union public service commission detailed application form

Page No. 1/9
UNION PUBLIC SERVICE COMMISSION
DETAILED APPLICATION FORM
CIVIL SERVICES(MAIN) EXAMINATION, 2013
Paste here identical
photograph as per
instruction of para 33.
Roll No. : 082646
Name : RAWISEN GURIA
1. Details of Fee paid : Fee to be paid is Rs. 200/-(Two hundred only)(Female/SC/ST/Physically challenged
candidates are not required to pay any fee)
Name of Post Office / Value of CRF Stamps
Indian
/ Indian
Mission with complete
Mission Receipt
address.
Space for affixing Central Recuritment Fee Stamps
(This is the sole mode prescribed for payment of fee)
Total Value :
N.B : Indian Postal Orders/Bank Draft/Money Orders/Crossed Cheque/Treasury Challan/Currency Notes/Postage/
Revenue/Court Fee Stamps etc. are not acceptable.
Roll No. :- 082646
| Candidate Signature :
Page No. 2/9
2. Name
| RAWISEN GURIA
3. (a) Address for correspondence to which | HOUSE NO. 61, 3RD MAIN, 11TH CROSS, SHREYAS
COLONY,
communication is to be sent
| JP NAGAR 7TH PHASE
Post Office:
| JP NAGAR
District:
| BANGALORE
State :
| KARNATAKA
Pin Code :
| 560078
(b) Telephone No. with STD Code
| 080-41161849
(c) Mobile No.
| 09007376510
(d) Fax No.
(e) E-mail address
(f) Permanent Postal Address
|
|
|
|
|
|
|
Post Office:
District:
State :
Pin Code :
[email protected]
VILLAGE - GUTUHATU
BARDA
KHUNTI
JHARKHAND
| 835227
4. Gender :
| MALE
5. Marital Status :
| UNMARRIED
6. Citizenship :
| A CITIZEN OF INDIA(1)
7. Mother tongue :
| MUNDARI
8. (a) Date of Birth
(b) Claimed Age relaxation(Enclose
documentary evidence in support
of your claim)
| 21-02-88
9. Place of Birth :
Town/Village
District
State
| No
| GUTUHATU
| KHUNTI
| JHARKHAND
| ST (2)
10. (a) Community
Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC
reservation should indicate their community as 'General Category (others) Code No.4'.
Note 2: Candidates belonging to neither SC,ST nor OBC Communities should write 'General'
Category(Others) Code No.4' against the column of community and not leave it blank.'.
Note 3: No change in the community status already indicated by a candidate in his / her application form for this
examination will ordinarily be allowed by the Commission.
Note 4: In case you are a 'SC, ST or OBC' candidate, enclose a copy of certificate in support of your claim.
Roll No. :- 082646
| Candidate Signature :
Page No. 3/9
11. Choice of Centre for Examination
| BANGALORE
12.(i)(a)Do you hail from Arunachal Pradesh/
Manipur/Meghalaya/Mizoram/Nagaland/
Sikkim and are claiming exemption
from appearing in INDIAN LANGUAGE
FOR PAPER A?
| NO
(b)Indian Language for Paper A
| HINDI
(ii) Optional Subject for paper VI & VII
| LAW
13. (a)Language Medium for Examination
for Paper I to Paper VII (Essay,General
Studies and for Optional Subject as
at (ii) of col.12 above)
| ENGLISH
Note : In case of candidates opting for literature in any of the Indian Language as optional subject for papers
VI & VII , they would have to write these two papers (VI & VII) in the script specified for that particular
language as given in Annexure IV of Instructions to candidate.
