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UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM
FOR CISF AC(EXE) LIMITED DEPARTMENTAL COMPETITIVE EXAMINATION, 2022

CISF No : 150200587
Rank : Sub Inspector(GD)
CISF Unit : DMRC DELHI

1. Name | RADHA RAMAN SINGH

2. (a) Address for correspondence to which | CIW OFFICE, CISF UNIT DMRC, SHASHTRI PARK
communication is to be sent |
Post Office: |
District: | NORTH EAST DELHI
State : | DELHI
Pin Code : | 110053
(b) Telephone No. with STD Code | -
(c) Mobile No. | 7382548053
(d) Fax No. |
(e) E-mail address | RADHARAMAN6143@GMAIL.COM
(f) Permanent Postal Address | BANGAON, BAJPATTI
|
Post Office: | BANGAON
District: | SITAMARHI
State : | BIHAR
Pin Code : | 843314

3. Gender : | MALE

4. Marital Status : | UNMARRIED

5. Citizenship : | A CITIZEN OF INDIA(1)

6. State of Domicile : | BIHAR

7. (a) Community | GENERAL (4)

Note 1: Candidates belonging to neither SC nor ST should write 'General' Category(Others) Code No.4'
against the column of community and not leave it blank.'.
Note 2: 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.

8. Date of Birth | 19-01-92

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
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9. Place of Birth :
Town/Village | BANGAON
District | SITAMARHI
State | BIHAR

10. Mother tongue : | MAITHILI

11. Choice of Centre for Examination : | DELHI

12. (a) Language Medium of

Examination for Essay and General
Studies in Paper I and II: | HINDI
(b) Language Medium for
Interview Test : | HINDI

13. (a) Have you passed the requisite qualifying | YES

examination, as specified in Rule-6

(b). Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:-
Examination Class/ Percentage CGPA Year of Subject(s) Name of Name of
Passed Division of Score Out of School/College Board/University
/Grade Marks(%) Passing /Institution
10th or Equivalent 2nd 55 2007 Hindi math science SRPN HIGH BSEB, PATNA
sanskrit social science SCHOOL, BAJPATTI
12th or Equivalent 1st 60 2009 Commerce SRKG COLLEGE, BSEB, PATNA
SITAMARHI
Graduation or 1st 62.62 2012 Commerce SRKG COLLEGE, BRABU,
Equivalent SITAMARHI MUZAFFARPUR

14. Present Unit Where Posted : | DMRC DELHI

15. No of Displeasures : |0

16. No of Warnings : |0

17. (a) Name of Father | SHAMBHU SINGH

(b) Name of Mother | DEZI DEVI
(c) Nationality of Father | A CITIZEN OF INDIA
(d) Nationality of Mother | A CITIZEN OF INDIA
(e) Father's present postal Address | BANGAON
(If deceased give last address) | BAJPATTI
Post Office: |
District: | SITAMARHI
State : | BIHAR
Pin Code : | 843314
(f) Mother's present postal Address | BANGAON
(If deceased give last address) | BAJPATTI
Post Office: |
District: | SITAMARHI
State : | BIHAR
Pin Code : | 843314

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
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(g) Father's Profession: | FARMER
(h) Mother's Profession: | HOUSE MAKER
(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) | NO
(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) | NO
(k) Annual income of your Father | RS.60000
(l) Annual income of your Mother | RS.0
(m) District to which your Father originally| SITAMARHI
belongs
(n) State to which your Father originally | BIHAR
belongs
(o) District to which your Mother originally| DARBHANGA
belongs
(p) State to which your Mother originally | BIHAR
belongs

18. (a) How many times have you appeared in

written examinations of CISF AC-LDCE so far,
including the current Examination in
,2022.(Write 1,2,3
in the opposite box as the case may be) | 3
(b) Appeared during the vacancy Year | 2020, 2021, 2022
Appeared during the vacancy Roll no. | 0800683, 0800002, 0

19. Were you ever Employed : | YES

Details of your employment(in chronological order -till date):-
Designation/ Monthly Whether Name of Place of employment
Position remuneration Permanent/ Period employer/ (Address)
(Total) in Rs. Temporary/ From To Organisation/
Ad hoc etc. Firm/Individual
SUB INSPECTOR 74000 PERMANENT 03-10-2015 Till date CISF DELHI

20. Have you ever been debarred by

any Public Service Commission
or SSC from any of their
Examinations/Selections? | NO

21. Please give Particulars of:-

(a) Particulars of prizes,medals |
scholarships,etc.
(b) Team/Games/Sports/N.C.C. |
/Hitchhiking/Mountaineering etc.
(c) Position(s) of distinction Leadership |
held in School/College
(d) Other extra curricular activities and | WATCHING MOVIES
interests (Such as hobbies etc.)

