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South East Central Rly Recruitment Against Cultural Quota

The South East Central Railway is accepting applications to fill 2 positions in Group C categories under a cultural quota. The positions are for Classical Dance (Bharatnatyam/Kathak) and Light Vocal, both female. Applicants must have the requisite degree/diploma in the relevant field and pass the 10th standard exam. Selection will involve a written exam, assessment of talent, and review of qualifications/awards. Applications must be submitted by June 14th, 2013 along with the required documents and fees.
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0% found this document useful (0 votes)
162 views12 pages

South East Central Rly Recruitment Against Cultural Quota

The South East Central Railway is accepting applications to fill 2 positions in Group C categories under a cultural quota. The positions are for Classical Dance (Bharatnatyam/Kathak) and Light Vocal, both female. Applicants must have the requisite degree/diploma in the relevant field and pass the 10th standard exam. Selection will involve a written exam, assessment of talent, and review of qualifications/awards. Applications must be submitted by June 14th, 2013 along with the required documents and fees.
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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SOUTH EAST CENTRAL RAILWAY

RAILWAY RECRUITMENT CELL Headquarters Office Personnel Department, Bilaspur (C.G.) Employment Notice No. P-HQ/RRC/761/2013-14
[

RECRUITMENT AGAINST CULTURAL QUOTA


Date of issue: 04.05.2013 Closing date : 14.06.2013 at 18.00 hrs.

Applications are invited in the prescribed format from eligible candidates for recruitment to 2 (Two) posts in Group C categories against cultural quota to be recruited in Pay Band-1 ` 520020200 on Grade Pay ` 1900/-/Pay Band-1 ` 5200-20200 on Grade Pay 2000/- on South East Central Railway in the following disciplines for the year 2013-14:1. DETAILS OF POSTS/DISCIPLINES Sl. No
1.

Discipline Classical Dance (Female) (Bharatnatyam/Kathak)

No. of post 01

Essential qualification Possession of Degree/Diploma/Certificate in relevant Classical Dance (Bharatnatyam/ Kathak) disciplines from government/ any government recognized institutes. Possession of Degree/Diploma/Certificate in relevant Light Vocal disciplines from government/ any government recognized institutes.

2.

Light Vocal (Female)

01

2.

ACADEMIC QUALIFICATIONS Passed Matriculation or its equivalent with not less than 50%marks in aggregate. Minimum percentage of 50% marks in aggregate is not applicable to SC/ST candidates and to those candidates (Irrespective of community),who possess qualifications higher than matriculation such as HSC/Intermediate/Graduation/Post Graduation.(or) Act Apprenticeship / ITI . No other qualification including Diploma in Engineering will be accepted as an alternative. Act Apprenticeship / ITI Certificate must be approved by SCVT/NCVT.

3. AGE LIMITS Candidates should have attained age of 18 years and should not have completed 30 years as on 01.07.2013.The upper age relax-able by 03 years for candidates belonging to OBC communities, by 05 years for candidates belonging to SC/ST communities.
3.1 EXTENT OF AGE RELAXATION:

A.

Serving Railway employees who have put UR - 40 years in three years of continuous service and OBC - 43 years substitutes who have put in three years of SC/ST - 45 years. continuous service or three years in broken spells in the Railways. Widow / Divorced women and women UR 35 years

B.

judicially separated but not remarried. C.

OBC - 38 years SC/ST - 40 years Persons who had ordinarily domiciled in By 05(five) years. the Kashmir Division of the State of Jammu and Kashmir during the period from 1st.January 1980 to 31 st. December 1989 Staff of quasi Administrative Offices of Relaxation of age will be to the extent of 5 years (or) Railway Organizations: service rendered by them in such organizations whichever is less. Ex-servicemen candidates Relaxation of age will be to the extent of service rendered by them in Defence services plus 3 years provided they have put in a minimum of 06 months service after attestation and up to the age of 40 years for reservists not employed in Government Service. Persons with Disability UR - 40 years OBC - 43 years SC/ST - 45 years.

D.

