services/Posts for
which they wish to be considered in order of preference.
They are advised to indicate as many preferences as they
wish to, so that having regard to the rank in the order of
merit, due consideration can be given to their preferences
when making appointment.
N.B. (i)Departmental candidates admitted to the
examination under age relaxation vide Rule 5(b) may give
their preferences for the Services/Posts in other Ministries/
Departments also.
N.B. (ii)Candidates admitted to the examination
under the proviso to Rule 6 will be considered only for the
posts mentioned in the said proviso, and their preference
for other Services and Posts, if any, will be ignored.
N.B. (iii)No request for addition/alteration in the
preferences indicated by a candidate in his/her application
will be entertained by the Commission.
4. The information earlier given by the candidates
in the simplified application form for the Examination will
be cross-checked with the information given by them in
this application form. If there are any serious discrepancies,
their candidature will be cancelled.
5. The candidates should paste a recent passport size
photograph in the space provided for it in the application
form. The photograph should be duly attested by a Gazetted
Officer/Principal of the College/Institution last attended.
6. A candidate who claims to belong to one of
the Scheduled Castes, the Schedule Tribes or the
Other Backward Classes should submit in support
of his claim an attested/certified copy of the
certificate in the form given in Appendix-I from
the District Officer or the Sub-Divisional Officer
or any other officer as indicated in Appendix-I of

the district in which his/her parents (or surviving parent)

ordinarily reside. Such an officer should have been designated
by the State Government concerned as competent to issue such
a certificate. If both his/her parents are dead, the officer
signing the certificate should be of the district in which the
candidate himself/herself ordinarily resides otherwise than
for the purpose of his/her own education.
7. A candidate must submit alongwith his/her application
an attested/certified copy of a certificate showing his/her
educational qualification prescribed in para 3(III) of the Notice
for the Examination published in the Employment News dated
08th January, 2011 and in Rule 6 of the Rules for the
Examination published in the Gazette of India dated 08th
January, 2011. The certificate submitted must be one issued
by the authority (i.e. University or other examining body)
awarding the particular qualification.
8. A candidate must enclose with his/her application an
attested/certified copy of certificate of age (indicating his/
her date of birth). The date of birth accepted by the Commission
is that entered in the Matriculation or Secondary School
Leaving Certificate or in a certificate recognised by an Indian
University as equivalent to Matriculation or in an extract from
a Register of Matriculates maintained by a University and that
extract must be certified by the proper authority of the
University. A candidate who has passed the Higher Secondary
Examination or an equivalent Examination may submit an
attested/certified copy of the Higher Secondary Examination
certificate or an equivalent certificate.
No other document relating to age like horoscopes,
affidavits, birth extracts from Municipal Corporation, Service
Records and the like, will be accepted.
The expression Matriculation/Higher Secondary
Examination certificate in this part of the instruction includes
the alternative certificate mentioned above.
Sometimes the Matriculation/Higher Secondary
Examination Certificate does not show the date of birth or
only shows the age by completed years or completed years
and months. In such cases a candidate must send in addition to
the Matriculation/Higher Secondary Examination Certificate
an attested/certified copy of the certificate from the
Headmaster/Principal of the Institution from where he/she
passed the Matriculation/Higher Secondary Examination
showing date of his/her birth or his/her exact age as recorded
in the Admission Register of the Institution.
Candidates are warned that unless complete proof
of age as laid down in these instructions is sent with the
application, the candidature of the candidate will be
rejected.
Note 1: A candidate who holds a completed Secondary School
Certificate need submit an attested/certified copy of
the page containing entries relating to age only.

fVIi.kh 2 & mEehnokj ;g ?;ku j[ksa fd vk;ksx mEehnokj dh tUe

dh mlh rkjh[k dks Lohdkj djsxk tks vkosnu i=k
izLrqr djus dh rkjh[k dks eSfV~d
+ y
q 's ku@mPprj ek;fed
ijh{kk izek.k i=k ;k led{k ijh{kk ds izek.k i=k esa ntZ
gS vkSj blds ckn mlesa ifjorZu ds fdlh vuqjks/ ij u
rks fopkj fd;k tk,xk vkSj u gh mls Lohdkj fd;k
tk,xkA
fVIi.kh 3 & mEehnokj ;g Hkh uksV dj ysa fd muds }kjk fdlh
ijh{kk esa izos'k ds fy, tUe dh rkjh[k ,d ckj ?kksf"kr
dj nsus vkSj vk;ksx }kjk mls vius vfHkys[k esa ntZ dj
ysus ds ckn mlesa ckn esa ;k ckn dh fdlh ijh{kk esa
fdlh Hkh vk/kj ij ifjorZu djus dh vuqefr ugha nh
tk,xhA
9- (1) tEew ,oa d'ehj jkT; ds vf/oklh ds :Ik esa vk;q esa
NwV ds ykHk dk nkok djus okys mEehnokj dks ml ftyk eftLV~+sV
ls] ftlds {ks=kkf/dkj esa og lkekU;r% jgk gS ;k tEew ,oa d'ehj
ljdkj }kjk mlds LFkku ij ukfer fdlh vU; izkf/dkjh ls bl
vk'k; ds izek.k i=k dh vuqiez kf.kr@ lR;kfir izfr izLrqr djuh gksxh
fd igyh tuojh 1980 ls 31 fnlEcj] 1989 rd dh vof/ ds
nkSjku og lkekU;r% tEew ,oa d'ehj jkT; esa gh jgk gSA
(2) vk;q esa NwV pkgus okys ,sls mEehnokj dks tks j{kk
lsokvksa esa dk;Z djrs gq, fodykax gqvk gS] egkfuns'kd] iqu%
LFkkiuk] j{kk ea=kky; ls ifjf'k"V&
ifjf'k"V&II esa fn, x, iQkeZ ij bl
vk'k; dk ,d izek.k i=k ysdj bldh ,d vuqizekf.kr@ izekf.kr
izfrfyfi izLrqr djuh gksxh fd og j{kk lsokvksa esa dk;Z djrs gq,]
fons'kh 'k=kq ns'k ds lkFk la?k"kZ esa vFkok v'kkafrxzLr {ks=k esa iQkSth
dk;Zokgh ds nkSjku fodykax gqvk vkSj ifj.kkeLo:Ik fueqZDr gqvkA
(3) vk;q esa NwV dk nkok djus okys HkwriwoZ lSfud] deh'kaM
vf/dkjh vkSj bZ- lh- vks-@,l- ,l- lh- vks- lfgr tSlk muds vius
ekeys esa visf{kr gS] izek.k i=k dh vuqizekf.kr@izekf.kr izfrfyfi]
laca/ izkf/dkfj;ksa ls ysdj ifjf'k"V&
ifjf'k"V&III esa fn, x, iQkeZ esa izLrqr
djsaA
(4) fu;e 5 ([k) ds varxZr vk;q lhek esa NwV ds fy, nkok
djus okys ljdkjh deZpkfj;ksa dks vius foHkkx@dk;kZy; ds v?;{k
ls ifjf'k"V&
ifjf'k"V&IV esa fn, x, iQkeZ esa izek.k i=k dh ewy izfr izLrqr
djuh pkfg,A
10- tks mEehnokj 'kkjhfjd :Ik ls v{ke gksus dk nkok djrk
gS mls lacaf/r lsok@inksa ij dk;Z fu"iknu gsrq] ,d ;k vf/d
'kkjhfjd vis{kkvksa@{kerkvksa tSlk fd bathfu;jh lsok ijh{kk] 2011
dh fu;ekoyh ds fu;e 19 esa fn;k x;k gS dks iwjk djuk gksxkA mls
ljdkjh vLirky@fpfdRlk cksMZ ds }kjk ifjf'k"V&
ifjf'k"V&V esa fn, x,
izk:Ik esa tkjh izek.k i=k dh ,d izekf.kr izfr izLrqr djuh gksxhA
11- mEehnokj ;g ?;ku j[ks a fd ba t hfu;jh ls o k
ijh{kk] 2011 es a mudh mEehnokjh iw . kZ r % vua f re gS
rFkk muds fu/kZ f jr ik=krk dh 'krks Z a dks iw j k djus ij
vk/kfjr gS A ;fn fyf[kr ijh{kk rFkk lk{kkRdkj ijh{k.k

