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¨sÁUÀ – 5 , 09 2022( 18 1944) . 569
Part – V BENGALURU, WEDNESDAY, 09, NOVEMBER, 2022( KARTHIKA, 18, SHAKAVARSHA, 1944) No. 569
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PɼÀPÀAqÀ ªÀAiÉÆëÄwAiÀÄ£ÄÀ ß «ÄÃjgÀ¨ÁgzÀ ÀÄ.
a)
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i)
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ii)
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iii)
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PÌÉ C¨sÀåyðUÉ F PɼÀPÀAqÀ ªÀAiÀĸÀÄì «ÄÃjgÀ¨ÁgÀzÀÄ.
i)
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ii)
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CºÀðvÁ µÀgvÀ ÀÄÛUÀ¼À°è AiÀiÁªÀÅzÉà §zÀ¯ÁªÀuÉUÀ½gÀĪÀÅ¢®è.
¸À»/-
(PÀªÀÄ¯ï ¥ÀAvï, L.¦.J¸ï)
qÉÊgÉPÀÖgï d£ÀgÀ¯ï D¥sï ¥Éưøï,
£ÉêÀÄPÁw,
PÁ®ðl£ï ¨sÀªÀ£À, CgÀªÀÄ£É gÀ¸ÉÛ,
¨ÉAUÀ¼ÀÆgÀÄ - 560001.3
Only for In-service candidates
¸ÉêÁ¤gvÀ À C¨sÀåyðUÀ½UÉ ªÀiÁvÀæ/
– ANNEXURE – ‘A’
C£ÀħAzsÀ ‘J’ /
CERTIFICATE
¥ÀæªÀiÁt ¥ÀvÀæ /
CfðzÁgÀ£ÀÄ J¯Áè CºÀðvÁ ªÀiÁ£ÀzÀAqÀUÀ¼À£ÀÄß ¥ÀÆgÉʹgÀĪÀÅz£À ÀÄß ªÀÄvÀÄÛ ªÁ¸ÀÛªÁA±ÀUÀ¼ÀÄ DvÀ£À ¸ÉêÁ
zÁR¯ÉUÀ½UÉ ºÉÆAzÁtÂPÉAiÀiÁVgÀĪÀÅzÀ£ÀÄß ¥Àj²Ã°¸À¯ÁVz.É F PɼÀPÀAqÀ vÀ¥Á¸ÀuÁ ¥ÀnÖAiÀÄ£ÀÄß PɼÀUÉ ¸À»
ªÀiÁrgÀĪÀªÀgÀÄ RÄzÁÝV ¥Àj²Ã°¹zÁÝgÉ.
Verified that the applicant fulfills all eligibility criteria and facts have been tallied from his
service records. The check list below has been personally verified by the undersigned.
I
(J) C¨sÀåyðAiÀÄ ¥ÀÆtð º¸É ÀgÀÄ ___________________________________ ¥Àæ¸ÀÄÛvÀ PÀvÀðªÀå
¤ªÀð»¸ÀÄwÛgÀĪÀ ºÀÄzÉÝ _______________________________________ ªÄÀ vÀÄÛ PÀvÀðªÀå ¤ªÀð»¸ÀÄwÛgÀĪÀ
¸ÀܼÀ _______________________.
(a) The Candidate’s Full Name ____________________________. Present post of the
candidate _______________________ and working place of the candidate
________________________.
(©) C¨sÀåyðAiÀÄ d£Àä ¢£ÁAPÀªÀÅ zÁR¯ÉUÀ¼À£ÀĸÁgÀ ______________________ DVgÀÄvÀÛz.É DvÀ£ À
ªÀAiÀĸÀÄì -----------PÉÌ ____________________ EgÀÄvÀÛzÉ.
(b) The Candidate’s Date of Birth, as per record is _________________. His age as on -
--------------is _______________ .
(¹) C¨sÀåyðAiÀÄÄ --------PÉÌ ¦.AiÀÄÄ.¹./vÀvÀìªÀiÁ£À «zÁåºÀðvÉ ºÆÉ A¢gÀÄvÁÛ£É. CªÀ£ÀÄ ___________
ªÀÄAqÀ½¬ÄAz À _____________ ªÀµÀðzÀ°è _______________________ ¥ÀjÃPÉëAiÀÄ°è
GwÛÃtð£ÁVzÁÝ£É.
(c) The candidate has a PUC/Equivalent Qualification as on ---------------- He has passed
.
__________________________ Examination from ______________Board in the year
___________ .
(r) C¨sÀåyðAiÀÄÄ zÁR¯É/¥æªÀ ÀiÁt ¥ÀvÀæPÀÌ£ÀĸÁgÀªÁV ______________________________
eÁw/¸ÀªÀÄÄzÁAiÀÄ/¥ÀæªUÀ ÀðPÉÌ ¸ÉÃjzÁÝ£É.