Note:(i) Specific category and place of posting will be decided by the South East Central Railway administration at the time of offering appointment to the selected candidate. (ii) The community break up of the posts notified will be decided at the time of offer of appointment based on the community of the selected candidates. Accordingly all the eligible candidates belonging to all categories (UR,OBC, SC/ST etc.,)may apply for the posts notified. (iii) Candidates belonging to SC/ST communities should produce a community certificate in the format given in Annexure-D of this Notification. (iv) Candidates belonging to OBC community should produce a community certificate in the format given in Annexure-E of this Notification. In addition the OBC candidates should enclose self-declaration of non-creamy layer status in the proforma given in Annexure-F. (v) Serving employee and Staff of Quasi administrative offices of Railway Organizations: No Objection Certificate and Bonafide Certificate giving the length of regular service etc. from the employer should be attached. (vi) Divorced/Judicially separated Women: Copy of Decree from the competent court of law for having divorced/judicially separated along with an Affidavit that she has not remarried since should be enclosed. (vii) Widow : Death certificate of her husband together with an Affidavit has not remarried since should be enclosed. (viii) Ex-Servicemen : Discharge certificate should be enclosed. (ix) Persons with Disability: Disability Certificate issued by Medical Board of appropriate Government in the prescribed format given in Annexure-G of this Notification should be enclosed. 4. DESIRABLE. (i) Experience in the field and performances given in AIR/Doordarshan etc. (ii) Prizes won at National level. 5. MODE OF SELECTION :I. Performance of candidates who apply in response to this notification and are found eligible for consideration for appointment against cultural quota shall be assessed on the basis of:(A) Written Test (Note: The written test will consist of objective type questions) 50 marks (B) Assessment of talent in the relevant field on (i) the basis of practical demonstration 35 marks (ii) Testimonials/Prizes etc. 15 marks Total 100 marks (Note:- The written examination will consist of objective type questions)

II. Candidates recommended for appointment will have to pass the requisite medical fitness standards prescribed for the posts to be identified by South East Central Railway administration. III. Call letters will be sent to eligible candidates for written Examination. Date of written examination will be announced later. List of eligible candidates and updates will be displayed in the SECR website www.secr.indianrailways.gov.in 6. SCALE OF PAY :- PB-1 ` 5200-20200 + Grade Pay ` 1900/- (RSRP)/ PB-1 ` 5200-20200 + Grade Pay ` 2000/- (RSRP) 7. HOW TO APPLY:(i) Candidates are required to apply in the enclosed format. The application should be filled in by the candidate in his/her own hand-writing. One passport size latest photograph of the candidate should be pasted in the specified space on the application form, duly signed on top by the candidate and attested by a gazetted officer. Two passport size photographs (same as affixed in the application form), duly signed on top by the candidate should also be attached along with the application form. All the copies of the certificates in support of age, caste, educational qualification, cultural qualification i.e. degree/diploma/certificate in the relevant disciplines Viz., Classical Dance (Bharatnatyam / Kathak), Light Vocal, duly attested by a gazetted officer, should be enclosed along with the application form. For UR & OBC candidates, applications should accompany bank draft or IPO amounting to Rs. 40/- (Rupees forty only) drawn in favour of FA & CAO/South East Central Railway/Bilaspur payable at Bilaspur towards examination fee. Remittance of examination fees in any other forms will not be accepted. Candidates belonging to SC/ST, Women, Minoriites {Muslim, Christians, Sikhs, Buddhists and Zorastrians (Parsis)} & Persons With Disabilities are exempted from paying the fees and those belonging to economically backward classes are also exempted from paying the fees, on production of necessary certificate in the format enclosed as Annexure C. Candidates belonging to economically backward classes will mean the candidates whose family income is less than Rs.50,000/- per annum. The following authorities are authorized to issue income certificates for the purpose of identifying economically backward classes:District Magistrate or any other Revenue Officer up to the level of Tehsildar. Sitting Member of Parliament of Lok Sabha for persons of their own constituency. Union Minister may also recommend for any persons from anywhere in the country. Sitting Members of Parliament of Rajya Sabha for persons of the district in which these MPs normally reside. Note: BPL Card or any other certificate issued by Central Government under a recognized poverty alleviation programme or Izzat MST issued by Railways will also be valid. The certificate for waiver of fee in respect of candidates belonging to economically backward classes is required to be issued on the letter head of the issuing authority as per the format enclosed as Annexure C. (v) Two self-addressed envelopes (size 23 cms X 10 cms) should be attached with the application. Serving employees should submit their applications through proper channel as per extant rules. More than one application in one envelope will be summarily rejected. 1. 2. 3. 4.

