Application For Security Assistant

Application for Security Assistant (Executive) Examination-2009 PART-I 1. Code and Name of center for written test (Refer table ‘A’. Application shall be rejected if boxes left unfilled) Center Code

For office use only Roll No.

Center Name

Candidate should affix his/ her recent self attested passport size photograph

2. a) Date of Birth (as per Matriculation certificate) Date Month Year b) Age (As on closing date) Years

Months

Days Signature of the candidate in box above preferably in Black ink/ Black ball pen

3. Male/ Female 4. a) Whether SC/ ST/ OBC

(Write ‘M’ for Male, ‘F’ for female)

(Write ‘Y’ for Yes, ‘N’ for No) Category with Code 1 for SC 2 for ST 3 for OBC 5. Whether the resident of J&K and seeking age relaxation (Write ‘Y’ for Yes, ‘N’ for No) 6. i) Whether Ex-serviceman: Yes/No ii) Total Service rendered as Ex-serviceman Years

Months

Days

7. Home State:………………………………………………………………………. 8. Nationality:……………………………………………………………………….. 9. Educational Qualification (Graduation Onwards) SI No.

Exam Passed

Subjects of study

Maximum marks

Marks obtained

%age of marks obtained

1 2 3 10.Previous experience Period Name of the Organization With Designation

Pay Scale

Last pay Drawn

Nature of duties From

To

11. Extra curricular activities:……………………………………………….. 12. Languages/dialects known and skill level (Reading-Writing-Speaking) (i)

…………………………………………………………………….

(ii)

…………………………………………………………………….

(iii)

……………………………………………………………………..

13. Are you prepared to service anywhere in India:

(Write Yes/No)

14. Name in Full:

15.Father’s Name:

16.Mailing Address

Pin Code 17.Permanent Address:

Pin Code I hereby declare that I satisfy the conditions of the eligibility advertised for admission for the examination. All the information made in this application are true to the best of my knowledge and belief. I am aware that if at any time, it is found that any information given above is false or incorrect then my candidature is liable to be cancelled. Place: Date:

Signature of the Applicant

PART-II To be filled by the Head of Office in which the candidate is serving. (Only for Government Employees) It is certified that: i) There are no circumstances rendering Shri/Ms………………. unsuitable for appointment as Assistant Central Intelligence Officer Grade-II /Executive ii) He/ She is regularly appointed as ………………………… with effect from ………….. and continues to be so employed iii) He/ She is permanent (state designation) ……………………….. of the (Name of the Department etc.)……… with effect from ……………. and continues to be so employed

iv) v)

The information given be Shri/Ms…………. in the application has been verified with reference to his/ her service record and is correct No disciplinary proceeding is pending or contemplated against Shri/Ms……………

OFFICE SEAL:………………………….

SIGNATURE:………………….. NAME:…………………………. DESIGNATION:………………. DEPARTMENT/ OFFICE…….

Admission card IB’s Assistant Central Intelligence Officer Grade II (Executive) Examination-2009 1. Name of the Candidate :………………………………………….. (To be filled in by the Candidate) 2. Roll Number:……………………………………………………… (For Office Use Only) 3. Date, Time and Center of Examination- See Annexure

(For office use only)

Candidate should affix his/her recent selfattested passport size photograph Assistant Director Subsidiary Intelligence Bureau (Ministry of Home Affairs) Government of India

To Name:…………………………………….. Address:…………………………………. (To be filled in by the candidate) Note: 1. Please attach a self-addressed un-stamped envelop of 10x23 cm size 2. This admission card should be of the size of 30x21cms. No deviation from the size indicated will be accepted 3. You will not be allowed admission in the examination hall if you fail to bring this admission card.