(d) The candidate belongs to _______________ Caste/Group/Category as per Service
record/Certificate.
--------
(E) C¨sÀåyðAiÀÄÄ ____________gÀAzÀÄ ¥Éưøï E¯ÁSÉUÉ ¸ÃÉ jzÁÝ£.É ¢£ÁAPÀ: PÉÌ
¥ÉÆ°Ã¸ï ¥ÉÃzÉ DV DvÀ£À ¸ÃÉ ªÁªÀ¢üAiÀÄÄ _________________ ªµÀ Àð_________ wAUÀ¼ÀÄ
__________ ¢£ÀUÀ¼ÁVgÀÄvÀÛzÉ.
(e) The candidate has joined the Police Department on ________________. His length of
Service as PC as on -------- is ________Years ______Months ______Days.
II
PÀqÀvÀ ®¨sÀå«®èzÀ CxÀªÁ EvÀgÀ PÁgÀtUÀ½UÁV PɼÀPÀAqÀ CA±ÀUÀ¼À£ÄÀ ß ¥jÀ ²Ã°¸À¯ÁV®è.
For lack of records or otherwise. I am unable to verify the following.
a. / Departmental Enquiry.
E¯ÁSÁ «ZÁgÀuÉ
b. / Involvement in Criminal Cases.
C¥gÀ ÁzsÀUÀ¼À°è vÉÆqÀVgÀĪÀÅzÀÄ
c. Caste/Group/Category
eÁw/¸ÀªÀÄÄzÁAiÀÄ/¥ÀæªÀUÀð
¥ÉÆ°Ã¸ï ¸ÀÆ¥ÀjAmÉAqÉAmï/WÀlPÁ¢üPÁj
Superintendent of Police/Unit Officer
(with Office Seal)R.N.I. No. KARBIL/2001/47147 POSTAL REGN. No. RNP/KA/BGS/2202/2017-19
Licensed to post without prepayment WPP No. 297
4
Only for In-service candidates
¸ÉêÁ¤gÀvÀ C¨sÀåyðUÀ½UÉ ªÀiÁvÀæ/
– ANNEXURE – ‘B’
C£ÀħAzsÀ ‘©’ /
DECLARATION
WÉÆõÀuÉ /
£Á£ÀÄ ¸ÉêÁ¤gÀvÀ ¥Éưøï PÁ£ïìmÉç¯ï (¹«¯ï) (¥ÀÄgÀĵÀ ªÀÄvÀÄÛ ªÀÄ»¼Á) ºÄÀ zÉÝAiÀÄ £ÉêÀÄPÁw §UÉÎ
C¢ü¸ÀÆZÀ£ÉAiÀÄ°è C£ÀħAzsÀUÀ¼À£ÀÄß UÀªÄÀ £«À lÄÖ N¢zÉÝÃ£É ºÁUÀÆ CªÀÅUÀ½UÉ §zÀݪÁVgÀĪÀÅzÁV F ªÀÄÆ®PÀ
zÀÈrüÃPÀj¸ÀÄvÉÛãÉ.
I have read the provisions in the Notification regarding the Recruitment to the post of Inservice Police
Constable (Civil) (Men & Women) carefully and I hereby declare to abide by the sub-rules.
1) £À£Àß ¥ÀÆtð º¸É gÀ ÀÄ ______________________________________________ ¥Àæ¸ÀÄÛvÀ PÀvÀðªÀå
¤ªÀð»¸ÀÄwÛgÀĪÀ ºÀÄzÝÉ ______________________________ ªÄÀ vÀÄÛ PÀvÀðªÀå ¤ªÀð»¸ÄÀ wÛgÀĪÀ ¸ÀܼÀ
_______________________.
My Full Name ______________________________________ working
as__________________ and place of working ________________________________.
2) £À£Àß d£Àä ¢£ÁAPÀ ________________ DVgÀÄvÀÛzÉ. CzÀÄ _________________ zÁR¯ÉAiÀÄ£ÀÄß
DzsÀj¹gÀÄvÀÛzÉ. ------ PÉÌ £À£Àß ªÀAiÀĸÀÄì _____________________ EgÀÄvÀÛzÉ.
My date of birth is ____________. My age as on ---------- is _____________. It is
supported by ____________ Document.