ds igys ;k ckn esa fdlh Lrj ij tkWap djus ij ;g ik;k x;k fd

os ik=krk dh fdUgha 'krksZa dks iwjk ugha djrs rks mudh mEehnokjh
vk;ksx }kjk j dj nh tk,xhA
12- mEehnokjksa dks vius vkosnu i=kksa ds lkFk fuEufyf[kr
izys[k vuqyXu dj vk;ksx dks Hkstus gSa%&
(1) vk;q ds izek.k i=k dh ,d vuqiez kf.kr@izekf.kr izfrfyfiA
(2) 'kSf{kd ;ksX;rk ds izek.k i=k dh ,d vuqiez kf.kr@izekf.kr
izfrfyfiA
(3) vuqlfw pr tkfr@vuqlfw pr tutkfr@vU; fiNMh Jsf.k;ksa
ds gksus dk nkok djus ds leFkZu esa izek.k i=k dh
,d vuqizekf.kr@izekf.kr izfrfyfi (tgkWa dgha ykxw
gks)A
(4) vk;q esa NwV ds nkos ds leFkZu esa izek.k i=k dh ,d
vuqizekf.kr@izekf.kr izfrfyfi (tgkWa dgha ykxw gks)A
(5) 'kkjhfjd v{kerk ds MkDVjh izek.k i=k dh vuqiez kf.kr@
izekf.kr izfrfyfi (tgkWa ykxw gks)A
(6) yxHkx 11-5 ls-eh- x 27-5 ls-eh- vkdkj ds fcuk
fVdV yxs nks fyiQkiQs ftu ij irk fy[kk gksA mEehnokj
dks fyiQkiQksa ij viuk Mkd dk iwjk irk vFkkZr
mEehnokj dk uke] edku uEcj] okMZ uEcj] eksgYyk
vkfn Li"V :Ik ls fy[kuk pkfg,A ,sls ekeyksa esa
tgkWa edku uEcj u gk]s mEehnokj dks viuk uke
fy[kus ds ckn vius firk dk uke rFkk Mkd irk Hkh
fyiQkiQksa ij fy[kuk pkfg,A
miq;qZDr izek.k&i=k ewy :Ik esa lk{kkRdkj ds le; izLrqr djus gksaxsA
fVIi.kh%& mEehnokjksa ls ;g vis{kk dh tkrh gS fd os vkosnu i=k
ds lkFk Hksts tkus okys izek.k&i=kksa dh vuqizekf.kr@
izekf.kr izfrfyfi;ksa ij vius gLrk{kj djsa rFkk rkjh[k Hkh
fy[ksAa
13- ftu ekeyksa esa vkosnu i=k lc vuqyXudksa jfgr ;k dqN
vuqyXudksa lfgr izkIr gksaxs muesa mEehnokjh jn~n dj nh tk,xhA
mEehnokj ;fn xk;c vuqyXudksa dks ckn esa Hkstrs gsa rks mUgsa Lohdkj
ugha fd;k tk,xkA mEehnokj ;g vo'; lqfuf'pr dj ysa fd
vkosnu&i=k Bhd ls Hkjk x;k gS vkSj mlds lkFk lHkh laxr
vuqyXud Hksts x, gSaA vkosnu izi=k dk dksbZ Hkh dkye fjDr u
NksM+k tk,A
14- mEehnokj vius vkosnu ds lac/ esa vk;ksx dks tks i=k
Hkstsa muesa ijh{kk dk uke] viuk iwjk uke] vuqekad rFkk tUe dh
rkjh[k vo'; fy[ksaA
15- mEehnokjksa }kjk vkosnu izi=k ds fofHkUu dkyeksa esa Hkjs
tkus okyh dksM la[;k,a ekxZn'kZu ladsr (vuqca/) esa nh xbZ gSaA
tgka dgha Hkh lwpuk dksM la[;k esa visf{kr gS ogka os mfpr dksM
la[;k dk mYys[k djsaA ,sls dkyeksa esa dksM la[;k ds vykok nh xbZ
vU;Fkk lwpukvksa ij dksbZ ;ku ugha fn;k tk,xkA

3
Note 2 : Candidates should note that only the date of birth
as recorded in the Matriculation/Higher Secondary Examination Certicate or an equivalent certificate on the date of submission of application
will be accepted by the Commission and no subsequent request for its change will be considered or
granted.

12. Enclosures to the application form to be sent to

the Commission by the candidates are as follows :

Note 3 : Candidates should also note that once date of birth

has been claimed by them and entered in the records
of the Commission for the purpose of admission
to an examination, no change will be allowed
subsequently or at a subsequent examination on any
ground whatsoever.

(iii) An attested/certified copy of the certificate in

support of claim to belong to Scheduled Castes/
Scheduled Tribes/Other Backward Classes
(wherever applicable).

9 (i) A candidate claiming age-relaxation as a

domicile of the State of Jammu and Kashmir should
produce an attested/certified copy of a certificate from the
District Magistrate in the State of Jammu and Kashmir
within whose jurisdiction he/she had ordinarily resided or
from any other authority designated in that behalf by the
Government of Jammu and Kashmir to the effect that he/
she had ordinarily been domiciled in the State of Jammu
and Kashmir during the period from the 1st January, 1980
to the 31st day of December, 1989.
(ii) A candidate disabled while in the Defence Services
claiming age concession should produce an attested/certified
copy of the certificate in the form given in Appendix -II,
from the Director General Resettlement, Ministry of
Defence to show that he/she was disabled while in the
Defence Services in operations during hostilities with any
foreign country or in a disturbed area and released as a
consequence thereof.
(iii) Ex-servicemen including Commissioned Officers
and ECOs/SSCOs claiming age concession should produce
an attested/certified copy of the certificate as applicable to
them, in the form given in Appendix-III, from the authorities
concerned.
(iv) A Government Servant claiming age concession
under rule 5(b) should submit a certificate in Original from
the Head of the Department/Office in the format given in
Appendix-IV.
10. A candidate claiming to belong to physically
disabled category shall be required to meet one or more of
the physical requirement/abilities, as laid down in Rule 19
of the Rules for the Engineering Services Examination,
2011, for performing the duties in the concerned Services/
Posts. He/She must submit a certified copy of the certificate
issued by Government Hospital/Medical Board in the format
given in Appendix-V.
11. The candidates should note that their candidature
for the Engineering Services Examination, 2011, will be purely
provisional, subject to their satisfying the prescribed eligibility
conditions. If on verification at any stage before or after the
examination it is found that they do not fulfil any of the
eligibility conditions, their candidature for the examination
will be cancelled by the Commission.

(i) An attested/certified copy of the certificate of age.

(ii) An attested/certified copy of the certificate of
educational qualification indicating the subjects.

(iv) Undertaking by the candidate seeking relaxation

as OBC candidate in support of claim of not
belonging to creamy layer, to be given in format
as mentioend in para-B-1 of Appendix-I.
(v) An attested/certified copy of certificate in support
of claim for age concession (wherever
applicable).
(vi) An Attested/certified copy of certificate in
support of claim to being physically handicapped
(wherever applicable).
(vii) Two self addressed and unstamped envelopes of
11.5 27.5 cms. size. Candidates should write
neatly his/her complete postal address i.e. his/her
Name, House No., Ward No., Mohalla etc. on the
envelopes. In case where House No., is not there,
the candidate should write his/her own full name,
followed by his/her fathers name with postal
address on the envelopes.
Originals of the above certificates are required to
be produced at the time of interview.
NOTE :Candidates are required to sign the attested/
certified copies of all certificates sent along with the
application form and also to put the date.
13. Any application received without all or some of
the enclosures will entail cancellation of candidature. Any
missing enclosures sent subsequently by the candidate will
not be entertained. The candidates must ensure that the
application form is properly filled in and is accompanied by
all the relevant enclosures. No column of application should
be left blank.
14. In all communications with the Commission
regarding this application, the candidate should mention the
name of Examination, his full name, Roll Number and date
of birth.
15. Code Numbers to be filled in by the candidates in
various columns of the application form are given in the
Guidelines for filling up the Application Form which is
Annexe showing. Wherever information is required to be
given in Code Nos., appropriate Code Nos. may be filled in.
Information given in such columns otherwise than in codes,
will not be taken into consideration.

