Annexure – II AINSTRUCTIONS FOR FILLING UP THE APPLICATION

I. The Commission uses standard application form for all its examinations.Therefore, please read the instructions given in the Notice of Examinationand also given below carefully before filling up the application form, inyour own interest.

II. Use only blue/black ball pen to write in the boxes, i.e.,

III. Instructions have been given for most items in the application itself whichshould be gone through carefully before filling up the boxes. For itemsfor which instructions are not available, further instructions given belowmay be gone through carefully.

IV. Please go through the instructions given below for filling up each itemnumbered in the application form:-

V. Request for change/correction in any particulars in the Application Form,once submitted, will not be entertained under any circumstances.

1. Name of the Examination Centre and 2. Centre CodesRefer to para-11 of the Notice of the Examination.

12.1. Code for seeking age relaxation.Refer to para 6 of the Notice of the Examination.

13. Preference for Posts‘P’ for Postal Assistant/Sorting Assistant Grade Pay Rs. 2400 forDepartment of Post.

‘D’ for Data Entry Operator Grade Pay Rs. 2400‘E’ for Data Entry Operator Grade Pay Rs. 1900‘L’ for Lower Division Clerk Grade Pay Rs. 1900

You are advised to be careful in exercising your preference as in theevent of your getting selected for both the posts, you will be consideredfor the posts in the order of your merit and preference for each post.Youare also advised that you will not be considered for posts for which youhave not excercised option.

15 VH candidates and such PH candidates as are entitled to scribes shouldspecify the medium in which they desire to take the Written Examination.Scribes will be arranged by the Commission accordingly.

16. If a Candidate belongs to one of the minority communities notified byGovt. namely Muslims, Christians, Sikhs, Buddhists, or Zoroastrians(Parsis), Write Code-08.

17. Educational Qualification and Subject Code: See Annexure – XUse ‘Others’ if any particular Educational Qualification or Subject is notassigned a code.

19. Address for communication

Write your complete communication address including your Name inEnglish in capital letters or in Hindi with blue/black ball pen. Do not forgetto write 6 digit PIN in the boxes.

20IMPORTANT: It is in the interest of the candidate to furnish e-mail ID and/ormobile number to enable the Commission at its option, to send call letter andany other information.

20. PhotographPaste your recent photograph of size 4cmx5cm as per specification inPara 14 of the Notice. Do not staple and do not get the photo attested.Please note that your application shall be rejected summarily withoutphotograph.

Box for Roll Number to be left unfilled (blank) by the candidate.

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Annexure-II B

Procedure for Online Submission of Application

Note: The facility of online Registration will be available from13.06.2015 to 13.07.2015 (upto 5:00 PM).

1. Online submission of the application may be made at websitehttp://ssconline.nic.in and http://ssconline2.gov.inInstructions are available at the site. Candidate should read theinstructions carefully before making any entry or selecting options.Candidate should supply all the required details while filling up theonline form. Mandatory fields are marked with * (asterisk) sign.

2. In registration, candidate will have to fill basic information. Onsubmission of details, candidate will be prompted to check thedetails and make any correction in the application.

3. Candidate may press “I agree” button after declaration oncehe/she finds that information supplied by him/her is in order andno correction is required. Thereafter no correction/modificationetc. will be allowed.

4. Then a page with Registration No. shall be generated. Note downregistration number or take out the print out of the page. Theapplication procedure is incomplete without payment, uploading ofphotograph and scanned signature.

5. Candidates who have to pay application fee can pay fee onlinethrough SBI Challan /Net banking and any credit and debit cards.

6. To pay fee in cash, candidate should take print out of challangenerated online after completion of registration. Candidate maygo to nearest SBI branch for depositing fees after 24 hours ofsubmission of online form.

7. Those who want to pay online through SBI Challan /Net bankingand any credit and debit cards, can go directly after submission ofform.

8. Those who are exempted from payment of fee can skip steps 5 to6.

9. Then upload a recently taken scanned photograph in 8 – bit JPGformat. The digital size of the file must be less than 12 kb andgreater than 4 kb and of resolution 100 pixel widths by 120 pixelsheight.

10.Then upload your scanned signature in JPG format. The digitalsize of the file must be less than 12 kb and greater than 4 kband of resolution 100X120 (Pixel).

