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ASSAM PUBLIC SERVICE COMMISSION

APPLICATION FORMAT

Note: PLEASE FILL IN THE FORM ACCORDING TO THE INSTRUCTIONS

(AT PAGE 4) TO CANDIDATES

ADVERTISEMENT NOITEM NO. OF THE POST.................

NAME OF THE POST APPLIED FOR...

LAST DATE FOR RECEIPTOF APPLICATION................

1. Nae o! t"e Ca#$%$ate %# !&''(IN BLOC LETTERS)

:

*. SE+: MALE,FEMALE :

-. Fat"e/0 #ae %# !&'' a#$o&2at%o#3 %! a#

:

4. Pe0e#t a$$e00 o! t"e a#$%$ate %# !&'' !o 2o0ta'o%at%o# V%''a5e,To6#

:

Loa'%t (%! 7%''a5e,to6# o %t) :

Po0t o!!%e :

P%# Co$e :

Te'e5a2" o!!%e :

Po'%e Stat%o# :

S&8D%7%0%o# :

D%0t%t :

9. Hoe a$$e00 %# !&'' :

V%''a5e,to6# :Loa'%t (%! to6# o %t) :

Po0t o!!%e :

P%# Co$e :

Te'e5a2" O!!%e :

Po'%e Stat%o# :

S&8 D%7%0%o# :

D%0t%t :

. Nat%o#a'%t :

;. Me#t%o# 6"et"e t"e a#$%$ate8e'o#50 to SC,ST(P),ST(H),OBC,MOBC.I!


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1*. RECOGNIED EDUCATIONAL,OTHER PROFESSIONAL UALIFICATION, TRAININGCOURSES3 ETC. (E#'o0e a 0e2aate S"eet3 6"ee #ee00a)

Ea.Pa00e$,De5ee,

Ta%#%#5o8ta%#e$

D%7%0%o#,Ga$e,

C'a00

Pee#ta5e o!

Ma0o8ta%#e$

ea o!2a00%#5

De5ee,D%2'oa

D&at%o# o!De5ee,

D%2'oa,Ta%#%#5o&0e

Boa$,U#%7e0%t,

I#0t%t&t%o#

S&8et0 tae#

Note: ATTACH SUPPORTING DOCUMENTS FOR UALIFICATION,SUCCESSFUL COMPLETION OFTRAINING AND MARS (IF AN) OBTAINED IN EACH E+AMINATION,TRAINING)

1-. E+PERIENCE (PARTICULARS OF ALL PREVIOUS AND PRESENT (IF AN EMPLOMENT

ARE TO BE FURNISHED)

Nae a#$

a$$e00 o!t"ee2'oe

Po0t "e'$ J"et"e

Ce#ta',StateGo7t.U#$eta%#5,

P%7ate

Pea#e#t,

Te2oa

Pe%o$

Fo To

Nat&e

o! $&t

Rea0o# !o 'ea7%#5

t"e o8

NOTE: ATTACH SUPPORTING DOCUMENTS.

14. I! E0e7%e a# e#t%o# 2e0o#a' #&8e :

Ra# :

Nae o! Se7%e :

Pe%o$ o! Se7%e :

(ATTACH SUPPORTING DOCUMENTS)

19. EtaC&%&'a At%7%t%e0 :

(a) S2ot :

(8) C&'t&a',At0 :

( ) L%tea :

(ATTACH SUPPORTING DOCUMENTS)

1. Atta" t6o "aate et%!%ate0o#e !o a 6e'' #o6# 2e0o# a#$ o#e !o aGaette$ o!!%e a#$ 6%te t"e% #ae0 a#$ $e0%5#at%o# %# t"e 02ae0 2o7%$e$!o t"e 2&2o0e o# t"e %5"t 0%$e

1...

*...

Pa5e: *


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1;. O2t%o#a' 0&8et0 a#$ #ae o! t"e Ce#te : (a) S&8et: 1. *.

: (8) Nae o! t"e Ce#te:

(I# a0e o! e&%te#t 8 6%tte# ea%#at%o# o#')

1=. Deta%'0 o! !ee : Fee to 8e 2a%$ a0 2e ate e#t%o#e$ %# t"e

a$7et%0ee#t (a22'%a8'e to e2'oe$ 2e0o#o#')

Nae o! t"e Tea0&o!!%e

No. a#$ Date o!Tea0& Ree%2t

Va'&e

R0. P.