ifjf'k"V&1
(d) Hkkjr ljdkj ds inksa ij fu;qfDr ds fy, vkosnu djus
okys vuqlwfpr tkfr vkSj vuqlwfpr tutkfr ds mEehnokjksa
}kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZA
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh-------------------------------------------------------------------------------------------------------lqiq=k@ lqiq=kh
Jh ---------------------------------------------------------------------------tks xkWoa @ dLck
----------------------------------------------------------------------------------------------ftyk@eaMy -----------------------------------------------------------jkT;@la?k jkT;
{ks=k ---------------------------- ds@dh fuoklh gS ---------------------------------------------------- tkfr@tutkfr ds@dh gS ftls fuEufyf[kr ds v/
hu vuqlwfpr tkfr@vuqlwfpr tutkfr ds :Ik esa ekU;rk nh xbZ gS%&
lafo/ku (vuqlwfpr tkfr;ka) vkns'k] 1950@
lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] 1950@
lafo/ku (vuqlfw pr tkfr;ka) (la?k jkT; {ks=k) vkns'k] 1951@
lafo/ku (vuqlwfpr tutkfr;ka) (la?k jkT; {ks=k) vkns'k]
1951@
[vuqlwfpr tkfr;ka vkSj vuqlwfpr tutkfr;ka lwph (la'kks/
u) vkns'k] 1956] cEcbZ iquxZBu vf/fu;e] 1960] iatkc iquxZBu
vf/fu;e] 1966] fgekpy izns'k jkT; vf/fu;e] 1970] mRrj
iwohZ {ks=k (iquxZBu) vf/fu;e 1971] vuqlwfpr tkfr;ka vkSj
vuqlwfpr tutkfr;ka (la'kks/u) vf/fu;e] 1976] fetksje jkT;
vf/fu;e] 1986] v:.kkpy izns'k jkT; vf/fu;e] 1986 rFkk
xksok] neu vkSj nho (iquxZBu) vf/fu;e] 1987 }kjk ;Fkk
la'kksf/r]
lafo/ku (tEew vkSj d'ehj) vuqlfw pr tkfr;ka vkns'k] 1956@
lafo/ku (v.Meku vkSj fudksckj }hi lewg) vuqlwfpr
tutkfr;ka vkns'k] 1959] vuqlfw pr tkfr;ka rFkk vuqlfw pr tutkfr;ka
(la'kks/u) vf/fu;e] 1976 }kjk ;Fkk la'kksf/r @
lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tkfr;ka
vkns'k] 1962@
lafo/ku (nknjk vkSj ukxj gosyh) vuqlwfpr tutkfr;ka]
vkns'k] 1962@
lafo/ku (ikafMpsjh) vuqlwfpr tkfr;ka vkns'k] 1964@
lafo/ku (mRrj izn's k) (vuqlfw pr tkfr;ka) vkns'k] 1967@
lafo/ku (xksok] neu vkSj nho) vuqlwfpr tkfr;ka vkns'k]
1968@
lafo/ku (xksok] neu vkSj nho) vuqlwfpr tutkfr;ka
vkns'k] 1968@
lafo/ku (ukxkyS.M) vuqlfw pr tutkfr;ka vkns'k] 1970@
lafo/ku (flfDde) vuqlwfpr tkfr;ka vkns'k] 1978@
lafo/ku (flfDde) vuqlfw pr tutkfr;ka vkns'k] 1978@
lafo/ku (tEew vkSj d'ehj) vuqlwfpr tutkfr;ka vkns'k]
1989@
lafo/ku (vuqlfw pr tkfr;ka) vkns'k] (la'kks/u) vf/fu;e]
1990@
lafo/ku (vuqlfw pr tutkfr;ka) vkns'k] (la'kks/u) vf/fu;e
1991@
lafo/ku (vuqlwfpr tutkfr;ka) vkns'k] (f}rh; la'kks/u)

vf/fu;e 1991@
vuqlwfpr tkfr;ka rFkk vuqlwfpr tutkfr;ka vkns'k (la'kks/u)
vf/fu;e] 2002@
lafo/ku (vuqlfw pr tkfr;ka) vkns'k (la'kks/u) vf/fu;e] 2002@
lafo/ku (vuqlfw pr tkfr;ka rFkk vuqlfw pr tutkfr;ka) vkns'k
(la'kks/u) vf/fu;e] 2002@
lafo/ku (vuqlfw pr tkfr;ka) vkns'k (f}rh; la'kks/u) vf/fu;e]
2002@
2- vuqlwfpr tkfr;ksa@vuqlwfpr tutkfr;ksa ds ,sls O;fDr;ksa
ds ekeys esa ykxw tks ,d jkT;@la?k jkT; {ks=k iz'kklu ls nwljs jkT;@
la?k jkT; {ks=k iz'kklu esa izoztu dj pqds gSaA
;g izek.k i=k Jh@Jherh@dqekjh ---------------------------------xzke@dLck -----------------------------------------------------------------ftyk@eaMy
-------------------------------------------------------------------------- jkT; @la?k jkT;
{ks=k --------------------------------------- tks --------------------------------------------tkfr@tutkfr ls lEc gS ftls -------------------------------------------------------------------------jkT;@la?k jkT; {ks=k esa vuqlwfpr tkfr@vuqlwfpr
tutkfr ds :Ik esa ekU;rk izkIr gS ds firk@ekrk Jh@Jherh --------------------------------------------------- dks tkjh izek.k i=k ds vk/kj ij
tkjh fd;k tkrk gSA
fnukad --------------------------------------------------- ds }kjk tkjhA
3- Jh@Jherh@dqekjh -----------------------------------------------------vkSj@;k mudk ifjokj vke rkSj ij@ls xkWao@dLck ---------------------------------------- ftyk@eaMy -------------------------------------- jkT;@la?k jkT;
{ks=k ---------------------------------------------------------------esa jgrs@jgrh gS
gLrk{kj
inuke
(dk;kZy; dh eksgj lfgr)
jkT;@la?k jkT; {ks=k
LFkku -----------------------------------rkjh[k -------------------------------tks 'kCn ykxw u gksa mUgsa dkV nsaA
@d`i;k jkIV~+ifr dk fof'k"V vkns'k fufnZ"V djsAa
tks iSjk ykxw u gks mls dkV nsaA
fVIi.kh & ;gkWa ^^vkerkSj ls jgrs@jgrh gS*a * dk vFkZ ogh gksxk tks
fjist
z Us Vs'ku vkiQ fn ihiy ,DV] 1950 dh /kjk 20 esa gSA
vuqlfw pr tkfr@vuqlfw pr tutkfr@vU; fiNM+h Jsf.k;ksa
dk izek.k i=k tkjh djus ds fy, l{ke izkf/dkfj;ksa
dh lwphA
(1) ftyk eftLVs~+V@vfrfjDr ftyk eftLVs~+V@dysDVj@fMIVh
dfe'uj@,Mh'kuy fMIVh deh'uj@fMIVh dysDVj@izFke
Js . kh dk LVkbZ i s U Mjh eftLVs ~ + V @ lc fMfotuy
eftLVs+~V@rkyqdk eftLVs~+V@,DthD;wfVo eftLVs~+V@,DLV~+k
vfLkLVsUV deh'ujA
(izFke Js.kh ds LVkbisUMjh eftLVsV+~ ls de jSd
a dk u gks)

4
APPENDIX-1

the Constitution (ST) Order (Second Amendment) Act, 1991.@

(A) The form of certificate to be produced by Scheduled

Castes and Scheduled Tribes candidates applying for
appointment to posts under the Government of India.