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11.Emails will be received by the candidates on completion ofRegistration. Copy of email may be retained to produce before theRegional Office in the event of any discrepancy.

12.Candidates are advised to go through the instructions carefullybefore filling up the application form.

13.Request for change/correction in any particulars in the ApplicationForm (both Online/Offline) shall not be entertained under anycircumstances. The Staff Selection Commission will not beresponsible for any consequences arising out of non acceptanceof any correction/addition/deletion in any particular filled inapplication form whatever the reasons may be.

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ANNEXURE-III

FORM OF CERTIFICATE TO BE SUBMITTED BY CENTRALGOVERNMENT CIVILIAN EMPLOYEES SEEKING AGE-

RELAXATION

(To be filled by the Head of the Office or Department in which thecandidate is working).

(Please see Para 6 of the Notice)

It is certified that *Shri/Smt./Km. _____________________is a Central

Government Civilian employee holding the post of _________ in the

pay scale Of ________________ with 3 years regular service in the

grade as on closing date (i.e. 13.07.2015).

Signature : _______________Name: _______________

Office seal

Place:Date :

(*Please delete the words which are not applicable.)

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ANNEXURE- IV

Form of Certificate for serving Defence Personnel (Please see Para-6 ofNotice for the Examination)

I hereby certify that, according to the information available with me

(No.) __________________________________ (Rank)

___________________ (Name) ___________________________ is

due to complete the specified term of his engagement with the Armed

Forces on the (Date) ____________________.

Place:(Signature of Commanding

Officer)Date:

Office Seal:

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ANNEXURE-V

UNDERTAKING TO BE GIVEN BY THE CANDIDATE COVERED UNDERPARA 6 OF NOTICE.

I understand that, if selected on the basis of the recruitment/examinationto which the application relates, my appointment will be subject to myproducing documentary evidence to the satisfaction of the AppointingAuthority that I have been duly released/retired/discharged from theArmed Forces and that I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex-Servicemen Re-employment in Central CivilServices and Posts rules, 1979, as amended from time to time.

I also understand that I shall not be eligible to be appointed to a vacancyreserved for Ex-S in regard to the recruitment covered by thisexamination, if I have at any time prior to such appointment, secured anyemployment on the civil side (including Public Sector Undertakings,Autonomous Bodies/Statutory Bodies, Nationalized Banks, etc.) byavailing of the concession of reservation of vacancies admissible to Ex-S.

I further submit the following information:a) Date of appointment in Armed Forces __________________b) Date of discharge ____________________c) Length of service in Armed Forces __________________d) My last Unit / Corps ____________________

(Signature of the Candidate)

Place:Date:

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ANNEXURE-VIFORMAT FOR SC/ST CERTIFICATE

A candidate who claims to belong to one of the ScheduledCaste or the Scheduled Tribes should submit in support of his claim anattested/certified copy of a certificate in the form given below, from theDistrict Officer or the sub-Divisional Officer or any other officer asindicated below of the District in which his parents(or surviving parent)ordinarily reside who has been designated by the State Governmentconcerned as competent to issue such a certificate. If both his parentsare dead, the officer signing the certificate should be of the district inwhich the candidate himself ordinarily resides otherwise than for thepurpose of his own education. Wherever photograph is an integral partof the certificate, the Commission would accept only attestedphotocopies of such certificates and not any other attested or truecopy.

(The format of the certificate to be produced by ScheduledCastes and Scheduled Tribes candidates applying for appointment toposts under Government of India)

This is to certify that Shri/Shrimati/Kumari*__________________________ son/daughter of___________________________________ of village/town/* inDistrict/Division *_______________________ of the State/UnionTerritory* _________belongs to the Caste/Tribes_______________ which is recognized asa Scheduled Castes/Scheduled Tribes* under:-

The Constitution (Scheduled Castes) order, 1950___________________

The Constitution (Scheduled Tribes) order, 1950 ________________The Constitution (Scheduled Castes) Union Territories order, 1951 *_______________ The Constitution (Scheduled Tribes) UnionTerritories Order, 1951*______________

As amended by the Scheduled Castes and Scheduled TribesLists(Modification) order, 1956, the Bombay Reorganization Act, 1960& the Punjab Reorganization Act, 1966, the State of Himachal PradeshAct 1970, the North-Eastern Area(Reorganization) Act, 1971 and theScheduled Castes and Scheduled Tribes Order(Amendment) Act,1976.

