STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH - 2016

FILLED IN ONLINE APPLICATION FORM

Recruitment for the posts of SCT PC (Mechanics) (Men)- Post Code No.26,
and SCT PC (Driver) (Men)- Post Code No. 27 in PTO
vide Notification No. 247/R&T/Rect.II/2016, dt:- 01.09.2016.
1.

Candidate's Name

: LAKSHMEE SOMARAJU

2.

Father's Name

: LAKSHMEE SATYANARAYANA

3.

Mother's Name

4.

Gender

: NOOKARATNAM
: Male

5.

Date Of Birth

6.

Community

: 02-Jul-1987
: OC

7.

SSC Or Equivalent RollNo.(Hall Ticket No.)

: 0221891

8.

Code of the Post applied

: 27 - SCT PC (Driver) (Men)

Post 1st Preference

: --

Post 2nd Preference

: -: --

Preserve the REGISTRATION NUMBER

for all your future correspondence.

REGISTRATION NUMBER

4008085
Pass Year :

2002
14.

9.

Educational Qualification for Post

Code 26 (as on 01.07.2016)

10.

Educational Qualification for Post

Code 27 (as on 01.07.2016)

: Must have passed Intermediate examination or any o

11.

Highest Qualification

: Intermediate

12. For candidates applying for Post code

No.27 Light Motor Vehicle License(as
on 01.09.2016)
If Yes, furnish the following

: HMV
: DLFAP105257482007

Present License
(i) If the candidate posses
HMV,furnish HMV License No.
(ii) Date of issue of LMV License

: --

(i) If the candidate posses LMV,furnish

HMV License No.

: --

(ii) Date of issue of LMV License

: 05-Dec-2007
: RTA RAJAHMUNDRY

(iii) Name and place of the issuing

Authority
13.

16.

15.

: Yes

Upload Community Certificate(For

BC,SC and ST)

: --

(i) If BC-E candidate, please

mention the caste

: -1.

Identification Marks (as per

SSC or Equivalent)

2.

: A MOLE BELOW THE RIGHT EAR

: A MOLE ON THE RIGHT SIDE OF THE CHEST

17.

Candidate Mobile No.

: 9490489717

18.

E-mail ID

: meesevagokavaram@gmail.com

19.

Address for Communication

: DOOR NO.16-4/9
KOTHAPETA
VEERALANKAPALLI
GOKAVARAM
PIN: 533286

20. Do you have an Aadhar Card

: Yes

Aadhar Card No.

: 869629945775

21. What is your preferred medium of Exam : Telugu

22. Are you presently a local of State of Andhra Pradesh
If Yes, What is your Local District
If No, Which State / Union Territory you belong to
If you have selected 'Telangana' as State to which you belong, as per GSR 591E
of Govt. of India, Candidates who migrate from Telangana to Andhra Pradesh
with in a period of 3 years from the 2nd Day of June, 2014 shall be regarded as
local candidate in Andhra Prades. Do you belong to this Category ?
23. Are you an Employee of Govt. of Andhra Pradesh.

: Yes
: East Godavari
: -: --

: No

If yes,furnish the following

(i) Date of Joining in Service

: --

(ii) Length of Service as on 01.07.2016

: Years: -- Months: -- Days:--

(iii) Are you Still in Service

: --

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24. Are you an employee of the Army, Naval or Air Force of the Union (for Age relaxation)

: No

If Yes, furnish the following

(i) Date of Entry

: --

(ii) Date of Discharge

: --

25. Have you worked as an instructor in NCC (for age relaxation)

: No

If yes,furnish the following

(i) Date of Entry

: --

(ii) Date of Discharge

: --

26.

Are you retrenched temporary employee in the State Census Department during
1991:(age relaxation)
If yes, Length of Service in Census

: No
: Years: -- Months: -- Days:--

27.

Are you a Home Guard Furnish details if you claim age relaxation under Home
Guard Quota (HG)
If yes,furnish the following

: No

28.

(i) Date of Enrollment

: --

(ii) Name of the Unit

: --

Do you claim reservation under Ex-Servicemen quota

Have you been discharged as on date of notification (01.09.2016)
If yes,furnish the following
(i) Date of Entry
(ii) Date of Discharge

: No
: -: -: --

If no,furnish the following

29.

(i) Date of Entry

: --

(ii) LikelyDate of Discharge

: --

Furnish details if you claim reservation under Home Guard Quota (HG)

: No

If yes,furnish the following

30.

31.

(i) Date of Enrollment

: --

(ii) Name of the Unit

: --

Furnish the details if you claim reservation under NCC ( NCC-A, NCC-B, NCC-C)
quota
If yes,furnish the following

: No

(i) If A-Certificate, Date on which A-Certificate was obtained

: --

(i) If B-Certificate, Date on which B-Certificate was obtained

: --

(i) If C-Certificate, Date on which C-Certificate was obtained

: --

Furnish the details if you claim reservation under CPP Quota

: No

If yes,furnish the details of your Parents

(ii) Gender

: -: --

(iii) Date of enrollment of your parent

: --

(iv) Name of the Present Post

: --

(i) Name of the Parent

v) Is your parent "Working" or "Retired" or "Died" as on date of notification i.e.,

01-09-2016

: --

If working ,furnish the following

a) If working Name of the Post

: --

b) Name of the Unit

: --

If 'Died' or 'Retired'
a) Name of last Post held

: --

b) Unit on which last post held

: --

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32.

As per the Rule 3 (G) of A.P. (SCT) Rules, 1999, involment in a Criminal case involving moral turpitude (OR) conviction for any offence in
any court of law, is a bar for employment.
Were you involved in any Criminal Case (s) at any time ?

: No

If yes,furnish the following

(ii)Name of the Police Station

: -- -: --

(iii) Name of the District

: --

(i) Crime No.& Year

33.

Were you ever arrested by the Police

: No

34.

Were you prosecuted by the Police in a Court of Law

: No
: --

35.

Were you involved in more than one Criminal case

: No

36.

Total No. of Criminal cases involved

: 00

37.

Were you at any time employed and discharged/terminated/removed/dismissed

from service of the Government (whether during training or later)?

: No

If yes, furnish the present stage of the case

If yes,furnish the following

(i) Name of the Post

: --

(ii) Name of the Department

: -: --

(iii) Date of Discharge / Terminated /

Removal / Dismissal
(ii) Name of the Department

38.

Fee Paid Through : AP Online

TransactionId/Reference Id

: -: APMDC8D8B4895E

Amount (in Rs.)

300

I Certify that I have read the Notification and I am proceeding to submit this application form after having understood
the eligibility and other criteria mentioned in the Notification. I undertake total responsibility for submitting correct
information to the best of my ability.

Date: 23-Sep-2016 13:01 PM

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