Himachal Pradesh Public Service Commission FORMAT OF APPLICATION APPLICATION FOR THE POST(S) OF _______________________ITEM.________ IN THE DEPARTMENT OF _________________,H.P.ADVERTISED VIDE ADVERTISEMENT NO. _____________ 1.Name of the applicant: (In capital letters) 2. Father's Name 3. Sex (Male/Female) D 4. Date of birth: D M M Y Y Y Y Paste recent (last six months period Pass-port size attested photograph PINCODE & Telephone No.) 6. Permanent address (IN CAPITAL LETTERS WITH PINCODE): 7. State to which he/she belongs: 8. Name of category: (General/SC/ST/OBC/WFF/Ex-man/ Dependent ward of Ex-man/ Physically/Visually handicapped) 9. Academic Qualifications: Sr.No. Exam. Passed %age of Marks Year of Passing Board/ Univers Subject 1. 2. 3. 10.Are you H.P.Govt.servant Yes/No)____________________________________________________ 11.Give Chronological detail of your employment: Sr.No. Name of Deptt. Post held From To Whether permanent/ Temporary/Tenure. Remarks. 1. 2. 3. 12.Particulars of Bank Draft : Bank Draft No. Name of Bank Date of issue Amount 13.Detail of documents enclosed: Sr.No. Name of Document 1. 2. 3. I hereby declare that I am an Indian National and 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 false or incorrect , my candidature is liable to be cancelled. Signature of the applicant (Declaration to be furnished by candidates belonging to other reserved catagories except categories of Scheduled Caste, Scheduled Tribe & Ward of Freedom Fighter.) I______________son / Daughter of Shri______________________________ Resident of village ___________________Post Office _____________Tehsil ______ _____________District __________, Himachal Pradesh ,do hereby declare that the contents of this application recorded/ filled -in-up by me are true to the best of my knowledge and that I shall produce the documents in support of these contents as and when required by the H.P.Public Service Commission and that in the event of these contents being found incorrect , I shall be liable to be debarred from any service / job under the Government of Himachal Pradesh for a period of three years and also I shall be liable for criminal proceedings. Date: Signature of the Applicant Place.
