FEDERAL PUBLIC SERVICE COMMISSION

F-5/1, Agha Khan Road, Islamabad

APPLICATION FORM No. .............................

Receiving Stamp of Head Quarters T.R

Please attach three

attested photographs

Receiving Stamp of Branch Office (for female candidate

aslo)

Batch No. --------------------- Diary No. -------------------- Roll No.----------------

Please read the Rule & Regulations carefully before filling the Application Form

(A) (i) Consolidated Adv. No. (ii) Case No. (Category Code if applicable )
/ 2 0 0 F. 4- / 2 0 0 -R

(B) Name of post applied for with BPS ..........................................................................................................

(C) Department ..........................................................................................................................................
(D) Ministry/Division ....................................................................................................................................
(1) Name : (Spelling as per Matriculation Certificate)

(2) (a) Date of Birth (As per Matric Certificate) (b) Age on Closing Date
Years Months Days
- - 1 9
(3) N.I.C.No. (Write both NIC Nos.)
(a) Old N.I.C.No. (b) Computerized NADRA N.I.C.No.
- -
(4) Domicile : (Mark relevant code of your domicile) District of Domicile..........................................
Sindh Sindh Punjab / Azad Northern
Domicile Balochistan NWFP FATA
Rural Urban Islamabad Kashmir Areas

Code 10 20 30 31 40 60 61 90

(5) (A) Sex M Male F Female

(B) Marital Status S Single
M
Married
(C) Religion M Muslim N Non Muslim

(D) Do you fall in the category of disabled candidates? If yes put a cross (x) in the relevant Box.

Vasualy impaired (Blind) Physical impaired Hearing/Speech (deaf & dumb)

(6) (a) Professional/Screening Tests Centres
D D.I. KHAN G GILGIT I ISLAMABAD K KARACHI L LAHORE

M MULTAN P PESHAWAR Q QUETTA S SUKKUR

(b) Interview’s Centres

I ISLAMABAD K KARACHI L LAHORE P PESHAWAR Q QUETTA

(7) Age Relaxation:

0 Not claimed (Within age limit) 1 Govt. Servant including serving in Armed Forces

Armed Forces Released/Retired

2 3 Schedule Caste 4 Budihist Community
Commissioned Officer/Personnel

5 Azad Kashmir 6 Northern Areas 7 Recognized Tribal Areas

(8) Postal Address :................................................................................................................................................................................

................................................................................................................

................................................................................................................

Phone No. (Off) .................................................(Res).....................................................

Mobile Phone ...................................................................................................................

Applicant’s Signature
Fax No. ................................................................................................................
 Page-2

(9) ACADEMIC QUALIFICATIONS:

(I) Write only academic qualifications from Matriculation onward in ascending order.
(ii) Writes result announcement date from result card/mark sheet
(iii) Write three principal subjects other than compulsory

RESULT DECLARATION DATE

DIVISION
GRADE
S. NAME OF BOARD /

OR
EXAMINATION PRINCIPAL SUBJECTS
No. UNIVERSITY
Day Month Year

1 Matriculation 2

2 Intermediate 2

1
3 2

4 2

1
5 2

1
6 2

Attach additional sheet if required on the same pattarn

(10) COURSES/TRAININGS (Certificate, Diploma, Post-Graduate Diploma, on job training etc.)

*WEEKS

FROM TO
GRADE

S.
NAME OF COURSE INSTITUTION & LOCATION
No.
Day Month Year Day Month Year

Attach additional sheet if required on the same pattarn

*If dates not given.

(11) EXPERIENCE:
(i) Start from first employment in ascending order (ii) Attach experience certificate for the post mentioned hereunder and experience of which is required for the post applied for.
PERIOD STATUS NATURE OF JOB

FROM TO
B. ORGANIZATION/ (Write to-date if you are still
NAME OF THE POST P. DEPARTMENT MAIN DUTIES PERFORMED
in service)
S.
Day Month Year Day Month Year

Fed. Govt.
Prov. Govt.
Arm. Forces
Semi Govt.
Pvt. Practice
Permanent
Temporary
Officiating
Contract
Ad-Hoc
Daily Wages
Honorary
Part Time
Apprentice
Page-3

Attach additional sheet if required on the same pattern.

 Page-4

(12) RESEARCH/PUBLICATIONS/PAPERS/ARTICLES:
Mark ‘R’ in the last column of the research report/paper/article/publication, if required in the advertisement.

S. PUBLICATION DATE
JOURNAL/CONFERENCES
No. TITLE PUBLISHER R
(In case of paper/article)
Day Month Year

Attach additional sheet if required on the same pattern

(13) Father’s Name : ..................................................................................................................

(14) Husband’s Name : ..................................................................................................................

