KARNATAKA STATE POLICE DEPARTMENT

APPLICATION FOR THE POST OF ARMED POLICE CONSTABLE (MEN)-2016

Pm (g) zU Cf-2016
Notification No /CZ

: 4018450

Application No

AS

Applying as a

01. Applicant's Full Name

Cfzg t g

: SHIVAKUMAR T

02. Mother's Name

vAi g

: RATHNAMMA

03.

Fathers Name
vAzAi g

05.

Address

Native District
06. Av f

: 29/Pw-4/2015-16 AP: 06/01/2016

: THIPPESWAMY T

: Direct Candidate

Unit Name

04. Gender
AU

: Mysore City

: Male

: 9TH CROSS MALAPPANA HATTY,M K HATTY POST,CHITRADURGA,CHITRADURGA,Karnataka,577502

6a. If Others
Evg

: Chitradurga

08. Email Id
E-

: shiva123.skt@gmail.com

09. Height of the Candidate

CsyAi Jvg

: 170.5

: Nil

07

Mobile Number
AS

: 8150093030

8a. Confirmation Email ID

E- jPgt

: shiva123.skt@gmail.com

11b. Date of issue of Certificate

it v vgu AP

: 24-Jul-2013

Reservation Details
11. Category
U

: 2A

11a. Sub Caste

: KURUBA

Do you belong to a family of an Ex-servicemen who while in service was permanently disabled or died in action ( Only for
12. Ex-servicemen Children )?
, Pvz vV zP Pv Cx gt Az if P PlAP jgg

: No

12a. Death while in service

Pv U gt Azg.

: No

Permanently disabled while in Service

12b. Pv U v Pv
Azg

: No

12c. Wife, Husband, Children, Step Children

Aqw, UAq, P, P

: No

12d. Select Family of an Ex-Servicemen

: Nil

Are you claiming PDP Reservation ?

13. Aid gv Csy w
Pgg ?

: No

Date of issue of Eligibility Certificate

13a. Cv it v vgu AP

: Nil

Are you claiming Kannada medium

Reservation ?
14. Pq izs Csy w
Pgg ?

: Yes

14a. Date of issue of Eligibility Certificate

Cv it v vgu AP

: 10-Mar-2014

: No

15a. Date of issue of Eligibility Certificate

Cv it v vgu AP

: Nil

: No

16a.

Are you a Government Employee ?

17. Pj Pgg ?

: No

Department
17a. ES

17b. Designation
z

: Nil

17c. Service rendered : Years

z U

Are you claiming Rural medium

15. Reservation ?
Ut izs Csy w
Pgg ?
Are you a candidate belonging to
Hyderabad-Karnataka Region ? /
16. zgz- PlP zz
CsyAi?

If yes, to which District you belong to ?

zz, Aii fU
AAg

: Nil

: Nil

: Nil

Months
wAU

: Nil

Days
U

: Nil

17d. Date of issue of NOC

gPu it v vgu AP

: Nil

18. Date of Birth

nz AP

: 09-Jun-1994

: 21 Years 7 Months 27 Days

18a. Age,As on date (05.02.2016)

Have you been involved in any Criminal

Case / Departmental Enquiry ?/
19. Aiizzg Cgzs Pgtz /
ES ZguAi zAiiVg ?

: No

details
19a. Give
g qz

: Nil

Have you been convicted in a Criminal

Case ?
20. Cgzs PzAi PU
Mngg ?

: No

details
20a. Give
g qz

: Nil

21. Have you submitted any application for the same post in any other units
zj zU Evg WlPU Cf g

: No

Educational Qualification Details

Are you a Degree holder or holder of a
Equivalent qualification from Recognized
University ?
22. zszg Cx CAVPv
zAiAz vvi zv
Agg?

: Yes

Educational Qualification
23. zv

: SSLC- STATE BOARD

25. Year of passing

Gwtgz

: 2010

26. Maximum Marks

Uj CAPU

: 625

If Equivalent, Please specify

24. vvi zv Azg . :

27. Secured Marks

Uz CAPU

Nil

28. Percentage
Pqg

: 362

: 57.92

Payment Details
29. Date of Challan Generation
Z fz AP

: 22-Jan-2016

30. Fee Paid

wz

32. Journal No.

d AS

: 1099044

33. Bank Branch Code

AP AZPq

35. Bank Address

AP

: J C R EXTENSION CHITRADURGA

31. Date of Payment

wz AP

: 250
: 40635

34. Bank
AP

: 04-Feb-2016

: SBM

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Date

: 11 March 2016 02:06 PM

IP Address

: 103.231.218.158

Applicants signature / Cfzg /-