the Scheduled Castes and Scheduled Tribes Orders

(Amendment) Act 2002@

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/tribe* which is recognised as a Scheduled Caste/
Scheduled Tribe* 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
List (Modification) Order, 1956; the Bombay Reorganisation
Act, 1960, the Punjab Reorganisation Act, 1966, the State of
Himachal Pradesh Act, 1970, the North Eastern Areas
(Reorganisation) Act, 1971, the Scheduled Castes and
Scheduled Tribes Order (Amendment) Act, 1976., the State of
Mizoram Act, 1986, the State of Arunachal Pradesh Act, 1986
and the Goa, Daman and Diu (Reorganisation) Act, 1987.]
the Constitution (Jammu and 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. @

the Constitution (Scheduled Castes) Order (Amendment) Act,

2002@
the Constitution (Scheduled Castes and Scheduled Tribes)
Orders (Amendment) Act, 2002 @
The Constitution (Scheduled Castes) Orders (Second
Amendment) Act, 2002@
% 2. Applicable in the case of Scheduled Castes/Scheduled
Tribes persons who have migrated from one State/Union
Territory Administration to another.
This certificate is issued on the basis of the Scheduled Castes/
Scheduled Tribes certificate issued to Shri/Shrimati*..............
....................................... Father/Mother of Shri/Shrimati/
Kumari ................................................... of village/town*
.......................................... in District/Division*............................
of the State/Union Territory*............................ who belongs to
the caste/tribe* which is recognised as a Scheduled Caste/
Scheduled Tribe in the State/Union Territory* of ...............
...................... issued by the .....................................
dated ......................................
% 3. 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)
State/Union Territory*

the Constitution (Dadar and Nagar Haveli) Scheduled Castes

Order, 1962.@
the Constitution (Dadar and Nagar Haveli) Scheduled Tribes
Order, 1962.@

Place : .....................................
Date : ......................................

the Constitution (Pondicherry) Scheduled Castes Order,

1964.@

*Please delete the words which are not applicable.

the Constitution (Uttar Pradesh) Scheduled Tribes Order,

1967.@

% Delete the paragraph which is not applicable.

the Constitution (Goa, Daman and Diu) Scheduled Castes

Order, 1968.@

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.

the Constitution (Goa, Daman and 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) Order (Amendment) Act, 1990.@
the Constitution (ST) Order (Amendment) Act, 1991.@

@Please quote specific Presidential Order.

**List of authorities empowered to issue Scheduled

Caste/Scheduled Tribe/OBC Certificates.
(i) 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.
(not below of the rank of 1st Class Stipendiary
Magistrate).

(2) phiQ izl

s hMsUlh eftLVsV+~ @,Mh'kuy phiQ islz hMsUlh eftLVsV+~ @
izslhMsaUlh eftLVs~+VA
(3) jsosU;w viQlj ftldk vksgnk rglhynkj ls de u gksA
(4) ml bykds dk lc fMohtuy vkfiQlj tgka mEehnokj
vkSj@;k mldk ifjokj vkerkSj ls jgrk gksA
([k) Hkkjr ljdkj ds inksa ij fu;qfDr ds fy, vkosnu djus
okys vU; fiNMs oxksZa ds mEehnokjksa }kjk izLrqr fd, tkus
okys izek.ki=k dk iQkeZA
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh --------------lqiq=k@lqiq=kh Jh ------------------------------------------------------------------- tks
ftyk@eaMy ------------------------------------------------------------------------------ ds
xkWao@dLck -------------------------------jkT;@la?k ------------------------- jkT;
{ks=k -------------------------------------------------------------- ds@dh fuoklh gSa
---------------------------- ds leqnk; ds gSa ftls fuEufyf[kr ds v/hu
fiNMs+ oxZ ds :Ik esa ekU;rk feyh gS%&
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
186 esa fnukad 13 flrEcj] 1993 dks izdkf'kr Hkkjr ljdkj]
dY;k.k ea=kky; ds fnukad 10 flrEcj] 1993 dk ladYi la12011@68@93&ch-lh-lh-(lh)A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
163 esa fnukad 20 vDrwcj] 1994 dks izdkf'kr Hkkjr ljdkj]
dY;k.k ea=kky; ds fnukad 19 vDrwcj] 1994 dk ladYi la12011@9@94&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 88
esa fnukad 25 ebZ] 1995 dks izdkf'kr Hkkjr ljdkj] dY;k.k ea=kky;
ds fnukad 24 ebZ] 1995 ds ladYi la- 12011@7@95&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 60
esa fnukad 11 ekpZ] 1996 dks izdkf'kr Hkkjr ljdkj] dY;k.k
ea=kky; ds fnukad 9 ekpZ] 1996 dk ladYi la- 12011@96@94&chlh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
210 esa fnukad 11 fnlEcj] 1996 dks izdkf'kr Hkkjr ljdkj]
dY;k.k ea=kky; dk fnukad 6 fnlEcj] 1996 dk ladYi la12011@44@96&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
236 esa fnukad 12 fnlEcj] 1997 dks izdkf'kr Hkkjr ljdkj]
dY;k.k ea=kky; ds fnukad 11 fnlEcj] 1997 dk ladYi la12011@99@94&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
239 esa fnukad 17 fnlEcj] 1997 dks izdkf'kr Hkkjr ljdkj]
dY;k.k ea=kky; dk fnukad 3 fnlEcj] 1997 dk ladYi la12011@13@97&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
241 esa fnukad 27 vDrwcj] 1999 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 27 vDrwcj]
1999 dk ladYi la- 12011@68@98&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
270 esa fnukad 6 fnlEcj] 1999 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; ,oa vf/dkfjrk ea=kky; ds fnukad 6 fnlEcj] 1999
ds ladYi la- 12011@88@98&ch-lh-lh-A

@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k 71

esa fnukad 4 vizSy] 2000 dks izdkf'kr Hkkjr ljdkj] lkekftd U;k;
vkSj vf/dkfjrk ea=kky; dk fnukad 4 vizSy] 2000 dk ladYi la12011@36@99&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
210 esa fnukad 21 flrEcj] 2000 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 21 flrEcj]
2000 dk ladYi la- 12011@44@99&ch-lh-lh-A
@Hkkjr ds vlk/kj.k jkti=k Hkkx 1] [k.M 1] la[;k
246 esa fnukad 6 flrEcj] 2001 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; dk fnukad 6 flrEcj]
2001 dk ladYi la- 12015@9@2000&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]
la[;k 151 esa fnukad 20 twu] 2003 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; dks fnukad 19 twu] 2003
ds ladYi la- 12011@1@2001&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]
la[;k 9 esa fnukad 13 tuojh] 2004 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 13 tuojh]
2004 dk ladYi la- 12011@4@2002&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]
la[;k 10 esa fnukad 16 tuojh] 2006 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 16 tuojh]
2006 dk ladYi la- 12011@9@2004&ch-lh-lh-A
@Hkkjr ljdkj ds vlk/kj.k jkti=k Hkkx 1] [k.M 1]
la[;k 67 esa fnukad 12 ekpZ] 2007 dks izdkf'kr Hkkjr ljdkj]
lkekftd U;k; vkSj vf/dkfjrk ea=kky; ds fnukad 12 ekpZ] 2007
dk ladYi la- 12011@14@2004&ch-lh-lh-A
Jh@Jherh@dqekjh ---------------------------------------------- vkSj@;k mudk
ifjokj lkekU;rk ftyk@e.My -------------------------- ds xkao@dLck
-------------------------------------- jkT;@la?k jkT; {ks=k esa fuokl djrs gSaA
;g Hkh izekf.r fd;k tkrk gSa fd ;g dkfeZd rFkk
izf'k{k.k foHkkx] Hkkjr ljdkj ds fnukad 8-9-1993 ds dk;kZy;
Kkiu la[;k 36012@22@93&LFkk- (,l-lh-Vh-) fnukad 9-3-2004 ds
dk- Kk- la- 36033@3@2004&LFkk-(vkj{k.k) dh vuqlwph ds dkye
3 es a fn, x, O;fDr;ks a @ oxks Z a rFkk dk;kZ y ; Kkiu la 36033@3@2004&LFkk- (vkj{k.k) fnukad 14-10-2008 (lEiUu vFkkZr
heh ys;j ls) lacfU/r ugha gSA
gLRkk{kj --------------------------inuke -----------------------(dk;kZy; dh eksgj)
jkT;@la?k jkT; {ks=k
LFkku % ----------------------------fnukad% --------------------------tks 'kCn ykxw u gks mUgsa dkV nsaA
@tks ykxw u gks mUgsa dkV nsaA
VIi.kh
fVIi.kh
VIi.kh%& ;gka ^^vkerkSj ls jgrs@jgrh gS*a * dk vFkZ ogh gksxk tks
fjizt
s Us Vs'ku vkiQ fn ihiy ,DV 1950 dh /kjk 20 esa gSA
vU; fiNMs oxZ (vks-ch-lh-) dk izek.k i=k tkjh djus
ds fy, l{ke izkf/dkjh ogh jgsaxs tks v-tk-@v-t-tkds izek.k i=k tkjh djus ds fy, l{ke gSaA

