ACHARYA N.G.

RANGA AGRICULTURAL UNIVERSITY

ADMN.CAMP OFFICE: VIJAYA DURGA TOWERS: M.G.INNER RING ROAD: GUNTUR-522 509: A.P.

APPLICATION FORM FOR THE POST OF SEED CERTIFICATION OFFICER

in
ANDHRA PRADESH STATE SEED CERTIFICATION AUTHORITY

For office use only No.

Affix Passport size
Photo

To be filled by the applicant

1. Full Name of the Applicant : Surname

(IN BLOCK LETTERS
as recorded in SSC /
Name
Matriculation Certificate)

2. Fathers / Husbands Name

:

3. Gender : M F
(Please put tick mark)

4. Date of Birth :
Date Month Year

5. Age as on 01.04.2017 :
Years Months Days

6. Social Status : SC ST Differentially BC GEN

( Please put tick mark abled
in appropriate box
in case of reserved Community
Candidate )

7. Educational qualifications : Qualification Marks % of Marks

secured
S.S.C.
Intermediate
B.Sc.(Ag)
M.Sc.(Ag)

8. Experience (Duration of :
Years Months Days
Experience with APSSCA
only)

Contd.2.,
 :: 2 ::

9. Languages known : Language Read Write Speak

(Please put tick mark)
Telugu
English
Hindi
If any other

10. Permanent Address H.No. / Flat No

:
Area / Locality
Village / Town
Mandal
District
State & Pin code

11. Present address / Mailing : H.No. / Flat No

Area / Locality
Village / Town
Mandal
District
State & Pin code

12. Particulars of Fees paid : Name of the DD / BC No. Date Amount

(Rs.)
Bank

13. Employment Registration No.:

14. Phone No. : 1) Land line :

2) Mobile :

DECLARATION

I here by declare that the particulars furnished above are true to the best of my knowledge and
belief and for any false averment will found later disqualify me from holding above appointment, if
selected and appointed.

Place:
Date: SIGNATURE OF THE APPLICANT

Contd.3.,
 :: 3 ::

CHECK LIST OF ENCLOSURES (FOR THE APPLICATION):

1. Age proof (as recorded in SSC / Matriculation Certificate)

2. Community Certificate in case of reserved candidates (given by Tahsildar of Mandal)
3. Qualifications, Study Certificate and Marks Lists of SSC/ Matriculation/ Intermediate /
B.Sc.(Ag), M.Sc.(Ag). A proof of proficiency in Telugu language ( suitable certificate must be
enclosed ).
4. Service Certificate in case of experienced candidates (given by The Director, APSSCA)
5. Affix (3) Passport size Photos (one on Application Form, two for the original & duplicate Forms
of Hall Tickets)

6. Crossed D.D. for Rs.1000/- ( Rs.500/- in case of SC/ST/Differentially abled candidates) drawn
in favor of The Comptroller, ANGRAU, Guntur.

7. Self addressed envelope size 22 x 9 cms. Duly affixing Rs. 20/- Postal Stamps for sending Hall
Ticket.

-------------------