Rea0o# o! 2ae#t o! "a'! ate o #o#2ae#t 0"o&'$ 8e 'ea' 0tate$

NOTE: ENCLOSE COP OF THE ORIGINAL TREASUR RECEIPT

1?. (a) Ae o& $e8ae$ !o a# ea%#at%o#

a#$,o 0e'et%o# o#$&te$ 8 t"e UPSC o a#State P.S.C

(8) Ae o& $e8ae$ !o a22'%#5 !o a#

Go7e#e#t 2o0t (A#06e


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INSTRUCTIONS FOR CANDIDATES

1. T"e Ca#$%$ate0 0"o&'$ ae!&'' 5o t"o&5" t"e te0 a#$ o#$%t%o#0 o! t"e a$7et%0ee#t3 2at%&'a'

(1) E$&at%o#a' &a'%!%at%o#3 (%%) A5e '%%t a#$ (%%%) E2e%e#e3 6"ee e2e%e#e %0 #ee00a.

*. O#' t"e a22'%at%o#0 o! t"e a#$%$ate0 6"o !&'!%'' a'' t"e te0 a#$ o#$%t%o# o! t"e a$7et%0ee#t0 %#e02et o! t"e 2o0t !o 6"%" t"e ae a22'%a#t0 0"a'' 8e e#teta%#e$.

-. T"ee 0"o&'$ 8e 0e2aate a22'%at%o# a#$ 0e2aate Tea0& C"a''a# !o ea" 2o0t.

4. A'' a#$%$ate0 6"et"e %# Go7e#e#t Se7%e o %# Go7e#e#t o6#e$ $eta%#5 o ot"e 0%%'a

o5a#%at%o#0,Co2oat%o#0,Boa$0,Bo$%e0 o %# 2%7ate e2'oe#t0 a 0&8%t t"e% a22'%at%o# $%et to t"eCo%00%o# 0&8et to !&'!%''%#5 t"e o#$%t%o# at %te No. 1- o! t"e a22'%at%o# !o. I! a# 0&" a#$%$ate

!o6a$0 "%0,"e a22'%at%o# t"o&5" "%0,"e Co#to''%#5 O!!%e,E2'oe3 "e,0"e 0"o&'$ e#0&e t"at t"ea22'%at%o# ea"e0 t"e A00a P&8'% Se7%e Co%00%o# 6%t"%# t"e 'o0%#5 $ate3 !a%'%#5 6"%" %t %0 '%a8'e to 8e

eete$ e7e# %! %t "a$ 8ee# 0&8%tte$ to t"e Co#to''%#5 O!!%e,E2'oe 8e!oe t"e 'o0%#5 $ate.

9. A22'%at%o#0 &0t 8e ao2a#%e$ 8 atte0te$ o2%e0 o! t"e $ee#t%o#e$ $o&e#t03 6"%" 0"o&'$8e ta55e$ 6e'' 6%t"o&t a# "a#e o! 5ett%#5 'o0t o# ta#0%t.

A22'%at%o#0 6"%" ae #ot ao2a#%e$ 8 a'' o a# o#e o! t"e $e e#t%o#e$ $o&e#t0 0"a'' #ot

8e e#teta%#e$ $e a# %&0ta#e0.

I. Co2%e0 o! a'' e$&at%o#a' (2a00) et%!%ate0 a#$ Ma0"eet0 !o Mat%,HSLC,HSSLC o#6a$0(atte0te$ o2%e0)

II. A5e Cet%!%ate %00&e$ 8 t"e e02et%7e Boa$0,U#%7e0%t (atte0te$ o2)III. E2e%e#e Cet%!%ate0 (6"ee #ee00a) %#$%at%#5 t"e 2e%o$ o! Se7%e,E2e%e#e 6%t" $ate0

(atte0te$ o2)IV. Ca0te Cet%!%ate (!o SC,ST (P),ST (H),OBC,MOBC) !o t"e a22o2%ate a&t"o%t.

V. I! t"e a#$%$ate %0 e2'oe$3 o%5%#a' Tea0& "a''a# et. 0"o6%#5 t"e $e2o0%t o! R0. 9.@@ (R0. *.9@%# a0e o! SC a#$ ST a#$%$ate0) a0 a22'%at%o# !ee 'ea' e#t%o#%#5 t"e #ae o! t"e 2o0t %# t"e

e'e7a#t o' o! t"e Tea0& "a''a# a#$ t"e !o''o6%#5 Hea$ o! Aot0 (%# t"e Hea$ o!Aot0 o')

HEAD OF ACCOUNTS

NON TA+ REVENUE OTHER NON TA+ REVENUE @@91 PUBLIC SERVICE COMMISSION 1@* STATEPUBLIC SERVICE COMMISSION APPLICATION,E+AMINATION FEE RECEIPT OF ASSAM PUBLIC

SERVICE COMMISSION.

Pa5e: 4

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