5
(ii) Chief Presidency Magistrate/Additional Chief
Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub Divisional Officer of the area where the candidate
and/or his/her family normally resides.
(B) The form of certificate to be produced by Other
Backward Classes candidates applying for appointment to
posts under the Government of India.
This is to certify that Shri/Shrimati/Kumari*...............
............................son/daughter* of Shri............................... of
village/town* ...........................in District/Division*............... of
the State/Union Territory*..................................belongs to the
....................Community which is recognised as a backward
class under :
@ Government of India, Ministry of Welfare Resolution
No. 12011/68/93-BCC (C) dated 10th September, 1993 published
in the Gazette of India Extraordinary Part-I, Section-1, No. 186
dated 13th September, 1993.
@ Government of India, Ministry of Welfare Resolution
No. 12011/9/94-BCC dated 19-10-94, published in the Gazette
of India Extraordinary Part-I, Section-1, No. 163 dated
20-10-1994.
@ Government of India, Ministry of Welfare Resolution
No. 12011/7/95-BCC dated 24-5-95, published in the Gazette of
India Extraordinary Part-I, Section-1, No. 88 dated
25-5-1995.
@ Government of India, Ministry of Welfare Resolution
No. 12011/96/94-BCC dated 9th March, 1996 published in the
Gazette of India Extraordinary Part-I, Section-1, No. 60 dated
11th March,1996.
@ Government of India, Ministry of Welfare Resolution
No. 12011/44/96-BCC dated 6th December, 1996 published in
the Gazette of India Extraordinary Part-I, Section-1, No. 210
dated 11th December,1996.
@ Government of India, Ministry of Welfare Resolution
No. 12011/99/94-BCC dated 11th December, 1997 published in
the Gazette of India Extraordinary Part-I, Section-1, No. 236
dated 12th December,1997.
@ Government of India, Ministry of Welfare Resolution
No. 12011/13/97-BCC dated 3rd December, 1997 published in
the Gazette of India Extraordinary Part-I, Section-1, No. 239
dated 17th December,1997.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/68/98-BCC dated the 27th
October, 1999 published in the Gazette of India Extraordinary
Part-I, Section-1, No. 241 dated the 27th October,1999.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/88/98-BCC dated 6th
December, 1999 published in the Gazette of India Extraordinary
Part-I, Section-1, No. 270 dated 6th December,1999.

@ Government of India, Ministry of Social Justice and

Empowerment Resolution No. 12011/36/99-BCC dated 4th April,
2000 published in the Gazette of India Extraordinary Part-I,
Section-1, No. 71 dated 4th April, 2000.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/44/99-BCC dated the 21st
September, 2000 published in the Gazette of India Extraordinary
Part-I, Section-1, No. 210 dated the 21st September, 2000.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12015/9/2000-BCC dated 6th
September, 2001 published in the Gazette of India Extraordinary
Part-I, Section-1, No. 246 dated 6th September, 2001.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/1/2001-BCC dated 19th
June, 2003 published in the Gazette of India Extraordinary
Part-I, Section, 1 No. 151 dated 20th June, 2003.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/4/2002-BCC dated 13th
January, 2004 published in the Gazette of India Extraordinary,
Part-I Section-1, No. 9 dated 13th January, 2004.
@ Government of India, Ministry of Social Justice and
Empowerment Resolution No. 12011/14/2004-BCC dated 12th
March, 2007 published in the Gazette of India Extraordinary,
Part-I, Section-1, No. 67 dated 12th March, 2007.
Shri/Shrimati/Kumari*................................and/or*
his/her* family ordinarily reside(s) in village/town*....................
............ of ...................... District/Division* of the State/ Union
Territory* of .............................
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 & Training O.M. No. 36012/22/93-Estt(SCT) dated
8-9-1993 O.M. No. 36033/3/2004-Estt.(Res.) dated 9th March,
2004 and O.M. No. 36033/3/2004-Estt.(Res.) dated 14th October,
2008.
Signature................................
**Designation............................
(with seal of Office)
State/Union Territory
Place....................................................
Date.....................................................
*Please delete the words which are not applicable.
@ Strike out whichever 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.
** Authorities empowered to issue Other Backward
Classes certificates will be the same as those
empowered to issue Scheduled Caste/Scheduled
Tribe certificates.

fVIi.kh 11%&vU; fiNM+h Jsf.k;ksa dk gksus dk nkok djus okys

mEehnokjksa dks ;g uksV djuk pkfg, fd muds izek.k
i=k esa nh xbZ mudh tkfr dk uke (orZuh lfgr) Bhd
ogh gksuk pkfg, tSlk dsUnzh; ljdkj }kjk le;&le;
ij vf/lwfpr lwfp;ksa esa izdkf'kr fd;k x;k gSA ftl
izek.k i=k esa tkfr ds uke esa fdlh izdkj dh fHkUurk
gks x h] mls vLohdkj dj fn;k tk,xkA

ij fd;k tk,xk ftlls mlds firk ewyr% lEc gSAa

vr% og mEehnokj tks ,d jkT; (;k jkT; ds fdlh
Hkkx) ls vU; jkT; (;k jkT; ds fdlh Hkkx) esa izot
z u
dj pqdk gS mls vU; fiNM+h Js.kh dk og izek.k i=k
izLrqr djuk pkfg, tks mls mlds firk dks ml jkT;
ftlesa og (firk) ewyr% lEc gS ls izkIr vU; fiNM+h
Js.kh ds izek.k i=k ds vk/kj ij tkjh fd;k x;k gksA

fVIi.kh 22%&mEehnokj ds vU; fiNM+h Js.kh ds gksus ds nkos dk fu/kZj.k

ml jkT; (;k ml jkT; ds fdlh Hkkx) ds vk/kj

fVIi.kh 33%& vk;ksx lkekU;r% mEehnokj }kjk igys gh bl ijh{kk

ds vius ljyhd`r vkosnu i=k esa n'kkZ;h tkrh; fLFkfr
es a fdlh Hkh ifjorZ u dh vuq e fr ugha ns x kA

([k&A) Hkkjr ljdkj

djus okys vU;
izi=k ds lkFk

ds v/hu inksa ij fu;qfDr ds fy,

ifNM+s oxksaZ ds mEehnokjksa }kjk foLr`r
ifjf'k"V&1 esa fn, x, opu dk

vkosnu
vkosnu
izk:iA

opu
eSa -------------------------------------------- iq=k@iq=kh Jh--------------------------- xkao@dLck@'kgj ------------------- ftyk --------------------- jkT; ----------------- dk fuoklh gwwWaA eSa ,rn}kjk ?kks"k.kk djrk gwWa fd esSa ------------------------- leqnk; dk gwWa ftls dkfeZd ,oa izf'k{k.k foHkkx ds
fnukad 8&9&1993 ds dk- Kk- la- 36012@22@93 LFkk- (,l- lhVh-)] esa fufgr vkns'kksa ds vuqlkj ukSdfj;ksa esa vkj{k.k ds fy, Hkkjr
ljdkj }kjk fiNMh tkfr ds :i esa ekU;rk nh x;h gSA eSa ;g Hkh
?kks"k.kk djrk gwWa fd eSa fnukad 8-9-1993 (le;&le; ij la'kksf/
r) ds mi;qZDr dk;kZy; Kkiu dh vuqlwph ds dkye 3 esa
mfYyf[kr O;fDr;ksa@oxksZ (hehys;j) ls laca/ ugha gwWaA
gLrk{kj --------------------------mEehnokj dk uke -----------------------vuqdzekad -------------------------

