FPSC FORM

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For Office Use Only

Website: www.fpsc.gov.pkE-mail : [email protected]: 051-9203410 & 9213386

APPLICATION FORM FOR COMPETITIVE EXAMINATION (CSS) - 2011010101010

Receiving Stamp

T.R. removed for Rs. ___________.

Photograph

Batch No. Diary No. Size 2 x 1.5

(must be paste herewith gum only)

Roll No.

1.

2.(a)

Name (In capital letters as per Matriculation Certificate)

Fathers Name

2. (b) Husbands Name (in case of married female candidates)

3. (a) Date of birth (As per Matric Certificate / CE Rules)

- - 1 9

3.(b)

Year

Age on 31.12.2010

Month Day

4. (a) Religion (Pleasetick the relevant box)

Muslim

5. (a) Gender

6. Postal Address

Non Muslim 4.(b)

If Non Muslim whether desires to be examined inIslamiat ( for details see para-1(vi) of Appendix-I ofCE Rules, 2011)

S M D W

Yes No

M F 5.(b) Marital Status

7. Permanent Address

8. Particulars about Spouse/Fiance:-Nationality________________ Age _____________Occupation__________________________________

Abbottabad

Education ___________________________Designation __________________________

Bahawalpur

Hyderabad

Muzaffarabad

Sialkot

Dera Ghazi Khan

Islamabad

Okara

Sukkur

Khyber Pakhtoonkhwa(Tribal Area)

Punjab (Tribal Area)

Dera Ismail Khan

Karachi

Peshawar

9. Examination Centre: (Pleasetick one)

Faisalabad

Lahore

Quetta

10. Domicile:

(Pleasetick one)

Gilgit

Larkana

Rawalpindi

Gujranwala

Multan

Sargodha

Balochistan

Sindh ( Rural )

Azad Kashmir

Balochistan(Recognized Tribes)

Sindh ( Urban )

Gilgit - Baltistan

Khyber Pakhtoonkhwa

Punjab(including Islamabad)

FATA

District of Domicile

11. Email __________________________Ph.Off__________________ Ph.Res ________________Mobile ______________

12. C.N.I.C. #

13. (a) Age Relaxation Claimed YES

-

NO

-

13.(b) If yes indicate the category

Azad Kashmir

Gilgit - Baltistan

Government Employee (In service)

Scheduled Caste

Disabled Candidate

Recognized Tribes/ Tribal Area

Buddhist Community

Armed forces (in service)

Signature of Applicant

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-2-Education Record. List below all institutions where you have been educated and the examinations passed. If, you have secured a position in any examination write 1/2/3 in t he relevantcolumn.For institutions in Pakistan give place/district under location. For institutions abroad mention the country only.

School/College/University &Location

Medium ofInstructionEnglish /Urdu

Years Name of ExaminationPassed

Date of resultAnnouncementdd/mm/yy

From To

Division(I/II) orGrade

(A/B/C)or CPGA

Board/ University(Examining Body)

Major Subjects *Distinctions achieved/Academic Awards etc.

R/M/F

In this column write R against the qualification (i.e. Bachelors Degree or higher) that make you eligible for appearing in the examination.In the case you are MBBS. Mark M and if you have graduated from foreign University, enter F.

15

S. No

From

Extra Activities

YearTo

Extra Curricular Activities/ Sports/ Hobbies

16. Disciplinary Action/Conviction: Was any disciplinary action, ever taken against you in any educational institution or department or were you ever debarred from government service or any examination/selection held byFPSC, or were you ever convicted for any crime other than a minor traffic offence (Put a cross in relevant box)?

No Yes (Pl. attach a statement giving full details. It will be kept confidential)

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Date(Exact dates must be filled in and no

box be left blank)

ProvincialGovt.

FederalGovt.

S. No Post and office held Name of Organization From To(Todate for inservice)

Type of organizationPut a cross (X) in one

relevant Column

Pvt.Practice/SelfEmployed

ArmedForces

un-employed

SemiGovt.

Nature Put a cross (X)in one relevant Column

Ad-hoc/Contact

BasicScale(if any)

Temporary

1

2

3

4

5

18. Languages: Name the languages in which you have any proficiency (mother tongue first) and grade your ability as A,B or C under the three columns below:- (A=Excellent , B=Good, C=Fair)

Name ofLanguage

Ability

Read Write SpeakCertificate/Diploma, if any

19. Full particulars of the near relations, if any i.e. father, mother, brothers, sisters, first uncles and first relations in law who are/were in Government service of Pakistan or elsewhere, specifying the posts held and whereposted.