3) ------ PÉÌ £Á£ÀÄ ¦AiÀÄĹ/vÀvÀìªÀiÁ£À «zÁåºÀðvÉ ºÉÆA¢zÀÄÝ, ________________ ªÄÀ AqÀ½¬ÄAzÀ
______________ ªÀµÀðzÀ°è _______________ ¥ÀjÃPëAÉ iÀÄ°è GwÛÃtð£ÁVzÉÝãÉ. CzÀPÉÌ DzsÁgÀªÁV
_____________ zÁR¯É EgÀÄvÀÛzÉ.
I am a PUC/Equivalent Qualification as on ------- I have passed ________________
Examination from __________ Board in ___________ Year. The supporting document is
__________ .
4) £Á£ÀÄ ______________ eÁw/¸ÀªÀÄÄzÁAiÀÄ/¥ÀæªÀUÀðPÉÌ ¸ÉÃjzÉÝã.É CzÀPÉÌ DzsÁgÀªÁV _____________
zÁR¯É EgÀÄvÀÛzÉ.
I belong to __________ Caste/Group/Category. The supporting document is __________
5) £Á£ÀÄ ___________________ gÀAzÀÄ ¥ÆÉ °Ã¸ï E¯ÁSÉUÉ ¸ÉÃjzÉ. ------ PÉÌ £À£Àß ¸ÉêÁªÀ¢üAiÀÄÄ
_____________ ªÀµÀð ________ wAUÀ¼ÀÄ _________ ¢£ÀUÀ¼ÁVgÀÄvÀÛzÉ.
I joined the Police Department on ___________. My length of Service as on
------ is _______________ years __________ months _________ days.
6) £Á£ÀÄ AiÀiÁªÀÅzÉà Qæ«Ä£À¯ï ¥ÀæPÀgÀtzÀ°è ¨ÁVAiÀiÁVgÀĪÀÅ¢®èªÉAzÀÄ ºÁUÀÆ £À£Àß «gÀÄzÀÝ E¯ÁSÁ «ZÁgÀuÉ
¨ÁQ EgÀĪÀÅ¢®èªÉAzÀÄ WÉÆö¸ÀÄvÉÛãÉ.
I declare that I have neither been involved in any Criminal case nor any Departmental
Enquiry is pending against me.
ªÉÄÃ¯É ºÉýzÀ «ªÀgÀUÀ¼ÀÄ ¤dªÉAzÀÄ £Á£ÀÄ F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ. AiÀiÁªÀÅzÉà ªÀiÁ»wAiÀÄÄ
¥ÀjÃPÉë/¸ÀAzÀ±Àð£/À £ÉêÀÄPÁw ªÀÄÄAZÉ, ¸ÀAzÀ¨sÀð CxÀªÁ vÀgÀĪÁAiÀÄ ¸ÀļÀÄî CxÀªÁ vÀ¥ÉàAzÄÀ PÀAqÀÄ §AzÀ ¸ÀAzÀ¨Àðs zÀ°è
CxÀªÁ C£ÀºÀðvÉ ¥ÀvÉÛAiÀiÁzÀ ¸ÀAzÀ¨sÀðzÀ°è £À£Àß «gÀÄzÀÝ PÀæªÀÄ PÉÊUÉƼÀÀÄzÁVzÉAiÉÄAzÀÄ £À£ÀUÉ w½¢gÀÄvÀÛzÉ.
I hereby declare that the above information is true. I am aware that I am liable for action against me in the event of
any information being found false or incorrect or ineligibility being detected before, during or after the
examination/interview/appointment.
C®èzÉ EzÉà §UAÉ iÀÄ ¥ÀjÃPÉëUÉ ºÁdgÁUÀzÀAvÉ £Á£ÀÄ vÀvÀìªÀiÁ£À ¥ÀjÃPÉë¬ÄAzÀ GZÁÑn¸À®ànÖ®èªÉAzÀÄ ¸ÀºÀ
WÉÆö¸ÀÄvÉÛãÉ.
I further declare that I have not been debarred from appearing for any similar examination.
Date/
¢£ÁAP:À C¨sÀåyðAiÀÄ ¥ÀÆtð ¸À»
Place/ Signature of the candidate
¸ÀܼÀ:
ಮುದ(cid:206)ಕರು (cid:178)ಾಗೂ ಪ(cid:206)(cid:144)ಾಶಕರು:- ಸಂಕಲ(cid:163)ಾ(cid:297)(cid:144)ಾ(cid:312)ಗಳ(cid:133), ಕ(cid:163)ಾ(cid:143)ಟಕ (cid:170)ಾಜ(cid:205)ಪತ(cid:206), ಸ(cid:144)ಾ(cid:143)(cid:312) (cid:144)ೇಂದ(cid:206) ಮುದ(cid:206)(cid:158)ಾಲಯ, (cid:166)ೆಂಗಳ(cid:136)ರು