STAFF SELECTION COMMISSION

BLOCK NO. 12, CGO-COMPLEX, LODHI ROAD, NEW DELHI

110003
HEAD CONSTABLE (MINISTERIAL) IN DELHI POLICE
EXAMINATION, 2022

REGISTRATION NO: 50001184709

APPLICATION RECEIVED (CONTENTS NOT VERIFIED)

1. NAME AS PER 2. NEW/ CHANGED 3. FATHER'S NAME 4. MOTHER'S NAME
MATRICULATION CERTIFICATE NAME
VAISHNAVI SINGH - DINESH KUMAR SINGH PRIYANKA SINGH
5. DATE OF BIRTH
6. AGE AS ON 01/01/2022 7. GENDER 8. CATEGORY
(DD/MM/YYYY)
04/10/2000 21.2 FEMALE UNRESERVED
9. WHETHER PERSON WITH DISABILITY (PwD)? 9.1 IF YES, TYPE OF DISABILITY
NO -
10. NATIONALITY 11. MARK OF VISIBLE IDENTIFICATION
CITIZEN OF INDIA MOLE ON FACE
14. MATRICULATION
13. MATRICULATION
12. MATRICULATION (10th CLASS) EXAMINATION BOARD (10th CLASS) YEAR OF
(10th CLASS) ROLL NO
PASSING
MADHYA PRADESH BOARD OF SECONDARY EDUCATION 165361619 2016
15. DO YOU POSSESS OBC CATEGORY CERTIFICATE NOTIFIED IN THE CENTRAL LIST OR BY THE GOVT. OF NCT OF
DELHI ?
NO
16. WHETHER A WIDOW/ DIVORCED/ JUDICIALLY SEPARATED WOMEN?
NO
17. WHETHER DEPARTMENTAL CANDIDATE OF DELHI POLICE ?
NO
18. WHETHER SON/ DAUGHTER OF SERVING, RETIRED OR DECEASED PERSONNEL/ MULTI-TASKING STAFF OF DELHI
POLICE
NO
19. HAVE YOU REPRESENTED A STATE AT THE NATIONAL LEVEL OR THE 19.1. IF YES, DISCIPLINE OF YOUR
COUNTRY AT THE INTERNATIONAL LEVEL IN SPORTS DURING PRECEEDING 3 SPORT
YEARS FROM THE CLOSING DATE OF RECEIPT OF ONLINE APPLICATIONS?
NO -
20. MEDIUM OF COMPUTER BASED EXAMINATION (CBE)
ENGLISH
21. PREFERENCE OF EXAMINATION CENTERS
EXAMINATION CENTER EXAMINATION CENTER EXAMINATION CENTER
(FIRST PREFERENCE) (SECOND PREFERENCE) (THIRD PREFERENCE)
INDORE ( 6006 ) UJJAIN ( 6016 ) BHOPAL ( 6001 )
 22.1. WHETHER YOU ARE AN EX- 22.2. DATE OF JOINING THE ARMED 22.3.DATE OF DISCHARGE/ LIKELY
SERVICEMAN (ESM) OR SERVING IN FORCES (DD/MM/YYYY) DATE OF DISCHARGE FROM ARMED
THE ARMED FORCES? FORCES (DD/MM/ YYYY)

NO - -

22.5. HAVE YOU ALREADY JOINED A

22.4. LENGTH OF SERVICE IN THE CIVIL POST BY AVAILING BENEFIT OF 22.6. DATE OF JOINING TO CIVIL POST
ARMED FORCES RESERVATION FOR EX-SERVICEMAN (DD/MM/YYYY)
(ESM) ?

- - -

23.1. WHETHER SEEKING AGE 23.2. IF YES,INDICATE CODE

RELAXATION ?
NO -
24.1. ARE YOU A NATIONAL CADET CORPS (NCC)
24.2. TYPE OF THE NCC CERTIFICATE
CERTIFICATE HOLDER ?
NO -
25. MEDIUM FOR TYPING TEST:
ENGLISH
26.1. DO YOU POSSESS DEGREE/ POST GRADUATE
26.2. IF YES, CLASS OBTAINED IN DEGREE/ POST
DIPLOMA AWARDED BY RASHTRIYA RAKSHA
GRADUATE DIPLOMA:
UNIVERSITY (RRU)?
NO -
27. HIGHEST EDUCATIONAL QUALIFICATION
BCA (17)
28. DETAILS OF QUALIFYING EDUCATION
12TH STANDARD
STATE/ UT OF
NAME OF BOARD/ PERCENT
STATUS PASSING YEAR BOARD/ ROLL NO CGPA
UNIVERSITY AGE
UNIVERSITY
MADHYA PRADESH
BOARD OF
PASSED 2018 MADHYA PRADESH 285345648 59.04 -
SECONDARY
EDUCATION
29. 22. DO YOU WANT TO MAKE AVAILABLE YOUR PERSONAL INFORMATION FOR ACCESSING JOB OPPORTUNITY IN
TERMS OF DoP&T'S O.M NO.39020/1/2016-ESTT.(B) DATED 21.06.2016 ?
NO
ADDRESS DETAILS
30. POSTAL ADDRESS 31. PERMANENT ADDRESS
147-A ABHINANDAN NAGAR SUKHLIYA 147-A ABHINANDAN NAGAR SUKHLIYA

DISTRICT: INDORE DISTRICT:INDORE

STATE: MADHYA PRADESH STATE: MADHYA PRADESH
PIN : 452010 PIN : 452010
MOBILE NO: 9893846214 EMAIL: [email protected]
32. WHETHER THE PHOTOGRAPH HAS BEEN TAKEN ON OR AFTER 17-FEB-2022?

YES
FEE PAYMENT AMOUNT TRANSACTION NO TRANSACTION DATE
EXEMPTED - - -
DECLARATION
1. I HAVE READ THE NOTICE OF THE EXAMINATION AND ACCEPT ALL THE TERMS & CONDITIONS OF THE
NOTICE OF THE EXAMINATION.

2. I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF ANY
INFORMATION BEING FOUND SUPPRESSED/FALSE OR INCORRECT OR INELIGIBILITY BEING DETECTED
BEFORE OR AFTER THE EXAMINATION, MY CANDIDATURE/ APPOINTMENT IS LIABLE TO BE CANCELLED.

3. I DECLARE THAT THE PHOTOGRAPH UPLOADED IN THE APPLICATION FORM HAS BEEN TAKEN ON OR
AFTER THE STIPULATED DATED.
PRINT TAKEN ON: 02/06/2022 11:07:04 AM IP ADDRESS: 122.168.225.157