APPLICATION FOR RECRUITMENT OF HOSTEL WELFARE OFFICER GR-II VISAKHAPATNAM DIST.,
(To be filled by the candidate)
Photo of the
applicant
duly attested
by the
Gazetted
Officer
Note: (i) Application must be filled up by the candidate in his/her own handwriting
(ii) While filling names & address fill up one letter in each box leaving one box between words.
1. Surname:
Name:
2. Father’s Name /
Husband Name:
3. Postal Address:
Mandal
District:
PIN
Phone No./Cell No.
4. Date of Birth :
(DD-MM-YYYY)
Age as on 1.7.2010(Yrs-Months-Days)
5. Gender (Put tick (√ ) mark
Male
Female
6. Community to which you belong to : (Put tick (√ ) mark)
OC
BC(A)
BC(B)
BC ( C )
BC(D)
7. Do you claim to be a local candidate (Put tick (√ ) mark)
BC(E)
SC
Yes
No
ST
(i) Particulars of study of the candidate in seven years ending with Class X.
Class
Name of the
Place
District
State
Duration
Institution
From
To
th
4
5th
6th
7th
8th
9th
10th
(ii) If the candidate has not studied in any school during the whole or any part of Seven years period
mentioned above, but claims to be a local candidate by virtue period of residence, he/she should submit
the particulars in the following table (certificate of residence in the proforma mentioned in the AnnexureIII shall be encloed
Sl. No.
Village
Mandal
District
Period of Residence
From
To
8. (i)Are you a Physically Handicapped ? (Put tick (√) mark)
(ii) If yes, please mention :
No
(Put tick (√) mark)
Visually Handicapped
Hearing Impaired
(iii) Scriber required (Put tick (√ ) mark)
9. Fees particulars:
Yes
Amount paid
Yes
Ortho.Handicapped
No
Rs.
D.D.No.
Date:
Name of the Bank:
Branch:
10. GENERAL QUALIFICATIONS : Intermediate/ B.Sc./ B.Com./ B.A./ Oriental Title
Sl.
No.
Name of the
Examination
Name of the
Board/University
Optional
Subjects
&
Medium
Register
No.
Optional
Subjects
&
Medium
Register
No.
Marks
Secured
Maximum
Month and
Year of
Passing
Examination
10. PROFESSIONAL QUALIFICATIONS:
Sl.
No.
Name of the
Examination
Name of the
Board/University
Date:
Total Marks
(Theory + Practical)
Secured
Maximum
Month and
Year of
Passing
Examination
Full Signature of the Applicant
DECLARATION
I hereby declare that all information furnished by me in this application is true and correct and
I undertake to produce the original documents at any moment, failing which my candidature
may be cancelled. I am fully aware that furnishing false information will lead to a criminal case
against me, apart from cancellation of my candidature as it amounts to cheating. I am alone
responsible If any wrong entries made by me in the application form.
Date :
Place :
Full Signature of the Applicant
ANNEXURE – I
CERTIFICATE OF RESIDENCE
(To be produced by the candidates who have not regularly studied during the whole or any
part of the relevant 7 years period but claims to be local candidates by virtue of residence)
It is hereby certified :
a) ThatSri/Smt/Kum_____________________________________________________________
S/o., W/o.,D/o., ________________________________appeared for the first time for
SSC Examination in_____________Month of ___________Year.
b) That he/she has not studied in any educational institution during the whole or
part of seven(7) consecutive academic years in which he/she first appeared for
the aforesaid examination.
c)
That in seven(7) years immediately preceding the commencement of the
aforesaid examination he/she resided in the following place (s) namely.
Sl.No.
Village
Mandal
District
Period
1
2
3
4
5
6
7
Office Seal
OFFICER OF THE REVENUE DEPARTMENT
(Not below the rank of Mandal Revenue Officer
In independent charge of a Mandal)
Station :
Date :
*STRIKE OFF WHOLE/PARTS AS THE CASE MAY BE.