6
Note 1 : Candidates claiming to belong to OBCs should
note that the name of their caste (including its spellings) as
indicated in their certificates, should be exactly the same as
published in the lists notified by the Central Government from
time to time. A certificate containing any variation in the caste
name will not be accepted.
Note 2 : The OBC claim of a candidate will be determined
in relation to the State (or part of the State) to which his/her
(B-1) The format of undertaking to be furnished along
with the DAF by Other Backward Class candidates applying
for appointment to posts under the Government of India.
UNDERTAKING
I . son/daughter of
Shri resident of Village/ Town/
City District . State/UT
hereby declare that I belong to the
. Community which is recognized as
a backward class by the Government of India for the purpose
of reservation in services as per orders contained in
Department of Personnel & Training Office Memorandum
No.36012/22/93-Estt(SCT) dated 8.9.1993. It is also
declared that I do not belong to persons/sections (Creamy
Layer) mentioned in Column 3 of the Schedule to the above
referred Office Memorandum, dated 8.9.1993 as ammended
from time to time.
Signature
Name of the Candidate
Roll No

father originally belongs. A candidate who has migrated from

one State (or part of the State) to another should, therefore,
produce an OBC certificate which should have been issued to
him/her based on his/her fathers OBC certificate from the
State to which he (father) originally belongs.
Note 3 : No change in the community status already
indicated by a candidate in his/her simplified application form
for this examination will ordinarily be allowed by the
Commission.

ifjf'k"V&
ifjf'k"V&II
j{kk lsok ds nkSjku fodykax gq, mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZ

izekf.kr fd;k tkrk gS fd la- ------------------------------------------------------------------------------------------- jSad ------------------------------------------------uke ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------;wfuV --------------------------------------------------------------------------ds j{kk lsokvksa esa dk;Z djrs gq, fons'kh 'k=kq&ns'k ds lkFk la?k"kZ esa@v'kkafrxzLr {ks=k
esa iQkSth dk;Zokgh ds nkSjku fodykax gq, vkSj ml fodykaxrk ds ifj.kkeLo:Ik fueqZDr gq,A

gLRkk{kj --------------------------------------------------------------------inuke --------------------------------------------------------------------fnukad -------------------------------------------------------------------tks 'kCn ykxw u gks mls d`Ik;k dkV nsa-

7
APPENDIX-II
THE FORM OF CERTIFICATE TO BE PRODUCED BY THE CANDIDATE DISABLED
WHILE IN THE DEFENCE SERVICES :
Certified that No. ....................................................... Rank ......................................................
Name ...................................................................................................................................................................
of Unit ................................................................................. was disabled while in the Defence Service
in operations during hostilities with a foreign country/in a disturbed area* and was released as a
result of such disability.

Signature......................................
Designation.................................
Date.............................................
*Strike out whichever is not applicable.

ifjf'k"V&
ifjf'k"V&III
(d) fueqZDr@lsok fuo`k
k dkfeZdksa ds fy, ykxw izek.k i=k
dk iQke
iQkeZ
Izkekf.kr fd;k tkrk gS fd la- ----------------jSad --------------uke --------------------------------------------------------------------------------------------ftudh tUe frfFk ------------------------------- gS ------------ ls -----------rd lsuk@ukS lsuk@ ok;q lsuk esa lsok dh gS vkSj og fuEufyf[kr esa ls
,d 'krZ iwjh djsa%&
(d) mUgksua s ikap ;k mlls vf/d o"kZ dh lSU; lsok dh gks
vkSj lqinq Z dk;Z dh lekfIr ij fjgk gq, gksa vU;Fkk
dnkpkj ;k dk;Z vdq'kyrk ds dkj.k c[kkZLr u gq, gksAa
([k) os lSU; lsok ds dkj.k gqbZ 'kkjhfjd fodykaxrk vFkok
v{kerk ds dkj.k ------------------------------- dks dk;ZeDq r gq,A
LFkku %
fnukad%
l{ke izkf/dkjh dk uke vkSj inuke
eksgj
([k) lsokjr dkfeZdksa ds fy, izek.k i=k dk iQkeZ (mu
lsokjr dkfeZdksa ij ykxw ftUgsa ,d o"kZ ds Hkhrj dk;ZeqDr
fd;k tkuk gS)A
eSa ,rn~ }kjk izekf.kr djrk gwWa fd esjs ikl miyC/ lwpuk
ds vuqlkj la- --------------------- jSad ---------------------- uke --------------------------------------- fnukad --------------------------- ls lsuk@ukSlsuk@ok;q lsuk
esa lsokjr gSa vkSj os fnukad ------------------------- dks l'kL=k lsukvksa esa
vius fofu;kstu dh fofufnZ"V vof/ iwjh djus okys gSaA
LFkku %
fnukad %
deku vf/dkjh ds gLRkk{kj
dk;kZy; dh eksgj
mDr ^^[k** izek.k i=k nsus okys mEehnokjksa dks fuEufyf[kr
opu nsuk gksxk%&
mEehnokjksa }kjk fn;k tkus okyk opu
eq > s Kkr gS fd ;fn bl vkos n u i=k ls la c a f /r
HkrhZ @ ijh{kk ds vk/kj ij p;u gks tkrk gS rks ;g fu;q D r es j s
}kjk fu;q D r iz k f/dkjh dks bl vk'k; dk la r ks " ktud fyf[kr
iz e k.k iz L rq r djus ds v/hu gks x h fd es a l'kL=k ls u kvks a ls
fof/or :Ik ls fueq Z D r@ls o kfuo` r @dk;Z e q D r gks x;k gw W a vkS j
;g fd le;&le; ij ;Fkkla ' kks f /r Hkw r iw o Z lS f ud (ds U nz h ;

flfoy lsokvksa rFkk inksa esa iqufuZ;kstu) fu;ekoyh] 1979 dh 'krksZa

ds vuqlkj HkwriwoZ lSfudksa dks xzk ykHkksa dk gdnkj gwWaA
LFkku %
fnukad %
mEehnokj ds gLRkk{kj
(x)
bZ-lh-vks-@,l-,l-lh-vks- ftUgksaus igys gh lsok dh
izkjfEHkd fu;fer vof/ iwjh dj yh gS vkSj fu;qfDr dh
c<+kbZ xbZ vof/ ij gS ds fy, izek.k i=k dk iQkeZA
;g Izkekf.kr fd;k tkrk gS fd la- -------------------------------jSad ----------------------------- uke -----------------------------------------------------ftudh tUe frfFk ---------------------------- gS --------------------------------- ls
lsuk@ukS lsuk@ok;q lsuk esa lsok dj jgs gSaA
2- mUgksaus igys gh vkjfEHkd dk;Zdky dh ikWap o"kZ dh
lsok --------------------------- dks iwjh dj yh gS vkSj vc os --------------rd c<+k, x;s dk;Zdky ij gSA
3- mUgsa flfoy jkstxkj esa vkosnu i=k nsus ds fy, dksbZ
vkifk ugha gS rFkk mUgsa flfoy jkstxkj feyus ij rhu ekg ds uksfVl
ij dk;ZeqDr fd;k tk,xkA
l{ke izkf/dkjh dk uke vkSj inuke
eksgj
LFkku%
fnukad%
izkf/dkjh tks izek.ki=k tkjh djus ds fy, l{ke gSa fuEu izdkj gS%a &
(d) bZ-lh-vks-@,l-,l-lh-vks- lfgr deh'kaM vf/dkfj;ksa ds
ekeys esa%&
Fky lsuk&fefyVjh lfpo dh 'kk[kk] Fky lsuk eq[;ky;]
ubZ fnYyhA
ukS lsuk &dkfeZd lsok funs'kky;] ukS lsuk eq[;ky;] ubZ
fnYyhA
ok;q lsuk& dkfeZd lsok funs'kky; (vf/dkjh)] ok;q
lsuk eq[;ky;] ubZ fnYyhA
([k) ts-lh-vks@vks-vkj- rFkk ukS lsuk vkSj ok;q lsuk ds
led{k ds ekeys esa%&
lsuk& fofHkUu jsthesUVy vfHkys[k dk;kZy;ksa }kjkA
ukS lsuk&ch-,-ch-,l-] eqEcbZA
ok;q lsuk&ok;q lsuk vfHkys[k ,u-bZ-vkj-MCY;w-] ubZ fnYYkhA

8
APPENDIX-III
(A) FORM OF CERTIFICATE APPLICABLE FOR
RELEASED/RETIRED PERSONNEL.

Forces and that I am entitled to the benefits admissible to Exservicemen in terms of the Ex-Servicemen (Re-employment
in Central Civil Service and Posts) Rules, 1979, as amended
from time to time.

