STATE LEVEL POLICE RECRUITMENT BOARD, ANDHRA PRADESH, MANGALAGIRI.

FILLED IN ONLINE APPLICATION FORM

Recruitment for the posts of SCT PC (Civil) (Men & Women)- Post Code No.21,SCT PC (AR) (Men & Women)-Post Code No.22,
SCT PC (APSP) (Men)- Post Code No. 23, Warder (Men) - Post Code No. 24, Warder (Women) - Post Code No. 25
in Prisons and Correctional Services Dept. and Firemen (Men)-Post Code No. 26 in Fire Services Dept.,
-2018, vide Notification No. 215/R&T/Rect.2/2018, dt:- 12.11.2018.

1. Name (As per SSC/Equivalent Certificate) KAKKALAPALLI NARAYANASWAMY

2. Father's/ Husband's Name KAKKALAPALLI SIVAIAH Preserve the REGISTRATION
3. Mother's Name KAKKALAPALLI LAKSHMIDEVI NUMBER for all your future
correspondence.
4. Gender Male
Date of Birth
5.
(As per SSC/Equivalent certificate)
24-06-1991 4139558
SSC/Equivalent Roll No. / 12.
6.
Year of passing
0671267 / 2006
7. Upload Certificate (SSC or Equivalent) Uploaded
Educational Qualifications
8. Intermediate
(as per Notification)
9. Community BC-A
Upload Community Certificate
10.
(For BC, SC and ST )
Uploaded
11. Do you belong to Ex-servicemen? No
If Yes, furnish the following i) Date Of Entry ---
ii) Date Of Discharge ---
Identification Marks
14.
(As per SSC/Equivalent certificate)
A SCAR NEAR THE RIGHT SIDE OF RIGHT EYE
13.
A BLACK MOLE ON THE CHEST
15. Mobile No. 9652112680
16. e-mail id swamynarayana159@gmail.com
17. (a) Do you have Aadhaar Card? Yes
(b) If yes, please mention number 968218891371
What is your preferred medium
18.
of Examination
Telugu
19. Which is your preferred place for 1st Ananthapur(Ananthapur)
writing Preliminary written
examination? 2nd Gooty(Ananthapur)
3rd Kurnool(Kurnool)
20. Post applied for as per your eligibility as per 21 - SCT PC (Civil) (Men & Women)
notification 26 - Firemen (Men)
22 - SCT PC (AR) (Men & Women)
24 - Warder (Men)
None

21. Which is preferred District for 1st Anantapuramu

appearing in PMT/PET after you
qualified in Preliminary Written 2nd Kurnool
Exam?
22. Are you a local of State of Andhra Pradesh? Yes
If yes, which is your Local District? Anantapuramu If No, which State/UT you belong to? ---
If you have selected 'Telangana' as State to which you belong, as per GSR 591E of Govt. of India, Candidates who migrate
from Telangana to Andhra Pradesh with in a period of 5 years from the 2nd Day of June, 2014 shall be regarded as local No
candidate in Andhra Pradesh, Do you belong to this Category?
Do you claim benefit of Age Relaxation (Please read Para No.10(b) of
Notification)
Yes
if yes, specify the applicable category
a) BC Yes b) SC No
c) ST AND ABOST No d) AP Govt. Employee Yes
e) Ex-Servicemen No f) NCC Instructor No
g) AP State Census Dept. No h) AP Home Guard No
i) Widow / Divorced / Judicially separated women No
As per Rule 3 (G) and as mentioned in Notification at Para Nos.25, 26 and 27, the candidates falling under certain categories shall be disqualified for
23.
recruitment. (Please go through the Notification)
Do you come under those categories?
If yes, please note that you are not eligible for recruitment.
No

24. Address for Communication 2/56 BC COLONY,MUDDINAYANAPALLI,Anantapuramu,KALYANDURG,515787

25. Fee Paid through : Payment Gateway Transaction Id./Reference Id. PHMP6918552637 Fee : 300
I Certify that I have read the Notification and I am proceeding to submit this application form after having understood the eligibility and other criteria mentioned in
the Notification. I undertake total responsibility for submitting correct information to the best of my ability.

21-11-2018 08:55:04 PM