TELANGANA STATE LEVEL POLICE RECRUITMENT BOARD TEST PC

(Communications) - 2016
Filled In Online Application
for the posts of Stipendiary Cadet Trainee Police Constable (Communications) (Men & Women)
Basic Details
Aadhar Card Number:
Medium of Written Examination :
Name of the Applicant(as per ssc or equivalent) :
Father/Husbands Name :
Mothers Name :
Gender :
Date of Birth(as per ssc or equivalent) :
Age as on 01-07-2016 :
Community
Do you belong to Section of Creamy Layer/Non-Creamy
Layer
Do you belong to ST and Aboriginal Tribe domiciled In
the agency areas of Adilabad / Khammam / Warangal /
Mahabboobnagar districts
Identification Marks1 :
Identification Marks2 :
Do you belong to State of Telangana :
If No, Which State :

309483020714
ENGLISH
VANKDOTH VINOD KUMAR NAIK
V.GANGU NAIK
V.BHOOLI BAI
Male
12-08-1993
22 years 10 months 20 days
ST
NA

Registration No
3002610

No

a mole on left hand middle finger

a mole on the right cheek
Yes
NA

Educational Details
Educational Qualifications as on 01-07-2016
Furnish to which District of Telangana State you are local

B.TECH-ELECTRONICS AND
INSTRUMENTATION ENGINEERING
WARANGAL

Study details from 4th class to 10th class

Class
4
5
6
7
8
9
10

Month
March
March
March
March
March
March
March

Year
2002
2003
2004
2005
2006
2007
2008

SchoolName
pragathi english medium high school
pragathi english medium high school
pragathi english medium high school
pragathi english medium high school
pragathi english medium high school
bhashyam high school
bhashyam high school

District
WARANGAL
WARANGAL
WARANGAL
WARANGAL
WARANGAL
Other than Telangana
Other than Telangana

Residence details
Year

Address

District

State Government Employee

Are you an employee of Telangana State Government
Date of joining service
Length of service as on (01-07-2016)
Are you still in service

No
NA
NA
NA

State Government Employee working in AP on order to serve basis

Are you an employee of Telangana State and Working in AP on order to
serve basis
Date of joining service
Length of service as on(01-07-2016)
Are you still in service

No
NA
NA
NA

Army/Navy/Air Force
Have you served as an employee in Army/Navy/Air Force
Date of entry
Date of discharge
Total service rendered
Do you claim reservation under Ex-Servicemen Quota
Have you been discharged as on date of notification(19-02-2016)

No
NA
NA
NA
No
NA

If still serving and yet to be discharged after the date of notification (19-02-2016)
Date of entry :
Likely Date of discharge :

NA
NA

NCC Instructor
Have you worked as an Instructor in NCC
Date of entry
Date of discharge
Total service rendered

No
NA
NA
NA

Retrenched employee/widow
Do you a Retrenched temporary employee in the state Census
Department during 1991
Length of service in census department
Are you a widow, divorcee/judicially separated women

No
NA
NA

Special Category
Do you come under any of the Special Category :
Applicable Category :

Yes
CPP

NCC
Certificate

NCC Certificate Issued Date

Children of Police Personnel (CPP)

Date of enrollment of your parent
Name of the Post
Name of the Unit
Is your parent working (or) retired (or) dead as on date of notification (19-02-2016)

13-12-1984
ASSISTANT RESERVE SUB INSPETCOR OF POLICE
TSSP FOURTH BN MAMNOOR CAMP
Working

Home Guard
Are you a Home Guard of Telangana State
Date of enrollment
Home Guard Number
Name of the Unit
No.of days worked as Home Guard (Between 18/02/2014 to 19/02/2016)
Are you still working as Home Guard as on date of notification (19-02-2016)

NA
NA
NA

NA

------------------Are you a Home Guard of Telangana State and working in A.P. State, on order to
serve basis
Date of enrollment
Home Guard Number
Name of the Unit
No.of days worked as Home Guard (Between 18/02/2014 to 19/02/2016)
Are you still working as Home Guard as on date of notification (19-02-2016)

Other Details(etc.,)

NA
NA
NA

NA

Do you have minimum Physical measurements as per Notification :