The Constitution (Jammu & Kashmir) Scheduled Castes Order,1956___________

The Constitution (Andaman and Nicobar Islands) Scheduled TribesOrder, 1959 as amended by the Scheduled Castes and ScheduledTribes order (Amendment Act), 1976*.

27The Constitution (Dadra and Nagar Haveli) Scheduled Castes order

1962.The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order

1962@.The Constitution (Pondicherry) Scheduled Castes Order 1964@The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967 @The Constitution (Goa, Daman & Diu) Scheduled Castes Order,

1968@The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @The Constitution (Nagaland) Scheduled Tribes Order, 1970 @The Constitution (Sikkim) Scheduled Castes Order 1978@

The Constitution (Sikkim) Scheduled Tribes Order 1978@The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@The Constitution (SC) orders (Amendment) Act, 1990@The Constitution (ST) orders (Amendment) Ordinance 1991@The Constitution (ST) orders (Second Amendment) Act, 1991@The Constitution (ST) orders (Amendment) Ordinance 1996The Scheduled Caste and Scheduled Tribes

Orders(Amendment)Act,2002The Constitution (Scheduled Caste) Orders (Amendment) Act,2002The Constitution (Scheduled Caste and Scheduled Tribes)

Orders(Amendment)Act,2002The Constitution (Scheduled Caste) Order (Amendment) Act,2007%2. Applicable in the case of Scheduled Castes, Scheduled Tribes

persons who have migrated from one State/Union TerritoryAdministration.

This certificate is issued on the basis of the Scheduled Castes/Scheduled tribes certificate issued to Shri/Shrimati_____________________Father/mother__________________________ ofShri/Srimati/Kumari*__________________________ ofvillage/town*___________________________ in District/Division* __________________of theState/Union Territory*________________ who belong to the_________________________________ Caste/Tribe which isrecognized as a Scheduled Caste/Scheduled Tribe in the State/UnionTerritory* issued bythe_______________________________dated____________________________.Shri/Shrimati/Kumari and /or * his/her family ordinarily reside(s) invillage/town*_______________________________________of________________ District/Division* _________________of theState/Union Territory of ____________________________

Signature__________________________** Designation________________________

(with seal of office)Place______________Date_______________

28* Please delete the words which are not applicable@ Please quote specific presidential order% Delete the paragraph which is not applicable.NOTE: The term ordinarily reside(s) used here will have the samemeaning as in section 20 of the Representation of the People Act,1950.** List of authorities empowered to issue Caste/Tribe Certificates:(i) District Magistrate/Additional District Magistrate/Collector/DeputyCommissioner/Additional Deputy Commissioner/Dy.Collector/Ist ClassStipendiary Magistrate/Sub-Divisional Magistrate/Extra-AssistantCommissioner/Taluka Magistrate/Executive Magistrate.(ii) Chief Presidency Magistrate/Additional Chief PresidencyMagistrate/Presidency Magistrate.(iii) Revenue Officers not below the rank of Tehsildar.(iv) Sub-Divisional Officers of the area where the candidate and/orhis family normally resides.NOTE: ST candidates belonging to Tamil Nadu state should submitcaste certificate only from the revenue divisional officer.

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ANNEXURE-VII

(FORM OF CERTIFICATE TO BE PRODUCED BY OTHERBACKWARD CLASSES APPLYING FOR APPOINTMENT TOPOSTS UNDER THE GOVERNMENT OF INDIA)

This is to certify that Shri /Smt./Kumari

_________________________son/daughter of

_______________________________ of village/town

_________________________

in District/Division ___________________________ in the

State/Union Territory ____________________________ belongs to

the __________________ Community which is recognized as a

backward class under the Government of India, Ministry of Social

Justice and Empowerment’s Resolution No.

_________________________ dated _________________*.

Shri/Smt./Kumari __________________________ and/or his/her family

ordinarily reside(s) in the ______________________ District/Division of

the ____________________________ State/Union Territory. This is

also to certify that he/she does not belong to the persons/sections

(Creamy Layer) mentioned in Column 3 of the Scheduled to the

Government of India, Department of Personnel & Training O.M. No.

36012/22/93-Estt (SCT) dated 8.9.1993**.

District Magistrate

Deputy Commissioner etc.

