BY REGISTERED / SPEED POST ONLY

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Annexure III PART B FORM 1

APPLICATION FOR RECRUITMENT OF POSTAL ASSISTANTS / SORTING ASSISTNTS

Post applied for

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(a) (b) (c) (d)

1.

Postal Assistants in Post Offices Postal Assistants in Circle Office and Regional Offices Postal Assistants in Savings Bank Control Organisation Sorting Assistants in Railway Mail Service

Name in full (in block letters) Fathers/Husbands name

2.

3.

Present Address

4.

a) Date of Birth (In Christian Era)

In figures and words as recorded in
SSLC / HSC / Cumulative Record. (Attach

attested copy of relevant certificates)

b) Place of Birth c) Age as on:

(last date of submission of application)

Years.Months..Days.

5.

Whether: a) SC / ST / OBC

(Mention caste & attach attested

photocopy of certificate issued by competent authority in the prescribed format)

b) Physically Handicapped

(Attach

attested copy of certificate issued by the competent Medical

Board)

c) Ex-Serviceman
(Attach attested copy of the certificate issued by the Defence Authority)

6.

Nationality

7. Educational Qualifications Examination Passed Sl No

Year of Passing

Marks Obtained Grade & Total %

Name of the board / University

i) ii) iii) iv) v)

SSLC 10+2 or 12th Class Graduation Post Graduation Whether studied Malayalam or any other local language recognized by (Kerala State Government) as a subject up to SSLC Whether passed 10+2 or 12 Class/ PUC with English as a compulsory subject Any other relevant information Languages Studied

vi)

vii)

a) I, Shri / Smt. / Kum. ______________________________ hereby declare that all the information given above is true to the best of my knowledge and belief. I understand that if any information is found to be false at a later stage, I am liable to be punished and my appointment will be terminated. I also understand that in the event of my failure to complete the pre-appointment training, for whatever reason, my selection is liable to be cancelled. b) I, Shri / Smt. / Kum. _________________________________________ being

physically handicapped understand that my selection is liable to be cancelled if it is found later on Medical examination by the competent authority that I do not come under the category of Physically handicapped defined in the relevant order. * c) I, Shri / Smt. / Kum. ___________________________________________________ son/daughter of _____________________________________resident of village / town / city________________________________District_______________________________ State_________________________________________ 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 and Training Office Memorandum No. 36012/22/93-Estt. (SCT) dated 08/09/1993. 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 *

d) I,

Sri__________________________________________

being

an

Ex-Serviceman

understand that if I am selected on the basis of the recruitment /Examination to which this application relates. My appointment will be subjected to my producing documentary evidence to the satisfaction of the appointment authority that I have been duly released/retired/discharged from Armed forces and that I am entitled to the benefits admissible to Ex-Serviceman in terms of Ex-Servicemen(Re employment in Central Civil Service and Posts Rules) 1979, as amended from time to time. *

Place: Signature of Candidate Dated: *(Delete if not applicable) Important: 1. Applications and the envelopes should be clearly super scribed indicating the post for which and division/unit to which applied. 2. Applications should be sent by registered or speed post only. Those sent through other means or by hand will not be accepted. 3. Applications addressed to any authority other than the Divisional Superintendents/ Asst. Director (Rectt), O/o the CPMG will not be considered.