FREE OF COST MEGHALAYA PUBLIC SERVICE COMMISSION APPLICATION FORM [AF 1] Instructions 1. Please fill the form using a ball point pen 2. Use block letters only 3. Enclose one self addressed envelope of 4" x 9" with this application form. Mention complete address with pin code on the envelope. 4. An amount of Rs. 40/- (Rupees 20/- for SC/ST) is required to be paid on submission of this form. This amount may be paid through a Treasury Challan or Postal Order or through Court Fee Stamps. In case payment is through Treasury Challan, please attach an original copy of the Treasury Challan with this form. In case payment is by Postal Order, please attach the Postal Order. In case payment is through Court Fee Stamps, the same may be affixed in the space provided on Page 4 of the form. The Court Fee Stamps must be cancelled by drawing two parallel lines across the face of the stamps. 5. Do not attach copies of any documents such as birth certificate, school certificate, HSLC certificate, headman's certificate, ST/OBC certificate etc. with this form. 6. Acceptance of this form by the MPSC does not constitute validity of candidature. Final validity of candidature shall be determined at a subsequent stage. 7. Read the advertisement for the post in question before filling up the form. Name of the Post applied for: ______________________________________________ 1. Full Name : (Please do not use any initials) Affix latest photograph of Surname ........ ....... size 3.5 x 4.5 Do not staple or pin. First name ......... ...... Use gum only. Middle name ........ ....... 2. Date of birth : Signature of candidate ________ Year 3. Sex : ________ Month _______ Date Male / _ Female 4. Marital Status : Married / Unmarried 5. Father's / Mother's name (Full name) and occupation:________________________________ 6. Husband's name : (in case of married females only) ________________________________ 7. Present address in full with Pin code: ________________________________ (This address will be used for all communication) _____________________Pin:________ 8. Contact Phone No.: (with STD Code) ________________________________ 9. Permanent address in full with Pin code: ________________________________ _____________________Pin:________ 10. Are you a Citizen of India : Yes / No If "Yes", how ? __________________________________________ 11. Is / Was your father a citizen of India : Yes / No 12. Address during the preceding four years : From: To: Address: __________________________ __________________________ __________________________ 13. Are you a member of Scheduled Caste / Scheduled Tribe/ Yes / No OBC ? If "Yes", indicate caste / tribe ______________________________ (Copy of certificate need not be enclosed) 14. Physically handicapped : Yes / No If "Yes", give details of handicap ______________________________ 15. Have you ever represented the Country/State Yes / No /District in any discipline in Sports If "yes" give details ______________________________ 16. Educational qualifications (from Matriculation / HSSLC upwards) (do not attach any copies of certificates / mark sheets) 17. Other qualifications : (if any) __________________________________________ 18. Are you trained in or a member of the National Cadet Corps or Territorial Army? Yes / No 19. Knowledge of languages : (Put 9 or x as the case may be) 20. Present occupation (if any) and duration: 21. Previous appointment held (if any), duration and reason for leaving : 22. Are you a temporary / retrenched personnel of a Temporary Department of Government of Meghalaya ? Yes / No If "Yes", give particulars 23. Higher initial pay desired (state amount) : ____________________________________ (to be filled in only in cases where higher initial pay is contemplated in the advertisement for qualified and experienced candidates) 24. Have you been debarred from any examination and/or Yes / No selection conducted by UPSC/State PSC/DSC? 25. Are you debarred from applying for any Government post : Yes / No 26. Place of birth ____________ ____________ ____________ ____________ Village/Town Police Station District State 27. Indicate your preferred center for written examination, in case an examination is held (Tick one) Shillong / Tura / Jowai (Note: Final allocation of the Center to a candidate will be made by the Commission, depending on the number of candidates, availability of examination hall etc. Indication of choice of center does not guarantee allotment of the same) 28. References : No. Name of Institution & address Date of entering Date of leaving Examination passed Division Subjects taken Language Understand Speak Read Write English Khasi Jaintia Garo (Give name & addresses of two responsible persons in your locality who would be prepared to vouch for you) A. ________________________ B. ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I also understand that my candidature is liable to be cancelled in case of any false statement. Date: ___________________ ________________________ Signature Affix Court Fee Stamps here