Dated:

Seal:

* The authority issuing the certificate may have to mention the details

of Resolution of Government of India, in which the caste of the

candidate’s is mentioned as OBC.

** As amended from time to time.

Note: The term ”Ordinarily” used here will have the same meaning as inSection 20 of the Representation of the People Act,1950.

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Annexure-VIII (FORM-II)

DISABILITY CERTIFICATE(IN CASE OF AMPUTATION OR COMPLETE PERMANENT PARALYSIS

OF LIMBS AND IN CASES OF BLINDNESS)(See rule 4)

Recent PP sizeAttestedPhotograph(showing faceonly) of theperson withdisability

(NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THECERTIFICATE)Certificate No. Date:

This is to certify that I have carefully examined

Shri/Smt/Kum_______________Son/wife/daughter of Shri

____________________________ Date of Birth________________ Age

_______________ years, male/Female___________

(DD/MM/YY)

Registration No.___________________ permanent resident of Home

No._____________________

Ward/Village/Street____________________Post Office_______________

District_____________

State____________________.

Whose photograph is affixed above, and an satisfied that :

(A) he/she is a case of:

locomotor disability

blindness

(Please tick as applicable)

the diagnosis in his/her case _____________________________

(A) He/She has __________________________% (in

figure)___________________ percent(in words) permanent physical

impairment/blindness in relation to his/her__________________(part of body)

as per guidelines(to be specified).

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2. The applicant has submitted the following document as proof of residence:-

Nature of Document Date of Issue Details of authority

issuing certificate.

(Signature and Seal of Authorised Signatory of

notified Medical Authority)

Signature/Thumbimpression of the person inwhose favour disabilitycertificate is issued.

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Annexure-VIII (FORM-III)

DISABILITY CERTIFICATE(In Case of Multiple disabilities)

(NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THECERTIFICATE)

(See rule 4)Recent PP sizeAttestedPhotograph(showing faceonly) of the personwith disability

Certificate No. Date:

This is to certify that I have carefully examined

Shri/Smt/Kum____________Son/wife/daughter of Shri

_______________________________Date of Birth_________Age

_______________ years, male/Female________ (DD/MM/YY)

________________________ Registration No. _________________ permanent

resident of Home No.________________ Ward/Village/Street ______________Post

Office__________ District___________State____________ whose photograph is

affixed above, and are satisfied that :

(A) He/She is a Case of Multiple Disability. His/her extent of permanent

physical impairment/disability has been evaluated as per guidelines(to be

specified) for the disabilities ticked below, and shown against the relevant

disability in the table below:

S.No.

Disability Affectedpart ofthe body

Diagnosis Permanent physicalimpairment/mentaldisabilities(in %)

1. Locomotor disability @

2 Low vision #

3. Blindness Both

Eyes

4. Hearing impairment $

5. Mental retardation X

6. Mental-illness X

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(B) In the light of the above, his/her over all permanent physical

impairment as per guidelines ( to be specified) is as follows:-

In figure___________________ percent.

In words:_____________________________________________________ percent.

2. This condition is progressive/non progressive/likely to improve/not likely to

improve.

3. Reassessment of disability is:

(i) not necessary

Or

(ii) is recommended/after ____________ years___________ months, and

therefore this certificate shall be valid till ____________

(DD) (MM) (YY)

@ e.g. Left/Right/both arms/Legs

# e.g. Single eye/both eyes

$ e.g. Left/Right/both ears.

4. The applicant has submitted the following document as proof of residence.

Nature of Document Date of issue Details of authority

issuing certificate

5. Signature and seal of the Medical Authority

Name and seal of Member Name and seal of Member Nameand seal of the

Chairperson

Signature/Thumbimpression of theperson in whosefavour disabilitycertificate isissued.

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Annexure-VIII (FORM-IV)

DISABILITY CERTIFICATE(In case other than those mentioned in Forms II and III)

(NAME AND ADDRESS OF THE MEDICAL AUTHORTIY ISSUING THECERTIFICATE)

(See rule 4)

Recent PP sizeAttestedPhotograph(showing faceonly) of the personwith disability

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt/Kum

_______________Son/wife/daughter of Shri __________ Date of Birth________

(DD/MM/YY) Age _________years, male/Female___________ Registration

No._____________ permanent resident of House No._____________________

Ward/Village/Street _________ Post Office_______________

District_____________State__________Whose photograph is affixed above, and an

satisfied that he/She is a Case of _________________disability. His/her extent of

percentage physical impairment/disability has been evaluated as per guidelines(to

be specified) for the disabilities (to be specified) and is shown against the relevant

disability in the table below:-

S.No.

