TELANGANA STATE PUBLIC SERVICE COMMISSION # HYDERABAD

(GENERAL RECRUITMENT)
Recruitment to the Posts of ASSISTANT EXECUTIVE EINGNEER IN VARIOUS
ENGINEERING SERICES
(General Recruitment)
NOTIFICATION NO: 31/2017
BASIC INFORMATION DATA
(CHECK LIST)
(To be filled by the candidate)

TSPSC ID :

Ref ID : PHOTO OF THE

CANDIDATE
HALL TICKET NO :

DATE OF VERIFICATION: /1/2018

Signature

Name of the Candidate

01 (as per SSC)

Father’s Name
02

Mother’s Name
03

04 Gender Male Female

Date of Birth
( as per SSC) D D M M Y Y Y Y
05

Years Months days

(Age as on 01/07/2017)
06

Date of
Branch/ acquiring
Qualification
Subjects certificate

BE/B.TECH
Qualification
(as on 02/06/2017) As per
07
Notification
Name of the
University :

Official use :
 OC SC ST BC
Community(integrated
Community Certificate A B C D E
Issued by Thasildhar for
08
SC/ST/BC from
Telangana State Govt)

Official use :

VH HH OH

09 PH-Category
Official use :

BC Candidates should Whether non-creamy YES NO

Submit Non Creamy layer certificate produced
Layer certificate as per
G.O.Ms.No:8 of 2014
10 Official use :
&

MemoNo.3009/BCW/
OP/2011, Dt: 18-12-
2015.

If age relaxation is
claimed, specify Whether relevant Certificate
. Years Produced
1) Retrenched Census
Employee (No. of years claimed for YES NO
2) Telangana State relaxation)
11 Govt. Employee
3) N.C.C
4) Ex-Service Men Official use :
5) SC/ST and BC

Class Year District State

IV
Indicate the evidence
(Original Study
V
Certificate to be
produced) OR
12 VI
Residence certificate for
7 yrs. Prior to SSC if
private Study. VII

VIII

IX

Local Zone to which 5th City

6th Zone
belongs Zone Cadre
State Other than
Telangana
Telangana
 Present Employment
details
13
(Government
Employees should
submit NOC)

1.
Other Certificates
14 ( If any )
2.

Declaration

I hereby declare that

i) All the columns filled in by me containing my biodata and other particulars, are true to the best of
my Knowledge.

ii) The certificates such as, my educational qualification, community certificate, date of birth (SSC),
study/residence in support of my claim for local candidature are genuine.

iii) I did not resort to any irregular or improper means in connection with my candidature for
selection.

iv) I am liable for permanent debarment from appearing for the recruitment to be conducted by
TSPSC and other PSCs and also criminal prosecution, if I am found involved in any unfair means
/ malpractice.

15
v) I further declare that the information furnished by me is correct and my candidature shall be
cancelled at any stage if it is found incorrect.

Address.

………………………………………………….

…………………………………………………

…………………………………………………..

Mobile No…………………………………

Place:
Date: Signature of the candidate.

TO BE USED FOR ADMISSION (OFFICIAL USE)

The Candidate Admitted.

Jr. ASST./A.S.O SECTION OFFICER ASST. SECRETARY

DY.SECRETARY