Page No. 1/9
UNION PUBLIC SERVICE COMMISSION DETAILED APPLICATION FORM CIVIL SERVICES(MAIN) EXAMINATION, 2013
Paste here identical photograph as per instruction of para 33.
Roll No. : 082646
Name : RAWISEN GURIA
1. Details of Fee paid : Fee to be paid is Rs. 200/-(Two hundred only)(Female/SC/ST/Physically challenged candidates are not required to pay any fee) Name of Post Office / Value of CRF Stamps Indian / Indian Mission with complete Mission Receipt address.
Space for affixing Central Recuritment Fee Stamps (This is the sole mode prescribed for payment of fee)
Total Value : N.B : Indian Postal Orders/Bank Draft/Money Orders/Crossed Cheque/Treasury Challan/Currency Notes/Postage/ Revenue/Court Fee Stamps etc. are not acceptable.
Roll No. :- 082646
| Candidate Signature :
Page No. 2/9 2. Name
| RAWISEN GURIA
3. (a) Address for correspondence to which | HOUSE NO. 61, 3RD MAIN, 11TH CROSS, SHREYAS COLONY, communication is to be sent | JP NAGAR 7TH PHASE Post Office: | JP NAGAR District: | BANGALORE State : | KARNATAKA Pin Code : | 560078 (b) Telephone No. with STD Code | 080-41161849 (c) Mobile No. | 09007376510 (d) Fax No. (e) E-mail address (f) Permanent Postal Address
| | | | | | |
Post Office: District: State : Pin Code :
[email protected] VILLAGE - GUTUHATU
BARDA KHUNTI JHARKHAND | 835227
4. Gender :
| MALE
5. Marital Status :
| UNMARRIED
6. Citizenship :
| A CITIZEN OF INDIA(1)
7. Mother tongue :
| MUNDARI
8. (a) Date of Birth (b) Claimed Age relaxation(Enclose documentary evidence in support of your claim)
| 21-02-88
9. Place of Birth : Town/Village District State
| No
| GUTUHATU | KHUNTI | JHARKHAND
| ST (2) 10. (a) Community Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC reservation should indicate their community as 'General Category (others) Code No.4'. Note 2: Candidates belonging to neither SC,ST nor OBC Communities should write 'General' Category(Others) Code No.4' against the column of community and not leave it blank.'. Note 3: No change in the community status already indicated by a candidate in his / her application form for this examination will ordinarily be allowed by the Commission. Note 4: In case you are a 'SC, ST or OBC' candidate, enclose a copy of certificate in support of your claim.
Roll No. :- 082646
| Candidate Signature :
Page No. 3/9 11. Choice of Centre for Examination
| BANGALORE
12.(i)(a)Do you hail from Arunachal Pradesh/ Manipur/Meghalaya/Mizoram/Nagaland/ Sikkim and are claiming exemption from appearing in INDIAN LANGUAGE FOR PAPER A? | NO (b)Indian Language for Paper A | HINDI (ii) Optional Subject for paper VI & VII | LAW 13. (a)Language Medium for Examination for Paper I to Paper VII (Essay,General Studies and for Optional Subject as at (ii) of col.12 above)
| ENGLISH
Note : In case of candidates opting for literature in any of the Indian Language as optional subject for papers VI & VII , they would have to write these two papers (VI & VII) in the script specified for that particular language as given in Annexure IV of Instructions to candidate. (b)Language Medium for Interview Test(c.f. para 27 of the Instructions) to Candidates)
| ENGLISH
14. (a) Whether you are a Physically Challenged Candidate
| NO
| 15. (a) Name of Father (b) Name of Mother | (c) Nationality of Father | (d) Nationality of Mother | (e) Father's present postal Address | (If deceased give last address) | Post Office: | District/City: | State : | Pin Code : | (f) Mother's present postal Address | (If deceased give last address) | Post Office: | District/City: | State : | Pin Code : | (g) Father's Profession: | (h) Mother's Profession: | (i) If your Father is in service,the post held by him (if retired, indicate the post held by him at the time of his retirement) | (j) If your Mother is in service,the post held by her (if retired, indicate the post held by her at the time of her retirement) | Roll No. :- 082646
RUSHEN GURIA RUPAI GURIA A CITIZEN OF INDIA A CITIZEN OF INDIA VILLAGE - GUTUHATU BARDA KHUNTI JHARKHAND 835227 VILLAGE - GUTUHATU BARDA KHUNTI JHARKHAND 835227 RETIRED HOME MAKER
OFFICE SUPERINTENDENT
NA
| Candidate Signature :
Page No. 4/9 (k) Annual income of your Father | (l) Annual income of your Mother | (m) District to which your Father originally| belongs (n) State to which your Father originally | belongs (o) District to which your Mother originally| belongs (p) State to which your Mother originally | belongs
RS.200000 RS.0 KHUNTI JHARKHAND KHUNTI JHARKHAND
16.Whether passed Degree or equivalent examination
| YES (Enclose copy of the Certificate )
17. Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination Passed
Class/ Percentage CGPA Year of Division of Score Out of /Grade Marks(%) Passing
10th or Equivalent
1
70.83
12th or Equivalent
1
76.40
Graduation or Equivalent
B
Subject(s)
Name of School/College /Institution
Name of Board/University
ENGLISH, HINDI, BISHOP WESTCOTT CISCE HISTORY CIVICS BOYS SCHOOL, GEOGRAPHY, NAMKUM, RANCHI MATHS, SCIENCE, ECONOMICS 2007 ENGLISH, DAV JAWAHAR CBSE HISTORY, VIDYA MANDIR, POLITICAL SHYAMALI, SCIENCE, RANCHI ECONOMICS, SOCIOLOGY Stream at Graduation Level :-LAW 3.26 7 2012 BA LLB HONS. THE WB NATIONAL THE WB UNIVERSITY OF NATIONAL JURIDICAL UNIVERSITY OF SCIENCES, JURIDICAL KOLKATA SCIENCES, KOLKATA
18. Were you ever Employed :
2005
| NO
19. Please give Particulars of:(a) Particulars of prizes,medals scholarships,etc. (b) Team/Games/Sports/N.C.C. /Hitchhiking/Mountaineering etc. (c) Position(s) of distinction Leadership held in School/College (d) Other extra curricular activities and interests (Such as hobbies etc.)
| WON RBI YOUNG SCHOLAR AWARD 2009-2010, WON OTHER EVENTS LIKE EXTEMPORE, QUIZ, SLOGAN WRITING ETC | PART OF FOOTBALL TEAMS IN INTRA UNIVERSITY AND INTRA SCHOOL EVENTS | ELECTED AS CLASS REPRESENTATIVE | READING BOOKS -FICTION. KEEN FOLLOWER OF FOOTBALL AND CRICKET WATCHING MOVIES, TELEVISION SERIES
20. In case you are considered for appointment to IAS/IPS ,your order of preference for various State cadres for which you would like to be considered. Roll No. :- 082646
| Candidate Signature :
Page No. 5/9 Note : It is clarified that as per the present scheme of things as envisaged by the Cadre Allocation Policy,2008,amended from time to time ,if a candidate appointed to the All India Services does not express his/her first preferences to his/her home cadre,he/she shall not be considered for his/her home cadre at all. The Candidates are therefore advised to excerise due diligence while filling up the above preferences. State Cadres
Order of preference
ANDHRA PRADESH AGMUT ASSAM,MEGHALAYA BIHAR CHHATTISGARH GUJRAT HARYANA HIMANCHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA MADHYA PRADESH MAHARASHTRA MANIPUR TRIPURA NAGALAND ORISSA PUNJAB RAJASTHAN SIKKIM TAMILNADU UTTARAKHAND UTTAR PRADESH WEST BENGAL
IAS 21 3 22 6 2 20 11 12 13 1 14 15 4 10 23 24 9 16 7 17 18 5 8 19
IPS 8 3 9 5 2 10 11 12 13 1 14 15 4 16 17 18 19 20 6 21 22 7 23 24
21. Your order of preference against the Services/Posts given below , for which you would like to be considered for appointment ., Note : It is clarified that the below order of services does not reflect their relative importance in the eyes of the Govt. and the candidates are advised to use their discretion while indicating preferences for various services. S.N. 1. 2. 3. 4. 5. 6. 7. 8.
Name of Services/Post Indian Administrative Service Indian Foreign Service Indian Police Service Indian P&T Accounts & Finance Service Group "A" Indian Audit & Accounts Service, Group "A" Indian Revenue Service,(Customs and Central Excise)Group "A" Indian Defence Accounts Service ,Group "A" Indian Revenue Service, (I.T.) Group "A"
Roll No. :- 082646
| Candidate Signature :
Order of Preference 1 2 3 9 7 6 8 4
Page No. 6/9 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
Indian Ordance Factories Service,Group "A" (Asstt. Works Manager-Administration) Indian Postal Service,Group "A" Indian Civil Accounts Service ,Group "A" Indian Railway Traffic Service,Group "A" Indian Railway Accounts Service ,Group "A" Indian Railway Personnel Service,Group "A" Post of Asstt. Security Commissioner ,Group "A" in Railway Protection Force Indian Defence Estates Service ,Group "A" Indian Information Service ,(Junior Grade) Group "A" Indian Trade Service,Group "A" (Grade III) Indian Corporate Law Service ,Group "A" Armed Forces Headquarters Civil Service ,Group 'B'(Section Officers'Grade) The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman&Diu and Dadra & Nagar Haveli Civil Service,Group "B" The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman&Diu and Dadra & Nagar Haveli Police Service,Group "B" Pondicherry Police Service , Group "B"
22. Have you ever been debarred by any Public Service Commission or SSC from any of their Examinations/Selections?
| NO
23. Whether you have been selected or applied for U.P.S.C. Examination /Recruitment:-
| YES
17 19 10 11 12 13 14 18 20 22 5 21 15 16 23
Details of other application for Examination/Recruitment held/to be held by UPSC :Name of Examination/Post
Month and year of Examination /Advt./No. /Item No. for Recruitment
Roll. No.
