ARUNACHAL PRADESH PUBLIC SERVICER COMMISSION

ITANAGAR

APLLICATION FORM FOR ADMISSION TO THE RECRUITMENT EXAMINATION FOR THE POST OF AGRICULTURE DEVELOPMENT OFFICER’ 2016

FORM NO. ___________ (For official use) Important instructions 1. Fill the box in Capital letters only. 2. Write with ball pen in the squares. Leave one box gap. 3. Paste your recent colour photograph in the space provided, one on the application form and other on attendance sheet. All the photographs should be self attested on front side. 4. Enclose supporting documents against Column No.5, 6, 8, 9,10,11. 5. All documents should be self attested or attested by Gazetted Officer with proper seal. 6. Applications of those candidates who do not follow the above instructions will be rejected.

1. NAME OF APPLICANT(Give one BOX gap between First/Middle/Surname)

2. FATHER’S/HUSBAND’S NAME

3. POSTAL ADDRESS FOR COMMUNICATION 4. PERMANENT HOME ADDRESS (With State & PIN No.) (With District Headquarter) ___________________________________________ ___________________________________

___________________________________________ ___________________________________

___________________________________________ ___________________________________

____________________________________________ ___________________________________

Tel/Mobile No. ______________________ Tel/Mobile No._______________

5. DATE OF BIRTH

(Attach self attested matriculation Certificate issued from Board/University.)

6. EDUCATIONAL QUALIFICATION : (Attach self attested certificate of B.Sc.( Agriculture Science) )

Cont..to page-2

PIN PIN

Day

Year

Month

Paste here firmly your

recent color passport

size photograph duly

self-attested on the

front side.

NB: Do not pin or staple

.

Page-2

7. NATIONALITY: ______________ 8. Caste/Tribe (Community): ____________ (Attach self attested Certificate)

9. (a) Address of Department : (in case of candidate already in service)

(b) Present Post/Service held :

(c) Date of appointment : (Attach self attested copy of NOC/Intimation letter from his/her HoD)

10. Disability Certificate : (In case of Person with Disability)

11. PRC ( For General Candidate) :

12. APPLICATION FEE : (enclose DD/IPO)

For those form other than obtained from Commission’s Office “Deposited in

the form of _________________(Demand Draft/Indian postal Order) which ever is

applicable to the tune of `________ (in figure)__________________________________

DD/IPO No. ____________________ Date _____________ Bank/Post Office ___________________

13. Have you ever been debarred by Union/ State Service Commission, Yes No (a) Date of debarment : (b) Period of debarment :

14. List of Enclosures/check list:

1. ______________________________ 5. _______________________________

2. _____________________________ 6. ________________________________

3. _____________________________ 7. _________________________________

4. _____________________________ 8. ________________________________

D E C L A R A T I O N

I hereby declare that the statement made by me in this application is complete and correct to the best of my knowledge and belief. I have carefully gone through the advertisement and conditions laid down thereof and also hereby undertake to abide by them. In the event of any information being found false or incorrect before, during and after this examination, the Commission can take action leading to cancellation of my candidature at any stage.

Place: Date:

Signature of the candidate in full with date.

ARUNACHAL PRADESH

PUBLIC SERVICE COMMISSION ITANAGAR

ATTENDENCE SHEET FOR THE POST OF AGRICULTURE DEVELOPMENT OFFICER (ADO)

RECRUITMENT EXAMINATION‘2016 NAME OF THE CANDIDATE…………………………………………………………………(to be filled by candidate)

ROLL NO ………………………………………………….. ( For office use)

Specimen Signature of the Candidate with date

(Sign in the box before submission of application form)

TO BE FILLED UP IN THE EXAMINATION HALL

Sl. No.

Subject and paper Answer-script/ OMR Sheet Bar

Code No.

Candidate’s Signature with

date

Invigilator’s Signature

1

2

3

4

N.B: Candidate’s signature on attendance sheet in the exam hall must be identical with his specimen Signature already appended above.

Signature of the Centre Superintendent.

(For use during Interview)

5 Viva-Voce Signature of candidate with date

Signature of the Duty Officer/Official

Paste here firmly your

recent color passport

size photograph duly

self-attested on the

front side.

(Do not sign on the

face)