S. No.

1.

2.

3.

Name of Relatives Relationship Post held / Department Place of duty

OfficiatingPermanentPrivate

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OPTIONAL SUBJECTS (600 MARKS)

20.A list of optional subjects is given below, the marks for subjects are shown against each. The candidates are required to selectoptional subjects carrying a total of 600 marks, but not more than 200 marks from any box/columns, as provided in the column ofrules. Please encircle the code number of the subjects in which you desire to be examined. Candidates will be responsible for anyerror inthe selection of subjects marked by them as wrong selection/combination of subjects will lead to rejection under the Rules.

Rules

Subject (s) carrying not more than 200 marks from CodeNo.11 to 14 can be opted.Note: Business Administration cannot be combined withPublic Administration.

Subject (s) carrying not more than 200 marks from CodeNo. 15 to 19 can be opted.

Code

11121314

1516171819

20212223

242526272829

30313233

34

353637383940

4142

Subject

Accountancy & AuditingEconomicsBusiness AdministrationPublic Administration

Political ScienceAgricultureForestrySociologyJournalism

Pure MathematicsApplied MathematicsComputer ScienceStatistics

PhysicsGeologyGeographyChemistryBotanyZoology

Islamic History & CultureHistory of Pak. & IndiaBritish HistoryEuropean History

History of the U.S.A.

LawConstitutional LawMercantile LawMuslim Law & JurisprudenceInternational LawInternational Relations

PhilosophyPsychology includingExperimental Psychology

SindhiPushtoPunjabiBalochi

Marks

200200100100

200100100100100

200200100100

200200200200200200

200200200200

100

200100100100100100

200200

Subject (s) carrying not more than 200 marks from Code No.20 to 23 can be opted.

Only one subject from Code No. 24 to 29 can be opted.

Only one subject from Code No. 30 to 34 can be opted

Subject (s) carrying not more than 200 marks from Code No.35 to 40 can be opted.Note: International Law cannot be Combined withInternational Relations.

Only one subject from Code No. 41 to 42 can be opted.

Only one Regional Language from Code No. 43 to 46 can beopted.Note: Regional Languages cannot be combined withUrdu.

43444546

100100100100

Only one National /Foreign/ Classical Language from CodeNo. 47 to 50 can be opted.Note: Urdu cannot be combined with RegionalLanguages.

47484950

English LiteratureUrduPersianArabic

200200200200

Caution : No subsequent change in the selection of optional subjects shall beallowed..

21.

1

Whether Disabled

Physically Impaired

YES NO 21. (b) If yes indicate the category

Hearing/ Hearing/Speech Impaired (Deaf & Dumb)2 3 Visually Impaired (Blind)

21. (c) Do you need: Helper Writer Computer (for visually impaired at Islamabad only)

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22.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

23.

Particulars about parents.

Father

Age

Qualification

Occupation / Designation present

Occupation / Designation (at the time of your birth)

Parents alive or dead, if dead year of death

Annual Income

Any other source of income / supporting income

Brothers/Sisters: Please indicate the order of birth of your brothers and sisters(including yourself); Step-brothers and step-sisters (if any) in the second column. Write B for brother, S for sister, SB for step-brother, SS for step-sister and X for yourself.In the column for occupation clearly indicate his/her occupation. If pertinent write Household student etc. In the nextcolumn mention the highest degree obtained. Class passed or class in which studying.

B,S,SB,SS or X

Age Occupation EducationS.No

7

89

101112

Detail of any previous attempt for Competitive Examinations (CSS).

S.No.

123

4

Year Roll No. Examination RESULT: Write A for Absent, F for Fail, P for Pass, &R for Recommended (if Recommended mention group)

B,S,SB,SS or X

Age Occupation Education

Mother

S.No

1

23456

24.

25. Occupational Groups:

The occupational groups/services to which you can be recommended are listed below (in alphabetic order).Please indicate your preference to these groups/services by writing 01, 02, 03, .12 in order of yourpreference in the relevant column below against the groups/ services, for which, you choose to be considered. Do notwriteany thing against the groups/services, for which, you do not wish to be considered.Note :- Disabled candidates in the categories of physically impaired, hearing/speech impaired (deaf & dumb) andvisuallyimpaired are allowed to indicate their preference against the four occupational groups/services only viz; (a) Commerce&

Trade Group, (b) Pakistan Audit & Accounts Service (c) Information Group and (d) Postal Group. Disabled candidatessecuring a position against prescribed 7.5% merit quota on all Pakistan basis may be considered for allocation toForeign Service of Pakistan on the basis of his/her choice.

