STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH - 2016

FILLED IN ONLINE APPLICATION FORM

Recruitment for the posts of SCT SI (Civil) (Men & Women)- Post Code No.11,SCT RSI (AR) (Men & Women)-Post Code
No.12, SCT RSI (SAR CPL) (Men) - Post Code No. 13, SCT RSI (APSP) (Men)- Post Code No. 14, Deputy Jailor (Male)Post Code No. 51 and Assistant Matron (Female)-Post Code No. 52, in Prisons and Correctional Services Dept.,-2016,
vide Notification No. 208/R&T/Rect.I/2016, dt:- 17.09.2016.

1.

Candidate's Name

: PUTAKA ANILKUMAR

2.

Father's Name

: PUTAKA PULLAIAH

3.

Mother's Name

4.

Gender

: PUTAKA PUSHPAVATHI
: Male

5.

Date Of Birth

6.

Community

: 01-Jul-1993
: SC

7.

SSC Or Equivalent Roll No.(Hall Ticket No.)

: 0923204104

8.

Educational Qualification

: B.Tech.

9.

Highest Qualification

: Others

Upload Community Certificate(BC/SC/ST)

: Uploaded

(i) If BC-E candidate, caste name

: --

10.

REGISTRATION NUMBER

5095052
Pass Year :

13.

Identification Marks (as per

SSC or Equivalent)

14.

Candidate Mobile No.

: 9492107683

15.

E-mail ID

: putakaanil045@gmail.com

16.

Address for Communication

: 3/145A
ILLURU
GARLADINNE
ANANTAPUR
PIN: 515611
: Yes

2009
11.

1.

: A MOLE ON THE RIGHT FOREFINGER

2.

: A MOLE NEAR THE RIGHT SIDE OF THE EYE

17. Do you have an Aadhar Card

12.

: 403942744130

Aadhar Card No.

18. What is your preferred medium of Exam

: English

19. Which is your preferred place for

writing Preliminary Written Exam

: Anantapuramu

20. Select Post Preference

Preserve the REGISTRATION NUMBER

for all your future correspondence.

1st : 11 - SCT SI (Civil) (Men & Women)

2nd : 51 - Deputy Jailor (Male)
3rd : 14 - SCT RSI (APSP) (Men)
4th : 12 - SCT RSI (AR) (Men & Women)
5th : 13 - SCT RSI (SAR CPL) (Men)

21. Are you presently a local of State of Andhra Pradesh

If Yes, What is your Local District

: Yes
: Anantapuramu

If No, Which State you belong to

: --

If you have selected 'Telangana' as State to which you belong, as per GSR 591E of Govt. of
India, Candidates who migrate from Telangana to Andhra Pradesh with in a period of 3 years
from the 2nd Day of June, 2014 shall be regarded as local candidate in Andhra Prades. Do
you belong to this Category ?

: --

22. Are you an Employee of Govt. of Andhra Pradesh.

: No

23. Do you claim benefit of Age relaxation / Reservation / Physical Events / Under
Ex-Servicemen Quota

: No

24. If you are BC Candidate, you are eligible for reservation quota, if you do not
belong to Creamy Layer

: I do not belong to Creamy Layer

25. Do you claim benefit of Physical Measurement under ABO-ST

: No
: -: --

(i) If Yes, What is your Native District

(ii) What is your Native Scheduled Area
26. Do you claim benefit of Special Reservation under any one or more of the
following categories (for Post Code Nos. 11,12,13,14)

27. Do you claim benefit of special reservation under CJP for Post Code No. 51 (Male)

: No

PE : No
CPP : No

PM : No

MSP : No

CDI : No

NCC : No

28. Do you claim benefit of Age-relaxation under Army, Naval or Air Force of the Union.

: No

29. Do you claim benefit of Age-relaxation under NCC (Worked as Instructor)

: No

30. Do you claim benefit of Age-relaxation under temporary employee in the State Census

: No

31. Fee Paid through : AP Online

: APPRC47EC4FDA4

with a minimum service of 6 months during 1991.

Transaction Id./Reference Id.

Amount (in Rs.) : 300

I Certify that I have read the Notification and I am proceeding to submit this application form after having understood
the eligibility and other criteria mentioned in the Notification. I undertake total responsibility for submitting correct
information to the best of my ability.

Date: 19-Oct-2016 23:02 PM