Whether you appeared at the Examination/Interview
Whether you were recommended for appointment
CIVIL SERVICES EXAMINATION 2012
NIL
306369
YES
NO
24. How many times have you appeared at the Civil Services(P) Examination so far, including the current Examination held in May,2013
|1
25. Details of examination in which you have appeared including CS(P),2013 Year 2012 Roll No. 306369
26. Have you ever accepted allocation to a Service/Post on the basis of Civil Services Examination held in earlier years? Roll No. :- 082646
| NO
| Candidate Signature :
Page No. 7/9 27. State of Domicile
| JHARKHAND
28. Amount of CRF stamp pasted
| Rs. 0
29. List of Enclosures sent by the candidate:--->Attested/Certified Copy of certificate of Age. --->Attested/Certified Copy of the certificate of educational qualifications. --->Attested/certified copy of certificate in support of claim to belong to Scheduled Castes/Scheduled Tribes/Other Backward Classes (where applicable), along with Annexure VI.
Roll No. :- 082646
| Candidate Signature :
Page No. 8/9 DECLARATION TO BE SIGNED BY THE CANDIDATE I, hereby declare that all statements and entries made in columns 1 to 29 of this application are true, complete and correct to the best of my knowlege and belief. I have read rule 14 of the Rules of the Examination and understand that in the event of any information being found false or incorrect or ineligibility being detected before or after the examination,action can be taken against me by the Commission. I further declare that I fullfill all the eligibility conditions regarding age limits, educational qualifications etc.prescribed for admission to the Examination. I have not exhausted the number of attempts admissible to me under the rule 4 of the Rules of the Examination. I have not with hold any information required as per this proforma. I have read the rules and instructions carefully and I hereby undertaken to abide by them. * I have informed my Head of the Office/Department in writing that I have applied for this examination.
** Signature of the Candidate Place: Date:
*Strike of this sentence, if not applicable. ** Application not signed by candidate is liable to rejection.
Roll No. :- 082646
| Candidate Signature :
Page No. 9/9 UNION PUBLIC SERVICE COMMISSION SUMMARY SHEET (FOR OFFICE USE ONLY) DATE:SESSION:-
ROLL NUMBER :NAME OF EXAMINATION :NAME :DATE OF BIRTH :OPTIONAL SUBJECT:PLACE OF BIRTH :TOWN/VILLAGE DISTRICT STATE
| | | | |
082646 CIVIL SERVICES(MAIN) EXAMINATION, 2013 RAWISEN GURIA 21-02-88 LAW
| GUTUHATU | KHUNTI | JHARKHAND
Please give Particulars of:(a) Particulars of prizes,medals scholarships,etc.
(b) Team/Games/Sports/N.C.C. /Hitchhiking/Mountaineering etc. (c) Position(s) of distinction Leadership held in School/College (d) Other extra curricular activities and interests (Such as hobbies etc.)
| WON RBI YOUNG SCHOLAR AWARD 2009-2010, WON OTHER EVENTS LIKE EXTEMPORE, QUIZ, SLOGAN WRITING ETC | PART OF FOOTBALL TEAMS IN INTRA UNIVERSITY AND INTRA SCHOOL EVENTS | ELECTED AS CLASS REPRESENTATIVE | READING BOOKS -FICTION. KEEN FOLLOWER OF FOOTBALL AND CRICKET WATCHING MOVIES, TELEVISION SERIES
Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination Passed
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Class/ Percentage CGPA Year of Division of Score Out of /Grade Marks(%) Passing
10th or Equivalent
1
70.83
12th or Equivalent
1
76.40
Graduation or Equivalent
B
2005
Subject(s)
Name of School/College /Institution
Name of Board/University
ENGLISH, HINDI, BISHOP WESTCOTT CISCE HISTORY CIVICS BOYS SCHOOL, GEOGRAPHY, NAMKUM, RANCHI MATHS, SCIENCE, ECONOMICS 2007 ENGLISH, DAV JAWAHAR CBSE HISTORY, VIDYA MANDIR, POLITICAL SHYAMALI, SCIENCE, RANCHI ECONOMICS, SOCIOLOGY Stream at Graduation Level :-LAW 3.26 7 2012 BA LLB HONS. THE WB NATIONAL THE WB UNIVERSITY OF NATIONAL JURIDICAL UNIVERSITY OF SCIENCES, JURIDICAL KOLKATA SCIENCES, KOLKATA