If you have applied for SCT SI (Civil/AR/SAR/TSSP/SPF/SFO) Mention
the Registration Number :
If you have applied for SCT SI (Communications) Mention the
Registration Number :
If you have applied for SCT SI (PTO) Mention the Registration Number :
If you have applied for SCT PC (Civil/AR/SAR/TSSP/SPF/Firemen)
Mention the Registration Number :

Yes
1020308
NA
NA
464413

Centre for PMT/PET

Centre for attending Physical Measurement Test and Physical Efficiency KARIMNAGAR RANGE
Test :
NOTE:The candidates who applied for SCT SI (Civil/AR/SAR/TSSP/SPF/SFO) OR SCT SI (Communications/PTO) & SCT PC (Communications), the centre for
attending PMT/PET will be one and the same zone. The centre for attending Final Written Examination for SCT PC (Communications) will be HYDERABAD district
only.

Criminal Case Details(etc.,)

Were you involved in any criminal case (s) at any time :
Crime No. & Year :
Name of the PS :
Name of the Dist :
Were you ever arrested by the Police :
If you were prosecuted by the Police in a court of law ,furnish present :
Were you involved in more than one Criminal case :
Total No. of Criminal cases involved :
Were you at any time employed and discharged/
terminated/removed/dismissed from service of the government (whether
during training or later) :
Name of the Post :
Name of the Department :
Date of Discharge/terminated/removal/ Dismissal :
Office address :

No
NA
NA
NA
NA
NA
No

NA
NA
NA
NA

Address for Communication

Name :
C/o :
H.No./colony :
Village :
Mandal :
District :
PinCode :
Mobile No :
Email Id :
SSC RollNo :

v.vinod kumar naik

4,block no 3,new apartments
mamnoor camp,4th bn tssp
Hanamkonda
WARANGAL
506166
8985444457
vankdothvinodkumarnaik@gmail.com
0468107

Payment Details
Transaction id./Reference Id :
Payment Through:
Amount (in Rs.)
Date and Time of Submission :

FHMP4319140147
BillDesk
200
3/1/2016 6:34:20 AM

I hereby declare that I have read the instructions issued in the notification dated 19-02-2016 of the Telangana State Level Police Recruitment
Board carefully and hereby undertake to abide by them. I further declare that I have not been debarred from appearing in any examination.
I declare that I fulfill all the conditions of eligibility regarding Age limits, Education qualifications etc., prescribed in the said notification.
I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand
that in the event of any information being found to be false or incorrect or incomplete and that I have suppressed any information or that I do not
satisfy the eligibility criteria,my candidature for the selection is liable to be rejected or cancelled and even after appointment my services are liable
to be terminated without any notice. I am willing to serve the department anywhere in the State/India if selected.
I declare that I am fully fit to compete in the PMT and PET and other Physical tests and my fitness is certified by the medical practitioner and as I
applied for the posts of PC(Communications) after going through about the physical requirement and other qualification and read the eligibility
criteria.I further declare that I have got myself medically checked up by a certified doctor in this regard, and that if any untoward incident occurs
during the course of PMT,PET or tests I shall be solely responsible and I declare that I am participating in all the above tests on my own accord
and on my own, without any coercion from anybody.
1) I have read all the instructions carefully and I am conversant with the instructions. I shall abide by the eligibility conditions and other regulations to be satisfied for
appearing at the recruitment test. Further, I assure that, I will not involve in any malpractice or illegal activities in the recruitment test. In case, I have furnished any
false information or involved in any malpractice or illegal activities, I am liable for punishment as per the existing law.
2) I am responsible for the correctness of the above details filled in by me and the COORDINATOR, TSLPRB is not responsible in any way.

SIGNATURE and LEFT HAND THUMB Impression of the Applicant to be done in the presence of the
Invigilator on the day of Examination in the Examination Hall
SIGNATURE OF THE Applicant
in the presence of the Invigilator

Note: The Applicants are required to take two print outs of this Filled in Online application form. One copy has to be submitted in the
Exam Hall to the Invigilator and the other has to be retained with the Applicant. 2) Applicants are not allowed into the Exam Hall even if
they are LATE BY A MINUTE. 3) This is a Computer Generated sheet and does not require the Signature of the COORDINATOR,
TSLPRB.