CABINET SECRETARIAT

(GOVERNMENT OF INDIA) Affix self-attested

recent passport
Note: Please fill in the form in English capital letters size coloured
Application for direct recruitment to the post of Field Assistant (Motor Transport) in Level-3 photograph

1. Name of the candidate :

RAJU RAM BIRDA
2. Nationality :
INDIAN
3. Gender :
MALE
4. Address for :
correspondence VPO-SUJANGARH, TEH. SUJANGARH
(Please mention PIN Code
and name of State clearly) DIST CHURU
State
RAJASTHAN PIN
331518
5. Contact No.
(Mobile) (Mandatory)
:
8764188848
Alternate No. :

6. Email ID (Mandatory) :
(IN BLOCK LETTERS) [email protected]
Father’s Name
7. :
SOHAN RAM
Mother’s Name
8. :
PRIYANKA DEVI
9. Date / Place of Birth : Date
15 Month 01 Year 1995
Place
SUJANGARH
10. Age as on 01.07.2022 : Years Months Days
27 05 17
11. Religion : HINDU
12. Category : General SC ST
(Tick ‘√ ’ whichever is applicable)

OBC Ex-Serviceman Central Government Employee

13. For ex–serviceman, : Years Months Days

specify length of Defense
service (Enclose copy of
discharge summary)
14. Marital Status :
UNMARRIED
If married,
a) Name of spouse :

b) Religion of spouse :

c) Nationality of spouse :

15. Educational qualifications from matriculation onwards. (Attach self-attested copies of all the mark-sheets /
certificates) :-
Board / University Year of Duration of the Total marks
Exam / Degree Passing Course obtained in
Subjects Studied
passed From To percentage (%)
10TH RBSE, AJMER 2010 JULY 2009 TO HINDI, ENGLISH, SST, 58.33
MAY 2010 SCIENCE, MATH, SANSKRIT
JULY 2011 HINDI, ENGLISH, GEOGRAPHY,
12TH RBSE, AJMER 2012 TO MAY 2012 COMPUTOR SCIENCE, HINDI LIT.
68.80

16. Details of Driving License (Attach self attested photocopies)

Vehicle Category License No. Issuing Authority Validity Period

RJ44-20140000057 06.01.2014 TO
LMV RTO SUJANGARH 05.01.2034
HMV 17.12.2015 TO
RJ44-20140000057 RTO SUJANGARH 15.06.2026

17. Details of Driving experience (Attach self attested photocopies)

Vehicle Category driven Details of Department / Period
Organisation
From To
LMV KKTC TRANSPORT 1.7.2015 1.07.2020

HMV KKTC TRANSPORT 10.7.2020 5.3.2024

18. Whether employed or not : Yes / No

If yes, details of employment

(Department, rank, pay level, date of joining etc.)

DECLARATION
I hereby declare that a) I fulfil the above laid down eligibility conditions for the post of Field Assistant
(Motor Transport); and b) I have not submitted any other application in response to this recruitment process. In
the event of information or part thereof being found incorrect at any stage, my candidature / appointment is liable
to be cancelled / terminated without any notice to me.

RAJURAM
Place: SUJANGARH Signature of the applicant with date

Date: 06.05.2024
 ANNEXURE-I
FORMAT FOR SC/ ST CERTIFICATE

A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should submit in
support of his/ her claim an attested/certified copy of a certificate in the form given below, from the District Officer
or the sub-Divisional Officer or any other officer as indicated below of the District in which his parents (or surviving
parent) ordinarily reside who has been designated by the State Government concerned as competent to issue such a
certificate. If both his parents are dead, the officer signing the certificate should be of the district in which the
candidate himself ordinarily resides otherwise than for the purpose of his own education. Wherever photograph is an
integral part of the certificate, the Commission would accept only attested photocopies of such certificates and not
any other attested or true copy.
(The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates
applying for appointment to posts under Government of India)

This is to certify that Shri/Shrimati/Kumari* __________________________ son/daughter of

___________________________________ of village/town*__________________ in District/Division
*_______________________ of the State/ Union Territory* ________ belongs to the
Caste/Tribes_______________ which is recognized as a Scheduled Castes/ Scheduled Tribes* under:-

The Constitution (Scheduled Castes) order, 1950 ___________________

The Constitution (Scheduled Tribes) order, 1950 ________________
The Constitution (Scheduled Castes) Union Territories order, 1951 *_______________
The Constitution (Scheduled Tribes) Union Territories Order, 1951*______________

As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification) order, 1956, the Bombay
Reorganization Act, 1960 & the Punjab Reorganization Act, 1966, the State of Himachal Pradesh Act 1970, the
North-Eastern Area (Reorganization) Act, 1971 and the Scheduled Castes and Scheduled Tribes Order
(Amendment) Act, 1976.

The Constitution (Jammu & Kashmir) Scheduled Castes Order, 1956___________

The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by the Scheduled
Castes and Scheduled Tribes order (Amendment Act), 1976*.
The Constitution (Dadra and Nagar Haveli) Scheduled Castes order 1962.
The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order 1962@.
The Constitution (Pondicherry) Scheduled Castes Order 1964@
The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967 @
The Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968@
The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @
The Constitution (Nagaland) Scheduled Tribes Order, 1970 @
The Constitution (Sikkim) Scheduled Castes Order 1978@
The Constitution (Sikkim) Scheduled Tribes Order 1978@
The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@
The Constitution (SC) orders (Amendment) Act, 1990@
The Constitution (ST) orders (Amendment) Ordinance 1991@
The Constitution (ST) orders (Second Amendment) Act, 1991@
The Constitution (ST) orders (Amendment) Ordinance 1996@
The Scheduled Caste and Scheduled Tribe Orders (Amendment ) Act 2002@
The Constitution (Scheduled Caste) Orders (Amendment) Act 2002@
The Constitution (Scheduled Caste and Scheduled Tribe) Orders (Amendment) Act 2002@
The Constitution (Scheduled Caste) Order (Amendment) Act 2007@
%2.Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from one State/ Union
Territory Administration.

