KARNATAKA STATE POLICE

RECRUITMENT - 2014
( ISO : 9001 - 2008 Certified Recruitment Process )
APPLICATION FOR THE POST OF SPECIAL RESERVE POLICE CONSTABLE-K.S.R.P ( MEN & WOMEN)-2014

j Pm - P.J.Dg. (g v ) zU Cf - 2014
Notification No /CZ AS

: 14/Pw-4/2013-14

01.

Name of the Battalion /WlPz g

: 8th Battalion Shimoga

02.

Application No / Cf AS

: 1408817

03.

Name of the Applicant/Cfzgg

g

: PRASHANTH S

04.

Gender / AU

: Male

05.

Email Id / E-

: webzone.smg@gmail.com

06.

Mobile No / AS.

: 9448124818

07.

Mother's Name / vAi g

: VIJAYA

08.

Father's Name / vAzAi g

: SAMY GOWDA D

09.

Address /

: S/O SWAMY GOWDA D

Street /

: 3RD CROSS

Area /

: SHANTHINAGARA

Taluk / vP

: RAGIGUDDA

District / f

: SHIMOGA

State / gd

: KARNATAKA

Pin Code / AS

: 577201

10.

Native District /Av f

: Shimoga

11.

Category / U

: 2A

11a.

Sub Caste / Gew

: kuruba

12.

Are You an Ex-servicemen? / if : No

Pg ?

12a

Height As Per Discharge Certificate

/Jvg, Aid it
vzgAv

: NIL

Service rendered in Army/Air

: NIL
Force/Navy / Aii Ai
Vz(s/Ai/P)

Description

12c. NOC issue date

: NIL

12d. Date of Discharge /Az

AidUAq AP

: NIL

12f. Years of Service rendered / z : NIL

z

12g. Whether availed ex-servicemen benefit : No

previously for any other post in
government / Az AidUAq
Avg if P w qz
Pj zU Pw Agg
13. Only for Ex-servicemen Children ( For : No
children of Ex-servicemen Permanently
disabled or died in action) /if P
PU iv (Pvz vV zP
Pv Cx gt Az Pg
PU)
SlNo

: 25/02/2014

11b. Certificate Issue Date / it v : 19 Nov 2011

vgt AP

12b. Are you presently serving in force ? : NIL

/ Ai wg?
12e.

Date / AP

: NIL

(i)

Death while in service /Pv

U gt Azg.

(ii)

Permanently disabled while in Service : NIL

/ Pv U v Pv
Azg

Remarks
No

Certification issue Date

NIL

14.

P.D.P /Aid gv

15.

Kannada Medium / Pq izs.

Yes

11 Feb 2014

16

Rural/ Ut

No

NIL

1/2

Are you a Govt. Employee ? / Pj : No

17.

Pgg?
: NIL

17b. Years of Service /z

17a. Department / ES

: NIL

17c. NOC issue Date / J.N..,

: NIL

vgt AP

18.

Date of Birth /nz AP

: 29 Mar 1993 ( Your Age to last date of submitting application 27/03/2014 is 21 Years 0
Months 1 Days)
No
Have you been involved in any Criminal :
Case / Department Enquiry? /
Aiizzg Cgzs Pgtz /
ES ZguAi zAiiVg
zVz g

19.

20.

Have you been convicted in a criminal

case ? / Cgzs PzAi
PU Mngg ?

: No

QUALIFICATION DETAILS
21. Are you holder of PUC or Equivalent
Qualification ? / Ai Cx
vvi zv Agg?

: No

21a. Equivalent Qualification, : NIL

if specify / vvi
zv Azg

22a. Educational Qualification / zv

: SSLC - STATE BOARD

22b. Year of Passing /

Gwtgz

: 2008

22c. Maximum Marks / Uj CAPU

: 625

22d. Secured Marks / Uz CAPU

: 292

23e. Percentage /

: 46.72

BANK PAYMENT DETAILS

23.

Date of Challan Generation / Z

fz AP

: 19 Mar 2014

23a.

Fee Paid /wz

23b.

Date of Payment / AzAi

irz AP

: 24-Mar-2014

23c.

Journal No. / d AS

: 1073089

23d.

Bank Branch Code / AP AZ : 40132

Pq

23e.

Bank /AP

: SBM

23f.

Bank Address / AP

: SHIMOGA BRANCH,P B NO 7,B H ROAD,SHIMOGA

24.

Have you submitted any application

for same post in other units /
zj zU Evg WlPU
Cf g

: No

24a.

Application No (Unit) / Cf AS
(WlP)

: NIL

250

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1.

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2.

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3.

F zAi DAiAi V Cf wgz F zAi Ai v AiU MPAqAv DVgvzAz

DAiAiiUz Arg F PwAi Ai v AiU Az F P Wv.

Date

29-Mar-2014 02:10:36 PM

IP

122.166.141.204

U AtV wgvz. Pw QAi Aq

I Agree/ Mgv.
2/2

Candidate's Signature /CsyAi