(For female married candidate)

(15) Nationality of Spouse (Wife/ Husband) Pakistani by birth Pakistani by migration

(16) Permanent Addresses ..................................................................................................................
(In Capital letters)
..................................................................................................................

..................................................................................................................

E-mail Address :__________________________________________ Telephone No. _____________________

Mobile No.________________________
(16a) Disabled candidates (Put a cross (X) in the relevant Box)
Do you need any assistance for attempting the question papers in the examination/test? If yes, please put a
cross(x) in the relevant Box:

Visually
Impaired
(Blind)
[
Writer

Computer

Audio Recorder

Braille
Physically
impaired [ Writer

Computer

Audio Recorder
Hearing/
Speech
(Deaf & Dumb) [ Writer

Computer

Audio Recorder

Note: (i) The disabled candidates seeking any type of assistance to attempt the examination will appear at Islamabad.
(ii) All other disabled candidates who do not require any assistance can appear at their respective centres.

(17) Attested copies of all required documents are attached in the following sequence: Yes / No.
Y/N
1. Original Treasury receipt for Rs.................................. Dated.............................Deposited in
National Bank of Pakistan/State Bank of Pakistan (Branch Name).........................................
Branch Code No............................................... District/City...............................................

2. National Identity Card ........................................................................................................

3. Matric Certificate (Proof of Date of Birth) ..............................................................................
4. Domicile Certificate of candidate.........................................................................................

5. Certificate from District Coordination Officer for candidate under Instruction No. 7 (a) ...............
6. Three photographs (to be attached at the provided space) .....................................................
7. Departmental Permission Certificate from present employer (if applicable) ..............................

8. All certificates of educational qualifications ..........................................................................

9. Experience certificates ......................................................................................................
10. whether the application has been signed by you? .................................................................

11. In case of Disabled candidates, certificate of disability from the comptent authority .................
(18) I certify that the statements made by me in answer to the foregoing questions 1-16 are true, complete and
correct to the best of my knowledge and belief. Submission of fake/forged documents and any misrepresentation of
omission discovered even after appointment may render my appointment liable to termination in addition to the action
decided by the Commission. I have also carefully read the General Instructions to the candidates, and I am bound by
the terms and conditions contained therein.
(19) The documents be arranged in the above said order, and all documents attached with the application form must
be numbered in continuation with the page number of the application form.

Date: ______________

Applicant’s Signature-2
 Page-5

ADDRESS FOR CORRESPONDENCE

(20) Important Note:

Please write your name and address in Capital letters Any change of address should be reported to FPSC immediately.
The Commission does not accept any responsibility in case of change in address not communicated to the
Commission Address “Care of Post Pox No.” etc. should not be written as postal authority does not accept Registered
letters at such addresses:

F. 4- /200 - Roll No. F. 4- /200 - Roll No.

Name : ........................................................ Name : ........................................................

Address : .................................................... Address : ....................................................
.................................................................. ..................................................................
.................................................................. ..................................................................
Postal Code : --------------------------------- Postal Code : ---------------------------------

F. 4- /200 - Roll No. F. 4- /200 - Roll No.

Name : ........................................................ Name : ........................................................

Address : .................................................... Address : ....................................................
.................................................................. ..................................................................
.................................................................. ..................................................................
Postal Code : --------------------------------- Postal Code : ---------------------------------

F. 4- /200 - Roll No. F. 4- /200 - Roll No.

Name : ........................................................ Name : ........................................................

Address : .................................................... Address : ....................................................
.................................................................. ..................................................................
.................................................................. ..................................................................
Postal Code : --------------------------------- Postal Code : ---------------------------------

FEDERAL PUBLIC SERVICE COMMISSION

Application Form No._____________

Name of Post____________________________________________________________________________

Case No.F-4__________________/200 -R________________ Add. No.________________________

Candidate’s Name :_______________________________________________________________________

Receiving Stamp of R & I

Received by ..................................................................... Signature

 Page-6
Annexure ‘A’
EXPERIENCE CERTIFICATE

Certified that Mr./Miss/Mrs........................................................................................................................

has been/is employed in this Ministry/Division/Department/Firm/Organization as.....................................................
from......................................to.................................(dates) whole time/part time/honorary basis/contract basis/daily
wages. The work of Mr./Miss/Mrs..................................................... while employed in this Ministry/ Division/De-
partment/Firm/Organization was/is satisfactory. The duties/job specifications are/were as follows :—

(1) ..............................................................................................................................................

(2) ..............................................................................................................................................

(3) ..............................................................................................................................................

(4) ..............................................................................................................................................

(5) ..............................................................................................................................................

Date of Issue.............................. Name of Issuing Authority..................

.......................................................
Designation......................................
BPS (or Equivalent)...........................
Office Stamp/Seal.............................

