STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH,

MANGALAGIRI.
FILLED IN ONLINE APPLICATION FORM
For the posts of SCT PCs (Civil) (Men & Women),
SCT PCs (APSP) (Men) in Police Dept.
Vide Notification Rc.No.161/SLPRB/Rect.2/2022, dt: 28.11.2022.

Basic Details
Registration No. 4120897
1. Name of the Candidate
VURITI AKHIL
(as per SSC or Equivalent Certificate)

2. Father's/ Husband's Name V VENKATA RAMANA

3. Gender Male
4. Date of Birth
20-Apr-1996
(as per SSC or Equivalent certificate)

5. SSC/Equivalent Roll No 1138122163

6. Community BC-D

7. Mobile No. 9392366460

8. e-Mail Id akhil.vuritii@gmail.com

Age Relaxation Details

9. As per the information you provided in Column Nos. 9 & 10 in Online Application Form (Stage 1), do you
BC-D
come under the Reservation Quota?
a) Do You come under Creamylayer or Non-Creamylayer I do not belong to Creamy Layer
b) Sub Caste(BC-E Candidates) NA
10. Do you claim benefit of Physical Measurements and age Relaxtion under category of ABO-ST? (Please
NA
go through the Notification)
What is your Native Scheduled Area NA
11. Do you claim age relaxation under category Employee of the A.P. Government? (Please go through the
No
Notification)
i) Date of Joining in Service NA
ii) Length of Service as on 28.11.2022 NA

iii) Are you still in Service NA

12. Do you claim age relaxation under Ex-servicemen and also relaxation in Physical Efficiency Test under
No
Ex-servicemen Category? (Please go through the Notification)
i) Ex-servicemen Joining Date NA
ii) Ex-servicemen Date Of Discharge NA
iii) Total Service rendered NA

13. Are you still working in Army,Navy or Airforce of the Union as on date of notification (28-11-2022)? NA
i) Date of Entry in Service NA
ii) Likely date of discharge NA
14. Do you claim age relaxation for having worked as an instructor in NCC? (Please go through the
No
Notification)
i) Date of Entry NA
ii) Date of Discharge NA

iii) Total Service rendered NA

15. Do you claim age relaxation for having Employed in the State Census Department during 1991? (Please
No
go through the Notification)

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If yes, Length of Service in Census Department during 1991 (in Days) NA
16. Do you claim age relaxation under Home Guard Category? (Please go through the Notification)
No
You may note that this is Applicable to Home Guard Working in Andhra Prasesh State Government
i) Name of the Unit NA
ii) Date of enrollment NA
iii) No of years since enrollment NA
iv) No. of days worked as Home Guard between 28.11.2020 to
NA
28.11.2022
v) Are you still working as Home Guard in AP as on 28.11.2022? NA
17. Do you claim age- relaxation under Widow, Divorcee/Judicially separated women? NA
i) If widow, furnish the Date of death of the Spouse NA
ii) If divorced women or judicially separated from her husband,
NA
inform the date of divorce or date of Judicial Separated
18. Do you claim age relaxation and Reservation under EWS Category? (Please go through the Notification) NA
Date of issuing the EWS certificate NA
Special Representation Details
19. Do you claim benefit of Special Representation for the post code nos. 21 & 23 No

I) If yes, furnish the applicable category NA

a). Furnish the details if you claim Special Representation under the Meritorious Sports Person Quota? (You should satisfy the
conditions as given in the Notification)
Meritorious Sports Persons-1 NA Name of the Sport / Game-1 NA
Meritorious Sports Persons-2 NA Name of the Sport / Game-2 NA
Meritorious Sports Persons-3 NA Name of the Sport / Game-3 NA
b). Furnish details of your parent if you claim Special Representation under Children of Police Personnel (CPP) Quota?
i) Date of enrollment of your parent NA
ii) Name of the post NA
iii) Name of the Unit NA
iv) Was your parent 'working' or 'retired' or 'dead' as on 28.11.2022 NA
c). For Children of Deceased & Incapacitated (CDI) Police Personnels due to violent action of extremists/Criminals/ Anti-Social
elements & retired on medical invalidation while on duty only. Furnish details of your parent if you claim Special Representation
under CDI Quota?
i) Date of enrollment of your parent NA
ii) Name of the post NA
iii) Name of the Unit NA
iv) Is your parent dead or retired on medical invalidation as on
NA
28.11.2022
d). Furnish the details if you claim Special Representation under NCC ( NCC-A, NCC-B, NCC-C) Quota?
Date on which the Certificate was
NCC-A NA NA
obtained
Date on which the Certificate was
NCC-B NA NA
obtained
Date on which the Certificate was
NCC-C NA NA
obtained
e).Furnish details if you claim Special Representation under Home Guard Quota? (HG) (those who are working in Andhra
Pradesh Government only)
i) Name of the Unit NA
ii) Date of enrollment NA
iii) No.of years since enrollment NA