22. Whether you have been selected or

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
 Page No. 4/8
appeared for U.P.S.C. Examination
/Recruitment:- | NO

23. List of Enclosures sent by the candidate:-

--->Self-Attested/Certified Copy of certificate of Age.
--->Self-Attested/Certified Copy of the certificate of educational qualifications.
--->Certificate from Head of Department / Cadre Controlling Authority, Signed and Verified by it verifying
their eligiblity.
--->Annexure Regarding Details of punishment etc.

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
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DECLARATION TO BE SIGNED BY THE CANDIDATE

I, hereby declare that all statements and entries made in columns 1 to 23 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 12 of the Rules of the examination.
Further certified that I have not availed three chances so far in competing in this examination and
information furnished by me against column 18 is correct.In case at any stage,even after my appointment
(If I am selected to the post) this information is found false or incorrect, my candidature may be
rejected/I may be reverted back to my substantive post, as the case may be, by the competent authority,
without assigning any reason thereof and also competent authority may take any appropriate discipilinary
action against me for furnishing false and incorrect information.
I have read provisions in the Rules and Notice of the Commission carefully and hereby undertake to abide.
Application not signed by the candidate will be rejected. Incomplete application will be also rejected .

* Signature of the Candidate

Place:
Date:

* Application not signed by candidate is liable to rejection.

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
 Page No. 6/8
UNION PUBLIC SERVICE COMMISSION
Certificate to be forwarded for CISF AC(EXE) Limited Departmental Competitive Examination , 2022
Roll No. ______________
(to be given by the UPSC)

1. CISF No :- | 150200587
2. Rank :- | SUB INSPECTOR(GD)
3. Name :- | RADHA RAMAN SINGH
4. Present Unit Where Posted :- | DMRC DELHI
5. Father's Name :- | SHAMBHU SINGH
6. Date of Birth :- | 19-01-92
7. Age as on 01.08.2022 :- | 30 Years
8. Date Of Appointment :- | 03102015
9. Educational Qualification :- | B.COM
10. Category(Gen./SC/ST) :- | GENERAL
11. No of Cash Rewards :- | 0
12. No of Commendations :- | 0
13. No of Punishments :- | As per ANNEXURE
14. No of Displeasures :- | 0
15. No of Warnings :- | 0
*16. No. of Chances of LDCE appeared in writted exam /availed and details thereof :

S.N. Appeared during vacancy Roll No. allotted Remarks

year
1 2020 0800683

2 2021 0800002

3 2022

I, hereby declare that all entries/statements made in columns 1 to 16 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 ineligibility being detected
before or after the examination,action can be taken against me by the Commission as per provisions contained under the
Rules of the Examination .
Further certified that I have not availed three chances so far in competing in this examination and information
furnished by me against column 16 is correct. In case at any stage,even after my appointment (if I am selected to the post)
this information is found false or incorrect, my candidature may be rejected/I may be reverted back to my substantive post, as
the case may be, by the competent authority , without assigning any reason thereof and also competent authority may take
any appropriate disciplinary action against me for furnishing false and incorrect information.
I have read provisions in the Rules and the Notice of the Commission carefully and I hereby undertake to abide.

Note 1 : Application not signed by the candidate will be rejected.

Note 2 : Incomplete application will also be rejected.
Signature of the Applicant
* To be filled by candidate.

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
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CERTIFICATE FROM THE CONTROLLING OFFICER

1. The details like CISF No,Rank, Name, Date of Birth, Date of Appointment, Category, Reward & Punishment, mentioned
in the application have been verified with reference to his/her service record and found correct.
2. He/She has completed 04 years of service as on 01.01.2022 in Rank of SI(GD)/Inspector(GD).
3. No criminal case or DE or other enquiry including sexual harassment is pending.
4. Certified that the Department/Office has no objection in permitting Shri/Smt._____________________ .
for applying to the Post of _______ in CISF.It is further certified that Shri/Smt.____________________ . has not been
awarded / any punishment during his entire service career.
5. His medical categorization for the year 2021 (should be valid upto August 2022) is ____________________ as specified
in CISF circular no (145) dated 28.01.2009. Xerox copy duly self-attested is enclosed.

Place:
Date:

TO BE SIGNED BY HEAD OF OFFICE

( With Stamp )

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
 Page No. 8/8
ANNEXURE
RECRUITMENT OF ACs (GD) IN CISF THROUGH LDCE-2022

Details of Punishments (Major/Minor) in entire service

CISF No :- | 150200587
Rank :- | SUB INSPECTOR(GD)
Name :- | RADHA RAMAN SINGH
CISF Unit :- | DMRC DELHI

S/No Date of Issue of Penalty Date of appeal, Outcome of Date of Penalty

Charge sheet. awarded by if any. apppeal with Revision awarded by
Disciplinary date. Wheather Petition, if any. Revisioning
Authority with exonerated Authority with
date of award. enhanced, or date.
reduced.
01 02 03 04 05 06 07

Signature of the Candidate

Verified by Commander

Signature of the Unit Commander

CISF No. :- 150200587 | This is a Printout of "PREVIEW OF THE FORM".This will not be accepted by
Commission.May take a printout after FINAL SUBMISSION only.
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