(b)Language Medium for Interview
Test(c.f. para 27 of the Instructions)
to Candidates)
| ENGLISH
14. (a) Whether you are a Physically
Challenged Candidate
| NO
|
15. (a) Name of Father
(b) Name of Mother
|
(c) Nationality of Father
|
(d) Nationality of Mother
|
(e) Father's present postal Address
|
(If deceased give last address)
|
Post Office:
|
District/City:
|
State :
|
Pin Code :
|
(f) Mother's present postal Address
|
(If deceased give last address)
|
Post Office:
|
District/City:
|
State :
|
Pin Code :
|
(g) Father's Profession:
|
(h) Mother's Profession:
|
(i) If your Father is in service,the post held
by him (if retired, indicate the post held
by him at the time of his retirement)
|
(j) If your Mother is in service,the post held
by her (if retired, indicate the post held
by her at the time of her retirement)
|
Roll No. :- 082646
RUSHEN GURIA
RUPAI GURIA
A CITIZEN OF INDIA
A CITIZEN OF INDIA
VILLAGE - GUTUHATU
BARDA
KHUNTI
JHARKHAND
835227
VILLAGE - GUTUHATU
BARDA
KHUNTI
JHARKHAND
835227
RETIRED
HOME MAKER
OFFICE SUPERINTENDENT
NA
| Candidate Signature :
Page No. 4/9
(k) Annual income of your Father
|
(l) Annual income of your Mother
|
(m) District to which your Father originally|
belongs
(n) State to which your Father originally |
belongs
(o) District to which your Mother originally|
belongs
(p) State to which your Mother originally |
belongs
RS.200000
RS.0
KHUNTI
JHARKHAND
KHUNTI
JHARKHAND
16.Whether passed Degree or equivalent examination
| YES (Enclose copy of the Certificate )
17. Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination
Passed
Class/ Percentage
CGPA
Year of
Division
of
Score Out of
/Grade Marks(%)
Passing
10th or Equivalent
1
70.83
12th or Equivalent
1
76.40
Graduation or
Equivalent
B
Subject(s)
Name of
School/College
/Institution
Name of
Board/University
ENGLISH, HINDI, BISHOP WESTCOTT
CISCE
HISTORY CIVICS
BOYS SCHOOL,
GEOGRAPHY,
NAMKUM, RANCHI
MATHS, SCIENCE,
ECONOMICS
2007
ENGLISH,
DAV JAWAHAR
CBSE
HISTORY,
VIDYA MANDIR,
POLITICAL
SHYAMALI,
SCIENCE,
RANCHI
ECONOMICS,
SOCIOLOGY
Stream at Graduation Level :-LAW
3.26
7
2012
BA LLB HONS. THE WB NATIONAL
THE WB
UNIVERSITY OF
NATIONAL
JURIDICAL
UNIVERSITY OF
SCIENCES,
JURIDICAL
KOLKATA
SCIENCES,
KOLKATA
18. Were you ever Employed :
2005
| NO
19. Please give Particulars of:(a) Particulars of prizes,medals
scholarships,etc.
(b) Team/Games/Sports/N.C.C.
/Hitchhiking/Mountaineering etc.
(c) Position(s) of distinction Leadership
held in School/College
(d) Other extra curricular activities and
interests (Such as hobbies etc.)
| WON RBI YOUNG SCHOLAR AWARD 2009-2010, WON
OTHER EVENTS LIKE EXTEMPORE, QUIZ, SLOGAN
WRITING ETC
| PART OF FOOTBALL TEAMS IN INTRA UNIVERSITY
AND INTRA SCHOOL EVENTS
| ELECTED AS CLASS REPRESENTATIVE
| READING BOOKS -FICTION. KEEN FOLLOWER OF
FOOTBALL AND CRICKET WATCHING MOVIES,
TELEVISION SERIES
20. In case you are considered for appointment to IAS/IPS ,your order of preference for various State cadres
for which you would like to be considered.
Roll No. :- 082646
| Candidate Signature :
Page No. 5/9
Note : It is clarified that as per the present scheme of things as envisaged by the Cadre Allocation
Policy,2008,amended from time to time ,if a candidate appointed to the All India Services does not express
his/her first preferences to his/her home cadre,he/she shall not be considered for his/her home cadre at all.
