Intelligence Bureau - Application For Assistant Central Intelligence Officer Grade

Application for Assistant Central Intelligence Officer Grade-II (Executive) Examination-2009PART-I

For office use only

1. Code and Name of center for written test (Refer table ‘A’. Application shall be rejected if boxes left unfilled) Center Code

Roll No.

Center Name

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

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

Months

Days

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

Signature of the candidate in box above preferably in Black ink/ Black ball pen (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. i) Whether Ex-serviceman: Yes/No ii) Total Service rendered as Ex-serviceman Years Months 6. Whether the resident of J&K and seeking age relaxation (Write ‘Y’ for Yes, ‘N’ for No)

Days

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

Exam Passed

Subjects of study

Maximum marks

10. Are you prepared to service anywhere in India 11. Name in Full:

Marks obtained

%age of marks

(Write Yes/No)

12. Father’s Name: 13. Mailing Address

Pin Code 14. 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 apart from any other legal action deemed fit. Date: Place: 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) The information given be Shri/Ms…………. in the application has been verified with reference to his/ her service record and is correct v) 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.