S. No.

1

2

3

4

5

6

7

8

9

10

11

12

26. (a)

(b)

Occupational Groups / Services (BS-17)

Commerce and Trade Group.

District Management Group.

Foreign Service of Pakistan

Information Group.

Inland Revenue Service

Military Lands & Cantonments Group

Office Management Group

Pakistan Audit and Accounts Service.

Pakistsan Customs Service

Police Service of Pakistan.

Postal Group.

Railways (Commercial and Transportation) Group.

No Yes

Order ofPreference

Previous experience of taking psychological test:

If yes, give the name of test taking organization: ___________________________________

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CHECK LIST

1. Please confirm if the following documents have been attached with the application form:

All documents attached with the form must be numbered in continuation with the page number of the application form infollowing sequence:-

Yes

(a) Original Treasury Receipt for Rs.1000/- Dated:_________________, Fee deposited in NBPBranch Name__________________________________________________Bank(Branch Code) _____________ City/District____________________________

Recent 4 Photographs (attested on back side, mentioning name and fathersname).

No

(b)

(c) Attested copy of Computerized National Identity Card.

Attested copy of Matriculation Certificate showingCertificate/Result Card/Marks Sheet is not acceptable.

Attested copy of Degree(s).

date of birth. Provisional(d)

(e)

(f) Attested copy of self Domicile Certificate

(g)

(h)

Certificate for Buddhist and Scheduled Caste Candidates. (Annex-A)

Certificate for Provincial/Federal Tribal Areas candidates and those belonging to Gilgit -Baltistan. (Annex-B).

Certificate from Kashmir Affairs Division for Azad Kashmir Nationals. (Annex-C).(i)

(j) Certificate for Minorities .(Annex-D)

(k) Departmental Permission Certificate (Annex-E) (for Government Servants).

In case of Ex-Employees of Armed Forces of Pakistan No Objection Certificate fromrelevant authority.

In case of Disabled candidates, certificate of disability from the competent authority.

(l)

(m)

(n) Whether you have signed the application? ( first page)

If any other documents are attached with application form please attach a separatelist:-

2.I have read and understood Rules for Competitive Examination, Regulations for Physical Examination andInstructions to Candidates before filling this application form and agree to abide by them.

3.I certify that the statements I have made in this application are true to the best of my knowledge and belief. I understandthat if any of the above statement is false in any material respect or omits any material information relevant to my previousexaminations, service, etc. my application is liable to be rejected and if appointed my appointment is liable to be terminated.

Place: _________________________

Date: __________________________

Signature of Applicant

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Note: Candidate should not write his/her postal address care of Post Box Number etc. as postal authorities do notacceptregistered letters at such an address.Please write your name and address in the spaces below:

Roll No.

Name

Address

/2011- CSS Roll No.

Name

Address

/2011- CSS

District District

Roll No.

Name

Address

/2011- CSS Roll No.

Name

Address

/2011- CSS

District District

Roll No.

Name

Address

/2011- CSS Roll No.

Name

Address

/2011- CSS

District District

Roll No.

Name

Address

/2011- CSS Roll No.

Name

Address

/2011- CSS

District District

FEDERAL PUBLIC SERVICE COMMISSSION

RECEIPT

To be filled in by the candidate

Received Application Form No.______________ of Competitive Examination, 2011 of

Mr./Miss/Mrs.__________________________________________________________

Signature and Official Stamp(with date)F.P.S.C.

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Annex A

Certificate to be produced by the Candidate belonging to scheduled caste/Buddhist Communityunder Para 4(ii) (a) of the Federal Public Service Commission Rules relating to the

Competitive Examination (CSS), 2011

This is to certify that Mr./Miss/Mrs. _________________________________________________ son/daughter/wife

of _____________________________________________________________________________________ of village/town

______________________________________________ in the District of ___________________ belongsto

_________________________________________________________________________________________

(i) Recognized Schedule Caste. (ii) Buddhist Community.

and is a permanent resident of the District _________________________________________ and his/her family ordinarily

resides in the village/town _________________________________________ of District __________________

Signature :_______________________________

Name :__________________________________Political Agent/DCO/District Magistrate

(Official stamp must be affixed here)

Date : ____________________

**************************************************************************************

Annex B

Certificate to be produced by the Candidate belonging to the Tribal Areasunder Para 4(ii) (b) of the Federal Public Service Commission

Rules relating to the Competitive Examination (CSS), 2011


of _________________________________________________________________________________ belongs to the

recognized tribe of (name of tribe)___________________________________ and is a permanent resident of village/ town

________________________________ of District/Tribal Area_________________________________ and his/her family

have been living in that area.

