KERALA PUBLIC SERVICE COMMISSION APPLICATION FORM Category No. Name of Post................................................................................................................ Scale of pay......................................... Department/Company/Corporation/Board/Local Authority................................................................................................................. Gazette date................................................................ Note:-(1) Leave 5 cm. space on the top of application form. (2) Furnish full correct information. Candidates should read the relevant Gazette Notification inviting applications before filling up the application form. Enclose self attested true copies of documents in proof of the claim. 1. Name with initials (In block capitals) 2. Address to which communications are to be sent (with District and Pincode) 3. (a) Date of birth (in figures and words) 3. (b) Sex: 4 (a) Community/Caste/Tribe with sub- caste 4. (b) Religion : 5. (a) Your qualification for the post (b) Additional qualification, if any (a) (b) 6. (a) Name of Mother/father/guardian (Specify the relationship) 6. (b) Mother tongue: 7. Nationality, State, District and Taluk to which you belong Nationality State District Taluk 8. (a) Choice of District/Circle (if applicable as per notification) 8. (b) Have you applied for the post in any other District as per this notification (Answer 'Yes' or 'No') 9. Are you eligible for relaxation of upper age limit, If so, give details. 10. Are you entitled to weightage/priority being Sportsman/Ex-serviceman/Physically handicapped, etc? Give details. 11. Are you employed on a regular basis under State/Central Government? Give details. 12. Have you been debarred from recruitment by Public Service Commission or dismissed from Service or convicted by Court of Law ? Give details. I hereby declare that the foregoing information is cosion of the documents in proof of the claim made in this application. Place: Date: DECLARATION rrect and complete to the best of my knowledge and belief and that I am in posses-Signature of Candidate 1