Note : (i) Experience certificate must be issued under the signature of an officer at least one step higher than the post
applied for. For example in case of a candidate for a post of BPS-17, the experience certificate must be
issued under the signature of head of the department/an officer of BPS-18 or equivalent as the case may be.

(ii) In case of candidate who served/is serving in a private Firm/Organization, experience certificate must be
issued under the signature of Chief Executive/Head of Private Firm/Organization.

(iii) Experience certificate must be issued on the official letter pad with reference/file No. and date of issue
and it should be duly stamped with full address. Telephone No. should also be indicated, failing which the
experience certificate will not be acceptable.
........................................................................................................................................................................
Annexure ‘B’
CERTIFICATE TO BE PRODUCED BY CANDIDATES BELONGING
TO THE TRIBAL AREAS

This is to certify that Mr./Miss/Mrs..........................................................................................................

Son/Daughter of..................................................................................................................................................
belongs to the recognised tribe of........................................................................................................................
and is a permanent resident of Village/Town..........................................................................................................
of District/Trible Area..........................................................................................................................................
and his/her family have been living in that area......................................................................................................
belongs to a Northern Area* Federally Administered Tribal Area* Provincially Administered Tribal Area*.

Note :—Tribal Area as defined vide Article 246 of the Constitution of the Islamic Republic of Pakistan.

*Strike out whichever is not applicable.

Dated............................................. Signature...................................
Political Agent
(Seal of the Office)
 Page-7

Annexure ‘C’

Certificate to be produced by the candidate from the Kashmir Affairs Division, Government of Pakistan,

This is to certify that Mr./Miss/Mrs..........................................................................................................

Son/Daughter of..................................................................................................................................................
is a permanent resident of Village/Town..................................................................... of District................................
of Azad Jammu & Kashmir Territory and has been living in the aforesaid areas or any other part of Pakistan.

Dated............................................. Signature.......................................

Designation....................................
(Office Seal). .
 FEDERAL PUBLIC SERVICE COMMISSION

Application Form No. ___________

DEPARTMENTAL PERMISSION CERTIFICATE FOR PERSONS IN

GOVERNMENT SERVICE

(To be detached from the application form and submitted to candidates employing
department before the closing date. No column should be left blank).

(1) (a) Full name of the advertised post______________________________________________________

(b) Name of Department/Division/Ministry________________________________________________
(c) Commission’s Advertisement No._______________ of 200_________________________________
(e) Case No.F-4_____________ /200 - R__________________________________________
(2) (i) Name of candidate______________________________Father’s Name_______________________
(ii) I.D. Card No. - -
(iii) Designation_________________________________________________BPS No.______________
(iv) Present department with complete address_____________________________________________
________________________________________________________________________________

(3) I have applied for the above post on the prescribed form separately. Departmental permission for submis-
sion of my application, may kindly be forwarded to the Secretary, Federal Public Service Commission, F-5/1, Agha
Khan Road, Islamabad, Closing date for receipt of application by the commission is ________________________________

Date_______________________ Signature of the candidate___________________

For use by the department (employer of the candidate)

Attention :—
Division/Department concerned must forward this certificate or communicate the refusal to F.P.S.C.
within 60 days from the closing date for receipt of applications or before interviews whichever is earlier,
failing which the head of the organization will have to account for its non-submission or delay to the
Government. On selection the department will have to relieve the official for joining the post.

No.____________________ Date________________

(4) Forwarded : Mr./Miss/Mrs____________________________________________________ is employed

in this department since ______________________he/she/holds a temporary/permanent/ad hoc/contract/daily wages
post under the Federal/Provincial/Semi Government/Government/Autonomous Corporation (Strike out not applicable).
His/her total continuous government service (Federal/Provincial is__________years_________months_________days.

(5) The candidate has availed extraordinary leave for ___________years__________Months__________

days and or has availed study leave for__________years__________months__________days.

(6) The place of domicile as declared by him/her and accepted at the time of first entry in Government/
Semi Government/Autonomous/Corporation service was___________________________Province/area. In case of Sindh,
indicate Sindh (Rural) or Sindh (Urban).

(7) There is nothing adverse in his/her performance evaluation report (PER)/annual confidential reports/
records, antecedents/character, which may render him/her ineligible/unsuitable for the post applied for.

(8) In case it is decided by the department to forward a case where adverse entries do exist in an officer’s/
Official’s record, extracts of the adverse entries from the relevant ACRs’ should be sent alongwith the departmental
permission certificate for information of the Commission. Also confirming that the adverse remarks were communicated
to the candidate and no appeal petition is pending for decision thereon.

Signature_____________________

Name________________________
Designation and department with
Secretary, complete address (to be signed by
Federal Public Service Commission, head of the Department/Division/
F-5/1, Agha Khan Road, Ministry
Islamabad. (Official stamp must be affixed)