It is certified that No..................... Rank.....................

Name..........................................whose date of birth is.....................
has rendered service from..................... to..................... in Army/
Navy/Air Force and he fulfils the following conditions :

Signature of Candidate

(a) Has rendered five or more years military service

and has been released on completion of assignment
otherwise than by way of dismissal or discharge
on account of misconduct or inefficiency.
(b) Has been released on account of physical disability
attributable to military service or on invalidment
on.....................
Station : ..........................
Date : ...........................
Signature and Designation of the
Competent Authority
SEAL
(B) FORM OF CERTIFICATE FOR SERVING
PERSONNEL
(Applicable for serving personnel who are due to be
released within one year).
I hereby certify that according to the information
available with me No.......................... Rank.........................
Name.......................................... is serving in the Army/Navy/
Air Force from.......................................... and is due to complete
the specified term of his engagement with the Armed Forces
on the date.....................
Place :

Place :
Date :
(C) FORM OF CERTIFICATE APPLICABLE
FOR SERVING ECOs/SSCOs WHO HAVE ALREADY
COMPLETED THEIR INITIAL ASSIGNMENT AND
ARE ON EXTENDED ASSIGNMENT.
It is certified that No...................... Rank.....................
Name.......................................... whose date of birth is.....................
is serving in the Army/Navy/Air Force from......................
2. He has already completed his initial assignment of
five years onand is on extended assignment
till.
3. There is no objection to his applying for civil
employment and he will be released on three months notice
on selection from the date of receipt of offer of appointment.
Station :
Date :
Name and Designation of the
Competent Authority
SEAL
Authorities who are competent to issue certificate are
as follows :
(a) In case of Commissioned Officers including
ECOs/SSCOs.
ArmyMilitary Secretary Branch, Army Hqrs.,
New Delhi.

Date :
Signature of Commanding Officer
Office Seal

NavyDirectorate of Personnel, Naval Hqrs.,

New Delhi.

Candidate furnishing certificate B as above will have to

give the following undertaking :

Air ForceDirectorate of Personnel Officers, Air

Hqrs., New Delhi.

UNDERTAKINGTOBEGIVENBYTHECANDIDATE:
I understand that if selected on the basis of the
recruitment/Examination to which this 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

(b) In case of JCOs/ORs and equivalent of the Navy

and Air Force.
ArmyBy various Regional Record Offices.
NavyBABS, Mumbai.
Air ForceAir Force Records NERW,
New Delhi.

ifjf'k"V&
ifjf'k"V&IV

fu;e 5([k) ds rgr vk;q esa NwV pkgus okys mEehnokj }kjk izLrqr fd, tkus okys izek.k i=k dk iQkeZ
(d) Jh@Jherh@dqekjh ---------------------------------------------------------------------------------- fnukad ls ----------------------- dk;kZy;@foHkkx esa
------------------------------------------------------- ds LFkk;h in ij (ewy :Ik ls) dk;Zjr gSaA
([k) Jh@Jherh@dqekjh ---------------------------------------------------------------------------------- fnukad ls ------------------------ dk;kZy;@foHkkx esa
------------------------------------------------------ ds in ij dsUnzh; ljdkj ds v/hu fu;fer vk/kj ij vLFkk;h lsok esa yxkrkj dk;Z dj jgh@jgs gSaA
(x)
;g foHkkx@dk;kZy; fuEufyf[kr izkf/dkjh ds fu;a=k.kk/hu gS] tks bathfu;jh lsok ijh{kk] 2011 dh fu;ekoyh ds fu;e
5([k) ds uhps dkye 1 esa fufnZ"V izkf/dkjh esa ls ,d gSA

(d`Ik;k ;gka lEc izkf/dkjh dk uke fy[ksa)

gLRkk{kj ---------------------------------------------------------------inuke -----------------------------------------------------------------ea=kky;@dk;kZy; ---------------------------------------------------

dk;kZy; dh eksgj

LFkku % ----------------------------------------fnukad % -----------------------------------------

tks 'kCn ykxw u gks mlssa dkV nsaA

9
APPENDIX-IV
THE FORM OF CERTIFICATE TO BE PRODUCED BY GOVERNMENT SERVANTS CLAIMING AGE
CONCESSION UNDER RULE 5(b)
Certified that:
*(a) Shri/Shrimati/Kum. ............................................................ holds substantively a permanent post of ................................
in the Office/Department of ........................................with effect from ...................................................
*(b) Shri/Smt./Kum. ....................................... has been continuously in temporary service on a regular basis under
the Central Government in the post of .......................................................in the ....................................................with
effect from .................................
(c) This Deptt./Office is under the control of the following authority, which is one of the authorities specified in
Column I below Rule 5 (b) of the Rules of the Engineering Services Examination, 2011.

(Please indicate here the name of the concerned authority)

Signature..............................................................
Designation.........................................................
Ministry/
Office.....................................................

Office Stamp
Place ........................
Date : ........................

10

ifjf'k"V&
ifjf'k"V&V
laLFkku@vLirky dk uke o irk
izek.ki=k la- ------------------------------------ fnukad ---------------------------v{kerk izek.ki=k
fpfdRlk cksMZ ds
v?;{k }kjk fof/
or~ vuqizekf.kr
v{kerk n'kkZus okyk
mEehnokj dk gky
dk iQksVksxzkiQ
;g izekf.kr fd;k tkrk gS fd Jh@Jhefr@dq- ---------------------------------------------------------------iq=k@iRuh@iq=kh Jh ------------------------------- vk;q
--------------------------------- fyax --------------------- igpku fpUg (fpUgksa)
----------------------- fuEufyf[kr Js.kh dh v{kerk LFkk;h :Ik ls gSA
d-

[k-

pyus esa vleFkZ ;k izefLr"dh; i{kk?kkr

(i) ch-,y-(BL)&nksuksa iSj [kjkc@izHkkfor ijUrq Hkqtk,a ughaA
(ii) ch-,-(BA)&nksuksa Hkqtk,a izHkkfor (d) {kh.k igqap
([k) detksj idM+
(iii) ch-,y-,-(BLA)&nksuksa iSj rFkk nksuksa Hkqtk,a izHkkfor
(iv) vk-s,y-(OL)&,d iSj izHkkfor (nk;ka ;k ck;ka)
(d) {kh.k igqap
([k) detksj idM+
(x)(xfrfoHkze@,VSfDld)
(v) vks-,-(OA)&,d Hkqtk izHkkfor
(d) {kh.k igqap
([k) detksj idM+
(x)(xfrfoHkze@,VSfDld)
(vi) ch-,p-(BH)&l[r ihB ;k dwYgs (cSB ;k >qd ugha ldrs)
(vii) ,e-MCY;w-(MW)&ekalis'kh; nqcy
Z rk rFkk lhfer 'kkjhfjd
lgu'kfDr

us=kghurk ;k de ({kh.k) n`f"V

(i) ch (B) & us=kghu
(ii)ih-ch- (PB) vkaf'kd :Ik ls us=kghu
tks Js.kh ykxw u gks mlssa dkV nsaA

