APPENDIX FORM 'A' [See Regulation 4(1)] Application for enrolment as a member of the Civil Defence Service) 1. Name in full ( in Block letters) 2. Father's / husband's name 3. Date of birth 4. Nationality 5. Permanent address. 6. Occupation and present address. 7. Name and address of present employer. 8. Educational qualifications. 9. Languages known ( to read / write / speak ). 10. Are you a member of the following: (i) Defence Forces(Army/Navy/Air Force) or any of their reserves: (ii) Territorial Army or any other auxiliary force of Defence Services; (iii) Civilian Cadre of Armed Forces of the Union, subject to Naval, Army Or Air Force law, other than " Casual Employees". (iv) Police Service; (v) Fire Service. 11. Are you an ex-service person; if so, give particulars. 12. Do you belong to the National Volunteer Force; if so, give particulars 13. Have you any previous experience in Civil Defence Corps? If so, give Particulars, including date. 14. Have you any preference for any particular section of Civil Defence Corps? If so, state the section. 15. Have you any special qualifications for enrolment in the section chosen by you ? If so, give detail. 16. In case of preference for service in Mobile Columns or Ambulance trains are you prepared to serve anywhere in India, should an emergency arise? 17. For how many hours and on what days of the week will you be available for Civil Defence Duty (for part-time volunteers only). 18. Do you have any conveyance (bicycle, motor car, motor cycle, etc.) 19. Are you suffering from any communicable disease; if so, give particulars. 20. Did you have small pox? If so, when. 21. Have you been vaccinated? If so, when. 22. Have you been inoculated for cholera/Typhoid/T.B., etc. ? If so, when. 23. Do you know First Aid/motor Driving? 24. Signature of applicant. DECLARTATION 1. I have read the "Civil Defence Regulations, 1968" 2. As far as I know, I am physically fit to render efficient service as a member of the Corps. 3. If my application is accepted, I am prepared to service as a whole-time/part-time member of the Corps, i.e., to undergo the appropriate Training and, in the event of an emergency occurring whilst I remain a member of the Corps, to carry out my obligations as a member thereof. 4. I undertake- (i) to carry out my duties in the Civil Defence Corps in accordance with the instructions and orders issued by the authorities concerned; (ii) to return, when I cease to be a member of the Corps, any articles of uniform, badge or other personal equipment issued to me; and (iii) to abide by the regulations of the Corps. Place : Date : This form duly completed should be submitted to : Name and address of Enrolling Authority___________________________________________ FOR OFFICIAL USE Recommendations of the Head of Corps/Staff officer concerned Admitted to (Corps, etc.) and allotted To (post No. etc.)____________ Signature ........... Signature ............ Designation ...........Designation ........... Date .............. Date ............... FORM B Form of Oath [ See Regulation 5 ] I, ............* son/daughter/wife of ........ Swear/solemnly affirm that I will be faithful and bear, true allegiance to India and to the Constitution of India as by law established, and that I will loyally carry out the duties entrusted to me( So help me God*) (* To be deleted as necessary)
