TELANGANA STATE LEVEL POLICE RECRUITMENT BOARD TEST SI - 2016

Filled In Online Application

for the posts of SCT Sub Inspector of Police (Civil) (Men and Women),SCT Reserve Sub Inspector of Police (AR)
(Men and Women), SCT Reserve Sub Inspector of Police (SAR CPL) (Men),SCT Reserve Sub Inspector of Police
(TSSP) (Men),Sub Inspector (Men) in Special Protection Force (SPF) Department, Station Fire Officer in Telangana
State Disaster Response and Fire Services Department
Registration No
1058068

Basic Details
Aadhar Card Number:
Medium of Written Examination :
Name of the Applicant(as per ssc or equivalent) :
Father/Husbands Name :
Mothers Name :
Gender :
Date of Birth(as per ssc or equivalent) :
Age as on 01-07-2016 :
Community
Do you belong to Section of Creamy Layer/Non-Creamy
Layer(For BC Applicants Only)
Do you belong to ST and Aboriginal Tribe domiciled In
the agency areas of Adilabad / Khammam / Warangal /
Mahabboobnagar districts
Identification Marks1 :
Identification Marks2 :
Do you belong to State of Telangana :
If No, Which State :

252895396977
TELUGU
SUNDARI SRAVAN KUMAR
SUNDARI SREENIVASU
RAMA KOTAMMA
Male
15-06-1989
27 years 0 months 17 days
BC-B
Non-CreamyLayer
NA

A MOLE ON THE RIGHT HAND INDEX FINGER

A mole on the left cheek
Yes
NA

Post(s) applied for

1st preference
2nd preference

11-SCT Sub Inspector of Police (Civil) (Men and Women) in Police Department
17-Station Fire Officer in Telangana State Disaster Response and Fire Services
Department
12-SCT Reserve Sub Inspector of Police (AR) (Men and Women) in Police Department
14-SCT Reserve Sub Inspector of Police (TSSP) (Men) in Police Department
16-Sub Inspector (Men) in Special Protection Force (SPF) Department
13-SCT Reserve Sub Inspector of Police (SAR CPL) (Men) in Police Department

3rd preference
4th preference
5th preference
6th preference

Unit Preferences for Post Code NO.11

1st preference
2nd preference

Zone VI
Zone V

Unit Preferences for Post Code NO.12

1st preference
2nd preference

Zone VI
Zone V

Unit Preferences for Post Code NO.17

1st preference
2nd preference
3rd preference

City of Hyderabad
Zone VI (excluding City of Hyderabad)
Zone V

Educational Details
Educational Qualifications as on 01-07-2016
Furnish to which District of Telangana State you are local

B.Tech
NALGONDA

Study details from 4th class to 10th class

Class
4
5
6
7
8
9
10

Month
April
April
April
April
April
April
April

Year
1998
1999
2000
2001
2002
2003
2004

SchoolName
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL
VIVEKAVANI V M HIGH SCHOOL

District
NALGONDA
NALGONDA
NALGONDA
NALGONDA
NALGONDA
NALGONDA
NALGONDA

Residence details
Year

Address

District

State Government Employee

Are you an employee of Telangana State Government
Date of joining service
Length of service as on (01-07-2016)
Are you still in service

No
NA
NA
NA

State Government Employee working in AP on order to serve basis

Are you an employee of Telangana State and Working in AP on order to
serve basis
Date of joining service
Length of service as on(01-07-2016)
Are you still in service

No
NA
NA
NA

Army/Navy/Air Force
Have you served as an employee in Army/Navy/Air Force
Date of entry
Date of discharge
Total service rendered
Do you claim reservation under Ex-Servicemen Quota
Have you been discharged as on date of notification(06-02-2016)

No
NA
NA
NA
No
NA

If still serving and yet to be discharged after the date of notification (06-02-2016)
Date of entry :
Likely Date of discharge :

NA
NA

NCC Instructor
Have you worked as an instructor in NCC
Date of entry
Date of discharge
Total service rendered

No
NA
NA
NA

Retrenched employee/widow
Do you a Retrenched temporary employee in the state Census
Department during 1991
Length of service in census department
Are you a widow, divorcee/judicially separated women

No
NA
NA

Special Category
Do you come under any of the Special Category :
Applicable Category :

No

Meritorious Sports Person quota

Name of the Sport

Category

NCC quota
Certificate

NCC Certificate Issued Date

Furnish details For Police Executive (PE)

Date of enrollment
Name of the Present Post
Name of the Unit Working
Date of declaration of Probation
Are you still working as on date of notification (06-02-2016)

NA
NA
NA
NA
NA

Furnish details For Police Ministerial (PM)

Date of enrollment
Name of the Present Post
Name of the Unit Working
Date of declaration of Probation
Are you still working as on date of notification (06-02-2016)

NA
NA
NA
NA
NA

For Children of Police Personnel (CPP)

Date of enrollment of your parent
Name of the Post
Name of the Unit
Is your parent working (or) retired (or) dead as on date of notification (06-02-2016)

