ESE DAF.
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UNION PUBLIC SERVICE COMMISSION
DETAILED APPLICATION FORM
ENGINEERING SERVICES ( MAIN ) EXAMINATION, 2019
Roll No. :
RID:
Branch :
1. Name |
2. (a ) Address for correspondence to which |
communication is to be sent I
Post Office :
City:
District:
State :
Pin Code :
( b ) Telephone No. with STD Code
(c ) Mobile No.
(d ) Fax No.
(e ) E- mail address
(0 Permanent Postal Address
Post Office:
City:
District:
State :
Pin Code :
3. Nationality
4. Gender
5. Marital Status
6. Citizenship
7. State of Domicile
8. (a ) Date of Birth
(b) Age Relaxation claimed
Roll No. :- I
Page No. 2/7
.
9 Place of Birth :
Town/Village
District
State
10. ( a ) Community |
Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC
reservation should indicate their community as 'General Category ( others ) Code No.4'.
.
Note 2: Candidates belonging to neither SC ST nor OBC Communities should write 'General '
Category( Others ) Code No.4' against the column of community and not leave it blank.'.
Note 3: No change in the community status already indicated by a candidate in his / her application form for this
examination will ordinarily be allowed by the Commission.
Note 4: In case you are a 'SC, ST or OBC' candidate, upload a scanned copy of certificate in support of your claim ,
ZL / I U
(f ) Name of the Caste as mentioned in | ()
the Community Certificate and I
Name of the issuing State
.
11 What Languages( including Indian Languages ) can you read/ write or speak ? Give particulars and state the
examination(s ) passed , if any , for each
Read Only Speak Only Read & Speak Read , Write & Examination(s )
Speak passed
12. ( a ) Do you possess the prescribed Educational
Qualification ( Vide rule-6 of the rules of the examination ).
Please upload a scanned copy of the Certificate
if answer is " YES"
( b) Do you have any Educational
Qualification obtained from a foreign
institution ?
.
13 Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:-
Examinution Class/ Percentage CGPA Year of Subject(s ) Name of Name of
Passed Division of Score Out of School/College Board/ University
Passing / Institution
s
—
FTT1
I
******
*
Page No. 3/7
ENGINEERING . ENGINEERING INSTITUTE OF PROUDYOGIKIVI
TECHNOLOGY. SHWAVIDYALAY
RGPV BHOPAL A . BHOPAL . M . P.
Higher Educational Qualifications : Commencing with Post Graduation or equivalent examination
Examination Class/ Percentage CGPA Year of Subject(s ) College Board/ University
Passed Division of Score Out of /Institution
/Grade Marks( % ) Passing
14. ( a ) Were you ever Employed : | YES
Details of your employment of any kindfin chronological order -till date ):-
Designation/ Monthly Whether Period Name of Place of employment
Position remuneration Permanent/ From To employer/ ( Address )
(Total ) in Rs. Temporary/ Organisation/
Ad hoc etc. Firm/Individual
( b ) Your present Employment
.
15 ( a ) Name of Father
( b ) Name of Mother
(c ) Nationality of Father
( d ) Nationality of Mother
(e ) Father's present postal Address
( If deceased give last address )
Post Office:
City:
District:
State :
Pin Code :
(f ) Mother's present postal Address
( If deceased give last address)
Post Office:
City:
Roll N o. I
Page No. 4/7
District:
State :
Pin Code :
(g ) Father’s Profession:
( h ) Mother's Profession:
(i ) If your Father is in service,the post held
by him (if retired, indicate the post held
by him at the time of his retirement )
( j) If your Mother is in service,the post held
by her ( if retired , indicate the post held
by her at the time of her retirement )
(k ) Annual income of your Father
( l ) Annual income of your Mother
( m ) State to which your Father originally |
belongs
( n ) District to which your Father originally
belongs
(o) State to which your Mother originally
belongs
( p) District to which your Mother originally
belongs
.
16 Have you claimed age relaxation
and/or fee exemption as Person
with Benchmark Disability candidates?
(If Yes,upload a scanned copy of
prescribed certificate in support of your claim ),
of your claim ).
. . .
17 Your order of preference against the Services/Posts given below for which you would like to be
considered for appointment. ( Please write your first preference as 1 and second preference as 2 and so on ) .
In case no preference is exercised,then '0' shall be filled against each services(s).
Category : CIVIL ENGINEERING
Name of Services/Post Order of Preference
INDIAN RAILWAY SERVICE OF ENGINEERS
INDIAN RAILWAY STORES SERVICE (CIVIL ENGG POSTS)
CENTRAL ENGINEERING SERVICE
CENTRAL ENGINEERING SERVICE ( ROADS) GR.A (CIVIL ENGG POSTS )
SURVEY OF INDIA GROUP A SERVICE
AEE(CIVIL) IN BORDER ROADS ENGINEERING SERVICE
INDIAN DEFENCE SERVICE OF ENGINEERS
AEE(QS&C ) IN MES SURVEYOR CADRE
Note 1 : No request for addition/alteration in the preferences indicated by a candidate in this application
form will be entertained by the commission.
Roll No.
Page No. 5/7
Note 2 : Candidate is advised to indicate all the Services/Posts (as given in para 2 of Notice ) for which he is eligible
in terms of the Rules in the order of preferences in Col. 17 of his/her application form .In case he/she does not give
any preference for any Services/Posts or does not include certain Services/Posts in Col. 17 of the application form,
it will be assumed that he/she has no specific preference for these Services/Posts and in that event he/she shall be
allocated to any of the remaining Services/Posts in the order as appearing in the notification and in which there are
vacancies after allocation of candidates according to the Services/Posts of their preference.
.
18 Whether you have applied for/been
selected for U.P.S.C. Examination
/ Recruitments earlier:- | YES
Details of other application for Examination/Recruitment held/to be held by UPSC
Name of Examination/ Month and year of Roll. No. Whether you appeared Whether you were
Recruitment Examination / Nam at the recommended for
of the Post for Examination/Interview appointment
Recruitment
.
19 Have you ever been debarred by
any Public Service Commission
or SSC from any of their
Examinations/Selections?
20. Please give Particulars of: -
( a ) Prizes, medals scholarships,etc that
you have been awarded .
. . .
( b) Team Games / Sports / N C C /
Mountaineering etc.
(c ) Position(s) of distinction /leadership
held in School/College
(d ) Other extra curricular activities and
interests (Such as hobbies etc.)
.
21 Person with Benchmark
Disability |
22. List of scanned copies uploaded by the candidate:-
—— > A Scanned Copy of certificate of Age.
> A Scanned copy of the certificates showing his/her educational qualification prescribed in para 3( iii ) of
the Notice of the Examination uploaded on the website of Commission and Rule 6 of the Rules of
Examination published in the Gazette of India dated 26th September, 2018.
.
Roll No :•
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DECLARATION TO BE SIGNED BY THE CANDIDATE
I, hereby declare that all statements and entries made in column 1 to 22 of this application
are true, complete and correct to the best of my knowledge and belief. In the event of any
information being found false or incorrect or ineligibility being detected before or after the
examination,action can be taken against me by the Commission under rule 11 of the
examination notified and published in the Gazette of India dated 26th September, 2018.
I have read the Rules and the instruction carefully and I hereby undertake to abide by them.
* I have informed my Head of Office/Department in writing that I have applied for this
examination.
Signature of the Candidate
Name :
Branch :
Place:
Date:
* Strike of this sentence,if not applicable.
Roll No. I