It is further certified that *Mr./Miss/Mrs. _____________________________________________________ belongs

to Gilgit - Baltistan which is a *Federally Administered Tribal Area as defined vide Article 246 of the

*Tribal * Provincial Administered Area

Constitution of the Islamic Republic of Pakistan.

Signature ________________________________

Name___________________________________Political Agent/DCO/District Magistrate


Date : ____________________

*Strike out which is not applicable.

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Annex C

Certificate to be produced by the Candidate from the Kashmir Affairs DivisionGovernment of Pakistan, under Para 4(ii) (c) of the Federal Public ServiceCommission Rules relating to the Competitive Examination (CSS), 2011

This is to certify that Mr./Miss/Mrs. ________________________________________________ son/daughter/wife

of ______________________________________________________________________ is a permanent resident of

village/town ______________________________ of District ________________ of Azad Jammu & Kashmir Territory and

has been living in the aforesaid areas or any other part ofPakistan.

Signature :__________________________

Name :_____________________________


Date : ____________________

*********************************************************************************

Annex D

Certificate to be produced by the Candidate belonging to minorityunder Para 7(x) of the Federal Public Service Commission Rules relating to the

Competitive Examination (CSS), 2011


of _____________________________________________________________________________________ of village/town

______________________________________________ in the District of ___________________ belongsto

________________________________________________Minority and is a permanent resident of the District

_________________________________________ and his/her family ordinarily resides in the village/town

_________________________________________ of District __________________

Signature ____________________

Name_______________________DCO/District Magistrate/Political Agent


Date : ____________________

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Annex-E

Serial No

DEPARTMENTAL PERMISSION CERTIFICATEFOR USE OF GOVERNMENT SERVANTS

(To be detached by the candidate from the Application Form and submitted to his employingDepartment.)

COMPETITIVE EXAMINATION (CSS), 2011

Name of candidate KHALID HUSSAIN____________________________________________

Fathers Name ABDULLAH MUGHERI___________________________________________

Designation ASSISTANT _______________________________Basic Scale 14__________

Department (with complete address) HOME DEPARTMENT SINDH SECRETRAITE KARACHI________

Place of duty DISTRICT PUBLIC SAFETY AND POLICE COMPLAINT___________________Tele (with city code) Office: ______________ Res: _______________Mob: 03455737724______

2.I have applied to the Federal Public Service Commission, Islamabad for the above Examination on the prescribedform. Necessary departmental permission for applying for the above said examination may kindly be forwarded to theSecretary,Federal Public Service Commission, F-5/1, Aga Khan Road, Islamabad, at the earliest. Closing date for receipt ofapplicationby the Commission is 15-09-2011________.3.I declare that the Department/Office in which I am serving is not an Autonomous/Semi-Autonomousbody/organization.

Signature and Name of Candidate

(TO BE FILLED IN BY THE DEPARTMENT)

No. _____________________________________ Date: ____________________

4.Forwarded; Mr. /Miss/Mrs. KHALID HUSSAIN___________________________________________________________ isemployed in this Department since 30-12-2009____. He/she holds a *Temporary/Contractual/Permanent post under the*Federal/Provincial Government and is drawing his/her pay in the BS 14____ .

5.The total period of continuous Government service since _30-12-2009_________rendered by him/ her on

31.12.2010 will be 01__Year(s) 00___ Month(s) 01___Day(s).

6.The place of domicile as declared by him/her at the time of first entry into Government Servicewas SINDH (R)_(Province/Area in case of Khyber Pakhtoonkhwa whether Khyber PakhtoonkhwaProvincially Administered Tribal Area or Khyber Pakhtoonkhwa settled area, and in case of Sindh whether Sindh (Rural)orSindh (Urban).

7.His/her character, so far as known to me is good and there is nothing against him/her which may render him/herineligible for the Competitive Examination, 2011.

8. Certified that this Department/Office is not an Autonomous/Semi-autonomous body/organisation.

Signature:

Name:

Designation:

Department:

Telephone No.:

ToThe Secretary,Federal Public Service Commission,

F-5/1, Aga Khan Road,Islamabad.

(Official Stamp must be affixed here)

Documents

FPSC FORM