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iv) No. of days worked as Home Guard between 28.11.2020 to
NA
28.11.2022
v) Are you still working as Home Guard in AP as on 28.11.2022 NA
Other Details
20. Which is your preferred place for writing Final Written Test?
1st Preference Visakhapatnam
2nd Preference kakinada
3rd Preference Guntur
21. Have you been involved in any Criminal case till today? No
Number of Criminal cases you were involved.
1.Crime No. & Year NA & NA
Name of the Police Station NA
Name of the District NA
Were you arrested by the Police in this case? NA

Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

2.Crime No. & Year NA & NA
Name of the Police Station NA
Name of the District NA
Were you arrested by the Police in this case? NA
Were you prosecuted by the Police in this case? NA
Furnish the present stage of the case. NA
3.Crime No. & Year NA &NA
Name of the Police Station NA
Name of the District NA
Were you arrested by the Police in this case? NA
Were you prosecuted by the Police in this case? NA
Furnish the present stage of the case. NA

4.Crime No. & Year NA &NA

Name of the Police Station NA
Name of the District NA
Were you arrested by the Police in this case? NA
Were you prosecuted by the Police in this case? NA
Furnish the present stage of the case. NA
5.Crime No. & Year NA & NA
Name of the Police Station NA
Name of the District NA
Were you arrested by the Police in this case? NA
Were you prosecuted by the Police in this case? NA

Furnish the present stage of the case. NA

22. Were you at any time employed and dismissed from service of the State or Central Government or
from the Service of any Central or State Government undertaking or local body or other authority ? No
(whether during training or later)

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Name of the Post NA

Name of the Department NA

Date of declaration of Probation NA
Date of Dismissal NA

Office Address NA
Post Preference Details
23. As per information provided by you in Column no. 22 In online application form (stage 1), Post Preferences
Preference Order Name of the Post
1st Preference SCT PC (Civil) (Men & Women)
2nd Preference SCT PC (APSP) (Men)
24. Indicate the Units you prefer in the event of selection for posts of SCT PC (Civil) (Men and Women)- Post Code-21 (Please
mention Unit Name in the order of preference mentioned below)
Preference Order Name of the Unit
1st Preference Visakhapatnam City
2nd Preference Visakhapatnam Rural
3rd Preference Vizianagaram
4th Preference Srikakulam
5th Preference East Godavari District
6th Preference Rajamahendravaram Urban
7th Preference West Godavari District
8th Preference Krishna
9th Preference Vijayawada City
10th Preference Guntur Urban
11th Preference Guntur Rural
12th Preference Prakasam
13th Preference S.P.S. Nellore
14th Preference Kurnool
15th Preference Kadapa
16th Preference Ananthapuramu
17th Preference Chittoor
18th Preference Tirupati Urban
25. Indicate the Units you prefer in the event of selection for posts of SCT PC (APSP) (Men)- Post Code-23 (Please mention Unit
Name in the order of preference mentioned below)
Preference Order Name of the Unit

1st Preference IRB Etcherla of Srikakulam District

2nd Preference IRB Rajamahendravaram

3rd Preference IRB Maddipadu of Prakasham Dist.