The Candidates are therefore advised to excerise due diligence while filling up the above preferences.
State Cadres
Order of preference
ANDHRA PRADESH
AGMUT
ASSAM,MEGHALAYA
BIHAR
CHHATTISGARH
GUJRAT
HARYANA
HIMANCHAL PRADESH
JAMMU & KASHMIR
JHARKHAND
KARNATAKA
KERALA
MADHYA PRADESH
MAHARASHTRA
MANIPUR TRIPURA
NAGALAND
ORISSA
PUNJAB
RAJASTHAN
SIKKIM
TAMILNADU
UTTARAKHAND
UTTAR PRADESH
WEST BENGAL
IAS
21
3
22
6
2
20
11
12
13
1
14
15
4
10
23
24
9
16
7
17
18
5
8
19
IPS
8
3
9
5
2
10
11
12
13
1
14
15
4
16
17
18
19
20
6
21
22
7
23
24
21. Your order of preference against the Services/Posts given below , for which you would like to be
considered for appointment .,
Note : It is clarified that the below order of services does not reflect their relative importance in the
eyes of the Govt. and the candidates are advised to use their discretion while indicating preferences for
various services.
S.N.
1.
2.
3.
4.
5.
6.
7.
8.
Name of Services/Post
Indian Administrative Service
Indian Foreign Service
Indian Police Service
Indian P&T Accounts & Finance Service Group "A"
Indian Audit & Accounts Service, Group "A"
Indian Revenue Service,(Customs and Central Excise)Group "A"
Indian Defence Accounts Service ,Group "A"
Indian Revenue Service, (I.T.) Group "A"
Roll No. :- 082646
| Candidate Signature :
Order of Preference
1
2
3
9
7
6
8
4
Page No. 6/9
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Indian Ordance Factories Service,Group "A" (Asstt. Works
Manager-Administration)
Indian Postal Service,Group "A"
Indian Civil Accounts Service ,Group "A"
Indian Railway Traffic Service,Group "A"
Indian Railway Accounts Service ,Group "A"
Indian Railway Personnel Service,Group "A"
Post of Asstt. Security Commissioner ,Group "A" in Railway Protection Force
Indian Defence Estates Service ,Group "A"
Indian Information Service ,(Junior Grade) Group "A"
Indian Trade Service,Group "A" (Grade III)
Indian Corporate Law Service ,Group "A"
Armed Forces Headquarters Civil Service ,Group 'B'(Section Officers'Grade)
The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman&Diu and Dadra &
Nagar Haveli Civil Service,Group "B"
The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman&Diu and Dadra &
Nagar Haveli Police Service,Group "B"
Pondicherry Police Service , Group "B"
22. Have you ever been debarred by
any Public Service Commission
or SSC from any of their
Examinations/Selections?
| NO
23. Whether you have been selected or
applied for U.P.S.C. Examination
/Recruitment:-
| YES
17
19
10
11
12
13
14
18
20
22
5
21
15
16
23
Details of other application for Examination/Recruitment held/to be held by UPSC :Name of
Examination/Post
Month and year of
Examination
/Advt./No. /Item
No. for Recruitment
Roll. No.
Whether you appeared
at the
Examination/Interview
Whether you were
recommended for
appointment
CIVIL SERVICES
EXAMINATION 2012
NIL
306369
YES
NO
24. How many times have you appeared
at the Civil Services(P)
Examination so far, including the current
Examination held in May,2013
|1
25. Details of examination in which you have appeared including CS(P),2013
Year
2012
Roll No. 306369
26. Have you ever accepted allocation
to a Service/Post on the basis
of Civil Services Examination
held in earlier years?
Roll No. :- 082646
| NO
| Candidate Signature :
Page No. 7/9
27. State of Domicile
| JHARKHAND
28. Amount of CRF stamp pasted
| Rs. 0
29. List of Enclosures sent by the candidate:--->Attested/Certified Copy of certificate of Age.
--->Attested/Certified Copy of the certificate of educational qualifications.