CDI quota

NA

NA

Date of enrollment of your parent :

Name of the Post :
Name of the Unit :
Is your parent dead (or) retired on medical invalidation as on 06-022016:

NA

NA

Furnish details for Members of SPF

Date of enrollment
Name of the Post
Name of the Unit
Date of declaration of Probation
Are you still working as on date of notification (06-02-2016)

NA
NA
NA
NA
NA

CSPF quota
Date of enrollment of your parent :
Name of the Post :
Name of the Unit :
Is your parent Working (or) retired (or) dead as on 06-02-2016 :

NA

NA

Other Details(etc.,)
Do you have minimum Physical measurements as per Notification :
Have you applied for SI(commn)/SI(PTO) vide notification
no.14/Rect/Admn-1/2016 dt 06.02.2016 :
If yes furnish Registration No :

Yes
No
NA

Centre for PWT

Centre for appearance of Preliminary Written Test :

HYDERABAD

NOTE: In case the applicant submits application for both SCT SI (Civil/AR/SARCPL/TSSP/SPF/SFO) and also SCT SI(Comm)&SCT SI(PTO), the applicant will be
allotted to Hyderabad District only. If there is no sufficient accomodation,he/she will be allotted to the Centres surrounding Hyderabad District
NOTE: In case the applicant applies for only SCT SI (Civil/AR/SARCPL/TSSP/SPF/SFO) and if the capacity of the Test Centres located in the district is not
sufficient,the Test Centres of the adjacent district may be allotted. No further communication in this regard will be entertained.

Criminal Case Details(etc.,)

Were you involved in any criminal case (s) at any time :
Crime No. & Year :
Name of the PS :
Name of the Dist :
Were you ever arrested by the Police :
If you were prosecuted by the Police in a court of law ,furnish present :
Were you involved in more than one Criminal case :
Total No. of Criminal cases involved :
Were you at any time employed and discharged/
terminated/removed/dismissed from service of the government (whether
during training or later) :
Name of the Post :
Name of the Department :
Date of Discharge/terminated/removal/ Dismissal :
Office address :

No
NA
NA
NA
NA
NA
No

NA
NA
NA
NA

Address for Communication

Name :
C/o :
H.No./colony :
Village :
Mandal :
District :
PinCode :
Mobile No :
Email Id :
SSC RollNo :

SUNDARI SRAVAN KUMAR

SUNDARI SREENIVASU
2-5
PONUGODU
Garide Palle
NALGONDA
508201
9160286811
sundarisravan@gmail.com
0622906

Payment Details
Transaction id./Reference Id :
Payment Through:
Amount (in Rs.)
Date and Time of Submission :

FUTI4313483955
BillDesk
500
2/24/2016 5:10:06 PM

I hereby declare that I have read the instructions issued in the notification dated 06-02-2016 of the Telangana State Level Police Recruitment
Board carefully and hereby undertake to abide by them. I further declare that I have not been debarred from appearing in any examination.

I declare that I fulfill all the conditions of eligibility regarding Age limits, Education qualifications etc., prescribed in the said notification.
I hereby declare that all statements made in this 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 to be false or incorrect or incomplete and that I have suppressed any information or that I do not
satisfy the eligibility criteria,my candidature for the selection is liable to be rejected or cancelled and even after appointment my services are liable
to be terminated without any notice. I am willing to serve the department anywhere in the State/India if selected.
I declare that I am fully fit to compete in the PMT and PET and other Physical tests and my fitness is certified by the medical practitioner and as I
applied for the posts of Sub Inspecter and other equivalent posts after going through about the physical requirement and other qualification and
read the eligibility criteria.I further declare that I have got myself medically checked up by a certified doctor in this regard, and that if any untoward
incident occurs during the course of PMT,PET or tests I shall be solely responsible and I declare that I am participating in all the above tests on
my own accord and on my own, without any coercion from anybody.
1) I have read all the instructions carefully and I am conversant with the instructions. I shall abide by the eligibility conditions and other regulations to be satisfied for
appearing at the recruitment test. Further, I assure that, I will not involve in any malpractice or illegal activities in the recruitment test. In case, I have furnished any
false information or involved in any malpractice or illegal activities, I am liable for punishment as per the existing law.
2) I am responsible for the correctness of the above details filled in by me and the COORDINATOR, TSLPRB is not responsible in any way.

SIGNATURE and LEFT HAND THUMB Impression of the Applicant to be done in the presence of the
Invigilator on the day of Examination in the Examination Hall
SIGNATURE OF THE Applicant
in the presence of the Invigilator

Note: The Applicants are required to take two print outs of this Filled in Online application form. One copy has to be submitted in the
Exam Hall to the Invigilator and the other has to be retained with the Applicant. 2) Applicants are not allowed into the Exam Hall even if
they are LATE BY A MINUTE. 3) This is a Computer Generated sheet and does not require the Signature of the COORDINATOR,
TSLPRB.