4th Preference IRB Chittoor

Study details
26. Are you a Local or Non-Local Candidate? Yes If Yes, which is your Local District? Visakhapatnam
27. Did you migrate from the State of Telangana to
No You have Migrated to which District? NA
Andhra Pradesh?
Date of Issue of Migration Certificate. NA
28. To Justify column 44 i.e Local status furnish the Whether Regular Study / Residence Details? Regular studies

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(a)To Justify your claim, furnish your Study/Residence details as applicable from 4th to 10th Class:
Sno Class Month Year School Name / Residential Address Name of the District
1 4th Class 6 2004 SFS SCHOOL Visakhapatnam

2 5th Class 6 2005 SFS SCHOOL Visakhapatnam

3 6th Class 6 2006 BHASHYAM PUBLIC SCHOOL Visakhapatnam

4 7th Class 6 2007 BHASHYAM PUBLIC SCHOOL Visakhapatnam

5 8th Class 6 2008 BHASHYAM PUBLIC SCHOOL Visakhapatnam

6 9th Class 6 2009 BHASHYAM PUBLIC SCHOOL Visakhapatnam

7 10th Class 6 2010 BHASHYAM PUBLIC SCHOOL Visakhapatnam

The following relevant ORIGINAL DOCUMENTS along with one set of Xerox copies will be submitted by me when I appear for
PMT/PET. I understood the instructions given in the Notification
a) Secondary School/Matriculation certificate or equivalent certificate in support of the date of birth.

b) Educational qualification: The candidate must have passed, as on 1st July, 2022, Intermediate or its equivalent examination
recognised by the State Government.
In the case of a candidate belonging to Scheduled Caste or Scheduled Tribe, as on 1st July, 2022, he/she must have passed
SSC or its equivalent Examination recognised by the State Government and should have studied Intermediate and appeared for
the Intermediate Examinations of 1st year and 2nd year.

c) A candidate belonging to Scheduled Caste or Scheduled Tribe, who did not pass the Intermediate or its equivalent examination but
passed SSC or its equivalent examination and studied Intermediate and appeared for the Intermediate Examination, must submit the
Memorandum of Marks of both the 1st and 2nd year Intermediate Examinations
d) A candidate belonging to the Open Category (OC), who wish to claim concession in age and reservation specified for the EWS
category, should submit the said Certificate issued by the competent authority as specified (Para no. 11 in the Notifiation).

e) A candidate belonging to the Backward Class, who wish to claim concession in age and also reservation specified for the Backward
Classes, must submit the LATEST Community & Date of Birth Certificate and Certificate of Non Creamy Layer issued by the
competent revenue authority as specified.
f) A candidate belonging to Scheduled Caste or Scheduled Tribe, who wish to claim concession in age and also reservation specified
for the SCs/STs, must submit the LATEST Community & Date of Birth Certificate issued by the competent authority as specified.
g) Certificate from the competent authority in respect of State Government employees/those who worked in the Army, Navy or Air
Force of the Indian Union/NCC Instructors/ retrenched temporary employees in the State Census Department during 1991 for
claiming age relaxation.
h) Residence certificate in the agency area from the competent authority in respect of candidates belonging to Scheduled Tribes and
Aboriginal Tribes in the agency area who claim relaxation in Physical Measurements or reservation.
i) Study certificate issued by the School authorities or Residence certificate (in case the candidate has not studied in any Educational
Institution preceding to SSC/Matriculation or equivalent (Private study)) issued by Tahasildar of the concerned Mandal, for
determining local status.

j) Home Guards Service Certificate/Certificate of CPP/Certificate of CDI issued on or after the date of notification, wherever applicable.

k) Ex-servicemen certificate / Meritorious Sports Persons Category (a), (b) or (c) Certificate / NCC ‘A’, ‘B’ or ‘C’ certificate etc.,
wherever applicable.
l) A candidate claiming age relaxation by virtue of being either a widow or a divorcee or a woman judicially separated from her
husband, and who has not remarried, should produce the relevant documentary evidence (Para 13 (B) (b)(vii) In the Notification).

m) Migration certificate i.e. candidate who migrated to any part of the State of Andhra Pradesh from the State of Telangana within a
period of seven years from the 2nd day of June, 2014 shall submit relevant certificate in order to claim local candidate status (Para
No. 21 in the Notification).

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