--->Attested/certified copy of certificate in support of claim to belong to Scheduled Castes/Scheduled
Tribes/Other Backward Classes (where applicable), along with Annexure VI.
Roll No. :- 082646
| Candidate Signature :
Page No. 8/9
DECLARATION TO BE SIGNED BY THE CANDIDATE
I, hereby declare that all statements and entries made in columns 1 to 29 of this application are true,
complete and correct to the best of my knowlege and belief. I have read rule 14 of the Rules of the
Examination and understand that in the event of any information being found false or incorrect or
ineligibility being detected before or after the examination,action can be taken against me by
the Commission.
I further declare that I fullfill all the eligibility conditions regarding age limits, educational qualifications
etc.prescribed for admission to the Examination. I have not exhausted the number of attempts admissible
to me under the rule 4 of the Rules of the Examination.
I have not with hold any information required as per this proforma.
I have read the rules and instructions carefully and I hereby undertaken to abide by them.
* I have informed my Head of the Office/Department in writing that I have applied for this examination.
** Signature of the Candidate
Place:
Date:
*Strike of this sentence, if not applicable.
** Application not signed by candidate is liable to rejection.
Roll No. :- 082646
| Candidate Signature :
Page No. 9/9
UNION PUBLIC SERVICE COMMISSION
SUMMARY SHEET
(FOR OFFICE USE ONLY)
DATE:SESSION:-
ROLL NUMBER :NAME OF EXAMINATION :NAME :DATE OF BIRTH :OPTIONAL SUBJECT:PLACE OF BIRTH :TOWN/VILLAGE
DISTRICT
STATE
|
|
|
|
|
082646
CIVIL SERVICES(MAIN) EXAMINATION, 2013
RAWISEN GURIA
21-02-88
LAW
| GUTUHATU
| KHUNTI
| JHARKHAND
Please give Particulars of:(a) Particulars of prizes,medals scholarships,etc.
(b) Team/Games/Sports/N.C.C.
/Hitchhiking/Mountaineering etc.
(c) Position(s) of distinction Leadership held in
School/College
(d) Other extra curricular activities and interests (Such
as hobbies etc.)
| WON RBI YOUNG SCHOLAR AWARD 2009-2010,
WON OTHER EVENTS LIKE EXTEMPORE,
QUIZ, SLOGAN WRITING ETC
| PART OF FOOTBALL TEAMS IN INTRA
UNIVERSITY AND INTRA SCHOOL EVENTS
| ELECTED AS CLASS REPRESENTATIVE
| READING BOOKS -FICTION. KEEN FOLLOWER
OF FOOTBALL AND CRICKET WATCHING
MOVIES, TELEVISION SERIES
Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination
Passed
Powered by TCPDF (www.tcpdf.org)
Class/ Percentage
CGPA
Year of
Division
of
Score Out of
/Grade Marks(%)
Passing
10th or Equivalent
1
70.83
12th or Equivalent
1
76.40
Graduation or
Equivalent
B
2005
Subject(s)
Name of
School/College
/Institution
Name of
Board/University
ENGLISH, HINDI, BISHOP WESTCOTT
CISCE
HISTORY CIVICS
BOYS SCHOOL,
GEOGRAPHY,
NAMKUM, RANCHI
MATHS, SCIENCE,
ECONOMICS
2007
ENGLISH,
DAV JAWAHAR
CBSE
HISTORY,
VIDYA MANDIR,
POLITICAL
SHYAMALI,
SCIENCE,
RANCHI
ECONOMICS,
SOCIOLOGY
Stream at Graduation Level :-LAW
3.26
7
2012
BA LLB HONS. THE WB NATIONAL
THE WB
UNIVERSITY OF
NATIONAL
JURIDICAL
UNIVERSITY OF
SCIENCES,
JURIDICAL
KOLKATA
SCIENCES,
KOLKATA

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