Disability Affectedpart ofthe body

Diagnosis Permanent physicalimpairment/mentaldisabilities(in %)

1. Locomotor disability @

2 Low vision #

3. Blindness Both

Eyes

4. Hearing impairment $

5. Mental retardation X

6. Mental-illness X

(Please strike out the disabilities which are not applicable)

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2. The above condition is progress/non progress/likely to improve/not

likely to improve.

3. Reassessment of disability is:

(i) not necessary Or

(ii) is recommended/after _______ years_______on ths, and therefore this

certificate shall be valid till_________ ________ _______

(DD) (MM) (YY)

@ e.g. Left/Right/both arms/Legs

# e.g. Single eye/both eyes

$ e.g. Left/Right/both ears.

4. The applicant has submitted the following document as proof of residence.

Nature of Document Date of issue Details of authority

issuing certificate

(Authorised Signatory of notified

Medical Authority

(Name and Seal)(Countersignature and seal of the CMO/Medical

Superintendent/Head of Government Hospital, in casethe certificates issued by a medical authority who is

not a permanent servant(with seal)

Note: In case this certificate is issued by a medical authority who is not agovernment servant, it shall be valid only if countersigned by the ChiefMedical Officer on the District.”

Signature/Thumbimpression of theperson in whosefavour disabilitycertificate is issued.

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ANNEXURE-IX

GOVERNMENT OF INDIA

FORM OF MEDICAL CERTIFICATE TO BE PRODUCED BY THEPHYSICALLY HANDICAPPED CANDIDATES WHO SEEK EXEMPTIONFROM APPEARING IN THE TYPEWRITING TEST FOR LOWER DIVISIONCLERK.

This is to certify that Sh/Smt/Kum_________________________son/daughter/wife of Shri______________issuffering from ________________.

Clinical diagnosis as a result of which he/she has the following disabilities.(Brief description of his/her disabilities)---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Photograph of candidate clearly showingFace with affected portion of thebody

_______________________________

This is a permanent disability and the extent of his/her disability works to ____% ofdisability.

This disability is likely to interfere with Typewriting (specify)

--------------------------------------------------------------------------------------------------------------------------------------------

Signature of candidate Signature of CivilSurgeon

Name:Place:Official Stamp:

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ANNEXURE - X

Essential Educational Qualification Code

Educational Qualification CodeMatriculation 01Intermediate/Higher Secondary 02Certificate 03Diploma 04BA 05BA (Hons.) 06B. Com. 07B.Com. (Hons.) 08B.Sc. 09B.Sc. (Hons.) 10B. Ed. 11LLB 12BE 13B. Tech 14AMIE (Part A & Part B) 15B.Sc. (Engg.) 16BCA 17BBA 18Graduation issued by Defence (Indian Army, Air Force,

Navy)19

B. Lib. 20B. Pharm. 21ICWA 22CA 23PG Diploma 24MA 25M.Com. 26M. Sc. 27M.Ed. 28LLM 29ME 30M. Tech. 31M. Sc. (Engg.) 32MCA 33MBA 34Others 35

38Subject Code for Educational Qualification

Subject of Educational Qualification CodeHistory 01Political Science 02Economics 03English Literature 04Hindi Literature 05Geography 06Commerce 07Law 08Physics 09Chemistry 10Mathematics 11Statistics 12Botany 13Zoology 14Agriculture Science 15Civil Engineering 16Electrical Engineering 17Mechanical Engineering 18Electronics Engineering 19Electronics & Power Engineering 20Electronics & Communication Engineering 21Electronics & Instrumentation Engineering 22Agriculture Engineering 23Computer Science 24Computer Application 25Information Technology 26Library Science 27Accountancy 28Work Accountancy 29Business Administration 30Mass Communication 31Journalism 32Mass Communication & Journalism 33Pharmacy 34Photography 35Printing Technology 36Nursing 37Assamese 38Bengali 39Malyalam 40Telgu 41Kannada 42Tamil 43Marathi 44Gujrati 45Urdu 46Sanskrit 47Others 48

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