ANNEXURE – II
CHECK LIST (Put tick ( √ ) mark)
1) Have you enclosed the following certificates.
a) Attested copies of the Pass Certificates and Mark Memos of Educational
Qualifications prescribed for the post.
YES / NO
b) Attested copy of SSC certificate (or its equivalent)
c)
YES / NO
Attested copy of community Certificates issued by the competent
Authority in case of SC, ST and BC
YES / NO
d) Attested copies of Study Certificate(s) in case of study from
Class IV to X
YES / NO
e)
Annexure – I Certificate of Residence in case of those who have not
Studied in any school up to the class 10th or its equivalent.
YES / NO
f)
Attested copy of certificate of proof of VH/HI/OH as the case may be
YES / NO
g)
Whether Two (2) self addressed and stamped envelops (10” x 4”) are
Enclosed.
YES / NO
2.
Have you affixed your latest photograph on the application
form and on Hall Tickets.
3.
Have all the columns in the application form been filled ?
4.
Have you submitted two latest Passport size Photographs ?
5.
Have you been in possession of required qualification for the post ?
YES / NO
YES / NO
Signature of the Candidate
YES / NO
YES / NO
Signature of the Official incharge of
the application receiving counter
B.C.WELFARE DEPARTMENT, VISAKHAPATNAM DISTRICT
HALL TICKET FOR THE RECRUITMENT OF HOSTEL WELFARE OFFICERS GRADE-II TEST 2011.
(For Office Purpose only)
Date:
Time:
Regd., No.
Examination Centre :
Pass port size
Phote of the
applicant
(to be attested
by any
gazetted
officer
------------------------------------------------------------------------------------------------------------------------------------1.
Name of the Candidate
:
2.
Father’s Name
:
3.
Caste
:
4.
Personal marks of Identification
:
i)
ii)
Signature of the Candidate
(at the time of examination only)
Signature of the Dist.B.C.Welfare
Officer/Member Secretary, DSC,
Visakhapatnam
B.C.WELFARE DEPARTMENT, VISAKHAPATNAM DISTRICT
HALL TICKET FOR THE RECRUITMENT OF HOSTEL WELFARE OFFICERS GRADE-II TEST 2011.
(For Office Purpose only)
Date:
Time:
Regd., No.
Examination Centre :
Pass port size
Phote of the
applicant
(to be attested
by any
gazette
officer
------------------------------------------------------------------------------------------------------------------------------------1.
Name of the Candidate
:
2.
Father’s Name
:
3.
Caste:
:
4.
Personal marks of Identification
:
i)
ii)
Signature of the Candidate
(at the time of examination only)
Signature of the Dist.B.C.Welfare
Officer/Member Secretary, DSC,
Visakhapatnam
INSTRUCTIONS:
1. All the columns should be filled by the candidate in his/her own hand writing
only.
2. In completed/unfilled applications will be summarily rejected.
3. Candidate should enclose attested zerox copies of the certificates.
4. No candidate is allowed to enter the examination hall, 5 Minutes after the
commencement of examination.
5. Total No.of vacancies: 15 ( OC – 5, OC (W) – 3, SC – 2, ST(W) – 1, BC A – 1,
BC B – 1, BCB (W) – 1, OH – 1).
6. Mode of Selection: On the basis of marks secured in written test (objective
type)
7. Written test will be in the standard of Graduation with B.Ed., level (DSC
School Asst., model) consisting of General Studies 75 Marks, covering topics
like polity, Economy, History, Geography, General Science etc., with focus on
Andhra Pradesh, General English 25 Marks, Test of Reasoning 25 Marks and
Current Affairs and aptitude 25 Marks.
8. Duration of the test: 3 Hours.
9. Use blue/black point pen only
10.Any corrections/over writing on the answer sheet, marks will not be awarded.
11.Question papers will be both in English and Telugu language.
12.In the written test, if 2 or more candidates secure same marks, preference shall
be given to the candidate, who is older in age and next preference shall be given
for higher qualification.
13.
Cell phone is strictly prohibited in the exam hall.