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CENTRAL INDUSTRIAL SECURITY FORCE

APPLICATION FORM FOR RECRUITMENT
OF CT/FIRE-2021
1.)Application Number FIREN2200911345
2.)Post Applied for CT/FIRE
3.)Candidate Name ANSHU KUMAR
4.)Fathers's Name ANIL SINGH

4.)Mothers's Name SUSHMA DEVI

5.)Date of Birth 08-03-2002
6.)Gender male
7.)Nationality INDIAN
8.)Religion HINDU
9.)Category General
10.)State/UT of Domicile BIHAR
11.)District of Domicile GAYA
12.)Highest Educational
12TH
Qualification
13.)Qualifing Educational
12TH
Qualification
14.)Whether seeking age
NO
relaxation
15.)Whether belong to Naxal
NO
affected district?
16.)Belongs to Hill Area NO
17.)(A)Communication
Address: (B)Permanent Address:
52 NAWAGADHI H.No: 52 NAWAGADHI GAYA
H.No:
GAYA Village: NAWAGADHI GAYA
Village: NAWAGADHI GAYA Post: CHAND CHOURA
Post: CHAND CHOURA PS: VISHNUPAD
PS: VISHNUPAD District: GAYA
District: GAYA State: BIHAR
State: BIHAR Pincode:823001
Pincode:823001
18.)Identification Marks: (a)A MOLE OF LEFT HAND

(b)A MOLE ON NOSE

19.)Fee Details: Reference Number CPABLMQPW7
Amount 100.00
Status Success
21.)EX-SERVICEMEN: NO
22.)Have you ever been
convicted by any court of law
NO
or any other judicial
Institution?
23.)Is there any case pending
against you in any court of NO
law?
24.)Has any FIR been lodged
and case is pending against NO
you?
25.)Was any FIR ever lodged
NO
against you in the past?
26.)Have you ever been
dismissed from any service
NO
under the Central or State
Govt.?
27.)Have your services ever
been terminated while on NO
probation?
28.)Have you migrated from
the State/UT of your origin to NO
another State/UT?
29.)Mobile No 9608767376
30.)Email ID? ANSHU95250@GMAIL.COM
31.)Date on which
20-01-2022
Photograph has been taken
32.)Whether the Date
mentioned in the photo is
YES
clearly printed on the
photograph?
 DECLARATION

(i)  I have read the Notice of Examination and accept all the Terms &
Conditions mentioned therein.

(i) I hereby declare that all the statements made in the 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 supressed/false or
incorrect at any stage or ineligibility being detected before or after the
Examination, my candidature/appointment is liable to be cancelled. i am
willing to serve anywhere in india.

       

Singnature