x-

Jo.kckf/r
(i) Mh (D) & cf/j
(ii) ih-Mh- (PD) vkaf'kd :Ik ls cf/j
(tks Js.kh ykxw u gks mlssa dkV nsa)
2- ;g fLFkfr izxfr'khy@vizxfr'khy@lq/kj dh laHkkouk@lq/kj
dh laHkkouk ugha gSA ------------- o"kZ ------------- eghus dh vof/ ds
ckn bl ekeys dh iquewZY;kadu dh vuq'ka'kk dh xbZ gS@vuq'ka'kk ugha
dh xbZ gSA
3- muds@mudh ekeys esa v{kerk dh izfr'krrk ---- izfr'kr gSA
4- Jh@Jherh@dqekjh ------------------------------------------------- vius nkf;Ro
ds fuoZgu ds fy, fuEufyf[kr 'kkjhfjd vis{kk,a iwjh djrs@djrh gS%a &
(i) ,iQ (F)&vaxfq y;ksa dks O;ofLFkr djds fd, tkus okys dk;Z
gk@ugha
(ii) ih-ih- (PP)&[khapdj rFkk /dsydj
fd, tkus okys dk;Z
gk@ugha
(iii) ,y (L)&mBk dj fd, tkus okys dk;Z
gk@ugha
(iv) ds-lh- (KC)&?kqVus ds cy ij cSBdj ;k
sfpax }kjk fd, tkus okys dk;Z
gk@ugha
(v) ch (B)&>qddj fd, tkus okys dk;Z
gkWa@ugha
(vi) ,l (S)&cSBdj fd, tkus okys dk;Z
gk@ugha
(vii) ,l-Vh- (ST)&[kMs+ jg dj fd, tkus okys dk;Z
gk@ugha
(viii) MCY;w (W)&py dj fd, tkus okys dk;Z
gk@ugha
(ix) ,l-bZ- (SE)&ns[k dj fd, tkus okys dk;Z
gk@ugha
(x) ,p (H)&lqudj@cksy dj fd, tkus okys dk;Z
gk@ugha
(xi) vkj-MCY;w (RW)&i<+dj ;k fy[kdj fd,
gkWa@ugh
tkus okys dk;Z
a
(MkW- ------------------) (MkW- ------------------)
lnL;
fpfdRlk cksMZ

lnL;
fpfdRlk cksMZ

(MkW- ------------------)
v?;{k
fpfdRlk cksMZ
vLirky ds fpfdRlk
v/h{kd@lh-,e-vks-@
izeq[k }kjk izfrgLRkk{kfjr
(eqgj lfgr)

10
APPENDIX-V
Name & Address of the Institute/Hospital
Certificate No. ................................... Date : ..........................
DISABILITY CERTIFICATE
Recent Photograph of
the candidate showing
the disability duly
attested
by
the
Chairperson of the
Medical Board.

This is certified that Shri/Smt./Kum. ...............................

son/wife/daughter of Shri ......................................... age ..........
sex ............ identification mark(s) ........................ is suffering
from permanent disability of following category :
A. Locomotor or cerebral palsy :
(i) BLBoth legs affected but not arms

C. Hearing impairment :
(i) DDeaf
(ii) PDPartially deaf
(Delete the category whichever is not applicable)
2. This condition progressive/non-progressive/likely to
improve/not likely to improve. Re-assessment of this case is
not recommended/is recommended after a period of ................
years ............................... months.*
3. Percentage of disability in his/her case is .......................
per cent.
4. Shri/Smt./Kum. ...................................... meets the
following physical requirements for discharge of his/her
duties :
(i) FCan perform work by manipulating
with fingers.
Yes/No
(ii) PPCan perform work by pulling and
pushing.
(iii) LCan perform work by lifting.

Yes/No
Yes/No

(iii) BLABoth legs and both arms affected

(iv) KCCan perform work by kneeling and

crouching.

Yes/No

(iv) OLOne leg affected (right or left)

(a) Impaired reach

(v) BCan perform work by bending.

Yes/No

(vi) SCan perform work by sitting.

Yes/No

(vii) STCan perform work by standing.

Yes/No

(viii) WCan perform work by walking.

Yes/No

(a) Impaired reach

(ix) SECan perform work by seeing.

Yes/No

(b) Weakness of grip

(x) HCan perform work by hearing/speaking.

Yes/No

(xi) RWCan perform work by reading and

writing.

Yes/No

(ii) BABoth arms affected

(a) Impaired reach

(b) Weakness of grip

(b) Weakness of grip

(c) Ataxic
(v) OAOne arm affected

(c) Ataxic
(vi) BHStiff back and hips (cannot sit or stoop)
(vii) MWMuscular weakness and limited physical
endurance.
B. Blindness or Low Vision :
(i) BBlind
(ii) PBPartially blind
* Strike out whichever is not applicable.

(Dr. .......................) (Dr. .......................) (Dr. .......................)

Member
Medical Board

Member
Medical Board

Chairman
Medical Board

Countersigned by the Medical

Superintendent/CMO/Head of
Hospital (With seal)

11

vuq c U/

vkosnu izi=k Hkjus ds fy, dksM la[;k

vkosnu izi=k ds fofHkUu dkyeksa dks Hkjus ls lEc} dksM ds Li"Vhdj.k uhps fn, x, gSa%&
dkye 12 % ukxfjdrk fLFkfr
dksM

fooj.k

01

Hkkjr dk ukxfjd

02

Uksiky dh iztk

03

HkwVku dh iztk

04

Hkkjr esa LFkkbZ :Ik ls jgus ds bjkns ls 1 tuojh] 1962 ls igys Hkkjr vk;k gqvk frCcrh 'kj.kkFkhZA

05

Hkkjr esa LFkkbZ :Ik ls jgus ds bjkns ls ikfdLrku] cekZ] Jhyadk] iwohZ viQzhdh ns'kksa dhfu;k] mxkaMk] la;Dq r x.kjkT;] ratkfu;k]
tkfEc;k] ekyoh] tSjs vkSj bFkksfi;k ;k fo;ruke ls izot
z u dj vk;k gqvk ewyr% Hkkjrh; O;fDr gksA

dkye 13%

vf/okl fLFkfr

dksM

jkT; vFkok la?k 'kflr {ks=k

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18

vka/ izns'k
v:.kkpy izns'k
vle
fcgkj
NRrhlx<
Xkksok
xqtjkr
gfj;k.kk
fgekpy izns'k
tEew vkSj d'ehj
>kj[k.M
dukZVd
dsjy
e?; izns'k
egkjk"V~+
ef.kiqj
es?kky;
fetksje

dksM
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

jkT; vFkok la?k 'kkflr {ks=k

ukxkyS.M
mMhlk
iatkc
jktLFkku
flfDde
rfeyukMq
f=kiqjk
mRrjk[k.M
mRrj izns'k
if'pe caxky
v.Meku ,oa fudksckj }hi lewg
paMhx<+
nknjk vkSj ukxj gosyh
neu vkSj nho
fnYyh
y{k}hi
iqMqpsjh

fVIi.kh% mEehnokjksa dks lgh dksM nsus esa vR;Ur lko/ku jguk pkfg,A tc dHkh ,d ;k nks ckDl tSls
mRrj ds fy, fn,
x;s gksa] rks lko/kuh j[kuh pkfg, fd ,d ls vf/d vad ,d ckDl esa vafdr u fd, tk,aA vxj dksM dks nks ;k nks ls vf/d vadks ls
fy[kk tkrk gS rks mrus gh ckDl fn, tkrs gSaA tc dHkh fdlh dksM esa 01 vFkok 02 tSlk vadu gks vFkkZr~ ck;ha vksj 0 gks rks dksM dk
vadu 0 ds fcuk ugha djuk pkfg, tSlk fd uhps fn[kk;k x;k gS%&
1

01
U

11
ANNEXURE

GUIDELINES
CODE NUMBERS FOR FILLING UP THE APPLICATION FORM
Codes to be given for filling up different columns in the application form are mentioned below :
Column 12 : CITIZENSHIP
Code

Description

01

a citizen of India

02

a subject of Nepal

03

a subject of Bhutan

04

a Tibetan refugee who came over to India before the Ist January, 1962 with the intention of permanently settling
in India.

05

a person of Indian origin who has migrated from Pakistan, Burma, Sri Lanka, East African countries of Kenya,
Uganda, the United Republic of Tanzania, Zambia, Malawi, Zaire or Ethiopia or Vietnam with the intention of
permanently settling in India.

Column 13 : STATE OF DOMICILE

Code

State or Union Territory

Code

State or Union Territory

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18

Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram

19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttrakhand
Uttar Pradesh
West Bengal
Andaman & Nicobar Islands
Chandigarh
Dadra and Nagar Haveli
Daman & Diu
Delhi
Lakshadweep
Puducherry

NOTE : Candidate should be twice sure of giving the right code. Whenever one or more boxes like
have been
provided for the answer, care has to be exercised that not more than one numeral is entered in one box. If the code requires two
or more digits then as many boxes have been provided. Further, whenever a code reads like 01 or 02 i.e. there is a 0 on the left,
one should take care to enter the code with the 0. The code should not be entered without 0 as illustrated below :

1
Wrong

01
Right