This certificate is issued on the basis of the Scheduled Castes/ Scheduled Tribes certificate issued to
Shri/Shrimati __________________________Father/mother of
Shri/Srimati/Kumari*___________________________of village/town*______________________ in
District/Division* ______________________of the State/Union Territory*______________________________
who belong to the _________________________________ Caste/ Tribe which is recognized as a Scheduled Caste/
Scheduled Tribe in the State/Union Territory* issued by
the________________________________dated____________________________.
3. Shri/Shrimati/Kumari and /or * his/ her family ordinarily reside(s) in
village/town*________________________________________ of ________________ District/Division*
_________________of the State/Union Territory of ____________________________

Signature__________________________
** Designation________________________
(with seal of office)
Place______________
Date_______________

* Please delete the words which are not applicable

@ Please quote specific presidential order
% Delete the paragraph which is not applicable.

NOTE: The term ordinarily reside(s) used here will have the same meaning as in section 20 of the Representation of
the People Act, 1950.
** List of authorities empowered to issue Caste/ Tribe Certificates:
(i) District Magistrate/ Additional District Magistrate/ Collector/ Deputy Commissioner/ Additional Deputy
Commissioner/ Dy. Collector/ Ist Class Stipendiary Magistrate/ Sub-Divisional Magistrate/ Extra-Assistant
Commissioner/ Taluka Magistrate/ Executive Magistrate.
(ii) Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/ Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.
NOTE: ST candidates belonging to Tamil Nadu State should submit caste certificate ONLY FROM THE REVENUE
DIVISIONAL OFFICER.

ANNEXURE-II

(FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO

POSTS UNDER THE GOVERNMENT OF INDIA)

This is to certify that Shri/Smt./Kumari ________________son/daughter of _______________________ of

village/ town ________________________ in District/Division ______________________ in the State/ Union
Territory ____________________________ belongs to the __________________ Community which is recognized
as a backward class under the Government of India, Ministry of Social Justice and Empowerment’s Resolution No.
_________________________ dated _________________*. Shri/Smt./Kumari __________________________
and/or his/her family ordinarily reside(s) in the______________ District/Division of the
____________________________ State/Union Territory. This is also to certify that he/she does not belong to the
persons/ sections (Creamy Layer) mentioned in Column 3 of the Scheduled to the Government of India,
Department of Personnel & Training O.M. No. 36012/22/93-Estt (SCT) dated 8.9.1993**.
District Magistrate
Deputy Commissioner etc.
Dated:
Seal:
* The authority issuing the certificate may have to mention the details of Resolution of Government of India, in
which the caste of the candidate is mentioned as OBC.
** As amended from time to time.
Note: The term “Ordinarily” used here will have the same meaning as in Section 20 of the Representation of the
People Act, 1950.
 ANNEXURE-III
UNDERTAKING TO BE GIVEN BY THE EX-SERVICEMEN

I …………………………………………………., bearing Roll No…………………., appearing for the

Document Verification of the ………………………………………. Examination, 20………., do hereby undertake
that:
(a) I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen Re-employment
in Central Civil Services and Posts Rules, 1979, as amended from time to time.
(b) I have not joined the Government job on civil side (including Public Sector Undertakings, Autonomous
Bodies/ Statutory Bodies, Nationalized Banks, etc.) in Group “C” and “B” posts on regular basis after
availing of the benefits of reservation given to ex-serviceman for re-employment; or
(c) I have availed the benefit of reservation as ex-serviceman for securing Government job on civil side. I
have joined as …………………………….on……………… in the office of
………………………………………………………… I hereby undertake that I have submitted the self-
declaration/ undertaking to my current employer about date wise detail of the application for the above
mentioned examination for which I had applied for before joining the present civil employment; or
(d) I have availed the benefit of reservation as ex-serviceman for securing Government job on civil side. I
have joined as …………………………….on……………… in the office of
……………………………………. Therefore, I am eligible for age-relaxation only;

I hereby declare that the above statements are true, complete and correct to the best of my knowledge and
belief. I understand that in the event of any information being found false or incorrect at any stage, my
candidature/ appointment is liable to be cancelled/ terminated
Signature: .....................
Name: …………….
Roll Number: ....................
Date: …………….
Date of appointment in Armed Forces: …………….
Date of Discharge: …………….
Last Unit/ Corps: …………….
Mobile Number: …………….
Email ID: …………….

ANNEXURE-IV

FORM OF CERTIFICATE TO BE SUBMITTED BY CENTRAL GOVERNMENT CIVILIAN EMPLOYEES SEEKING AGE-

RELAXATION
(To be filled by the Head of the Office or Department in which the candidate is working)

It is certified that *Shri/Smt./Km. ________________ is a Central Government Civilian employee holding the post
of _______________________ in the pay scale of Rs.___________________ with 3 years regular service in the
grade as on closing date. This office has no objection for his/ her appearing in the ________________ Examination.

Signature ___________________
Name_________________
Office Seal _________________
Place:
Date:
(*Please delete the words which are not applicable.)