112, RIPON STREET, (NEW BUILDING) 3RD FLOOR, KOLKATA-700016
COMBINED COMPETITIVE EXAMINATION, 2012 FOR RECRUITMENT TO THE POSTS OF SUB-INSPECTOR/LADY SUBINSPECTOR/SERGEANT IN KOLKATA POLICE
KOLKATA POLICE RECRUITMENT BOARD
ADVERTISEMENT NO. ICA -------------------CAUTION: (1) A candidate should fill in the application form correctly against all the items in his own handwriting in blue/black ball point pen and furnish required documents/particulars. Applications not in the prescribed format, without photograph, with inadequate fee, without requisite documents, with incomplete particulars/information, with unsigned declaration or defective shall be rejected. (2) Over writing and correction, if any should be accompanied by signature of the candidate, failing which the application will be liable to be rejected. (Closing time & date for receipt of Application: Time- 5:00pm date: 03/02/2012)
(Space for office use only) Roll No.
Space for pasting of recent passport size photograph of the candidate with his full signature thereon (3.5 cm x 3.5 cm)
To The Member Secretary,
Kolkata Police Recruitment Board, 112, Ripon Street, (New Building) 3rd Floor, Kolkata, Kolkata- 700 016.
Sir, I intend to appear at the above examination. Necessary particulars are furnished below. 1. (a) Post(s) applied for i) S.I. in K.P. ii) Sgt. in K.P. iii) L/S.I. in K.P. iv) Both(SI/Sgt.) in K.P. (b) If applied for both the posts (for male candidate only). Indicate order of preference: i) ___________________________________ ii) ___________________________________ 2. IPO/Demand Draft No. …………………… Date……………of Rs. 150/- deposited in favour of KPRB. 3. Name in full: ______________________________________________________ (CAPITAL LETTERS) 4. Religion: _____________________ GEN OBC Category A Category B SC ST
5. (a) Indicate your community /category : (put a ‘ √ ’ mark in appropriate box) SC/ST/OBC candidates not belonging to the state of West Bengal should indicate their community as: ‘General’ [If SC/ST/OBC of West Bengal, pl attach attested photocopies of certificate (s)]
(b) If SC/ST/OBC, mention your Sub-caste: and the state from which SC/ST/OBC certificate obtained and the designation of issuing authority. 6. (a) Date of Birth : (As recorded in Admit card/Certificate of Madhyamik or equivalent examination. Attach attested photocopies of Admit card/Certificate)
(b) Age as on 01/01/2012: (c) Do you claim relaxation of age : (i) As SC/ST/OBC of West Bengal (Write ‘Yes’ or ‘No’)
________yrs ________month ________day(s)
(ii) As Departmental candidate of Kolkata Police (Write ‘Yes’ or ‘No’) (d) Place of Birth: 7. Sex (Put a ‘√ ’ mark in the appropriate box Vill/Town _________________________ P.S ________________________ Dist _____________________________ : Male State ______________________ Female
8. (a) Whether a citizen of India : (Write ‘Yes ‘or ’No‘) (b) Whether a natural citizen or a citizen by registration (If by registration, attach attested photocopy of certificate) 9. Father’s Name: 10. Guardian’s /Husband’s Name: 11. (a) Complete Postal Address of correspondence including name of Post office, Sub-division, District & State (In capital letters) (b) Police Station: 12. (a) Permanent Address: ________________________ Pin ____________________________________________________ ____________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
________________________________________________________ ________________________________________________________ ________________________________________________________
(b) Police Station:
Pin Urdu Nepali
13. State your choice of language (i.e. the language you want to write in Paper-III,...