(ii)

(iii)

(iv)

(vi)

8. WHOM TO APPLY:Application should be addressed to and sent by post to the Dy. Chief Personnel Officer(Recruitment), Railway Recruitment Cell(RRC), South East Central Railway, R.T.S. Colony, Near Kendriya Vidyalaya, Bilaspur (Chhattisgarh)- 495004 or should be dropped in the box provided at Railway Recruitment Cell(RRC), Dy. CPO(Rectt.)s Office, R.T.S colony, Near Kendriya Vidyalaya, Bilaspur, before closing date (up to 18.00 Hrs. of 14.06.2013). The envelope containing application should be super-scribed on the top - Employment Notice No. PHQ/RRC/761/2013-14 Recruitment against Cultural Quota over South East Central Railway. Application received after 18.00 hrs of 14.06.2013 shall not be entertained. 9. GENERAL CONDITIONS: The decision of Recruitment Cell in connection with selection will be final. No correspondence shall be entertained from candidates who are not selected. The Railway administration will not be responsible for any postal delay or wrong delivery. Canvassing in any form will disqualify the candidate. Log on to our web site www.secr.indianrailways.gov.in for updates regarding the recruitment. The application which suffer from material irregularities such as unsigned, incomplete, illegible, without all enclosures, without examination fee of Rs. 40/- where ever applicable (which is non-refundable in any case), not on prescribed format, without attested copies of certificates/testimonials and the application which in the opinion of Railway administration are otherwise invalid, shall be rejected.. This has the approval of competent authority. Encl. : Application format.(Annex A B C D EF &G) Sd/Deputy Chief Personnel Officer/Recruitment For Chief Personnel Officer SECR/Bilaspur Copy forwarded for information and necessary action to :1. Divisional Railway Manager (P)/S.E.C. Railway, BSP, R & NGP. 2. CPRO/BSP. He is requested to arrange publication of this Employment notice through the Employment News and Local News Papers. 3. General Secretary, DPMRMU, AISC/ST REA/Bilaspur. 4. Director, Employment Exchange, Raipur, Chhattisgarh. 5. Asst. Director of Employment, Sub. Regional Employment Exchange, Plot No. 194, Dharampeth, cement Road, Shivaji Nagar, Nagpur -10, Maharastra. 6. CAO/Construction, Bilaspur 7. CWM/WRS/Raipur 8. Dy. CME(W/S)/MIB/Nagpur 9. Director Employment and Training Jabalpur(MP) Encl. : As above.

Sd/Deputy Chief Personnel Officer/Recruitment for Chief Personnel Officer SECR/BSP

Annexure-A APPLICATION FORMAT (SECR)


FOR RECRUITMENT OF CANDIDATES AGAINST CULTURAL QUOTA FOR THE YEAR 2013-14
(TO BE FILLED IN BY THE CANDIATES IN HIS/HER OWN HANDWRITING)

Employment Notice No. P-HQ/RRC/761/2013-14 Discipline applied for ----------------------------------------------------To Dy Chief. Personnel Officer(Rectt.) Railway Recruitment Cell(RRC) South East Central Railway R.T.S. Colony, Bilaspur. 1. 2. 3. 4. 5. 6. 7. 8.
Affix recent Passport size of Photographs duly signed by the Candidate and Attested by any Gazetted officer

Name of the applicant in full (in block letters) .......................... . Fathers name/Husband s name. Date of birth (in figures)(in words) ........................... .. Community UR/OBC/SC/ST .. Religion Sex :- (Male/Female) :

Nearest Railway Station:.. Correspondence address in full with Pin code ... ... Permanent address in full with Pin code .. ..
Tick()appropriate column, if applicable (Enclose self attested copy of Certificate in support of claim)
Persons with Disabilities Visually Hearing
Handicapped Handicapped
ExServicemen

9.

10.

Orthopedic ally
Handicapped

Widowed/ Divorced/ Judicially separated

Economic ally Weaker Section

Serving Railway Employee

(VH)

(HH) (OH)

Staff of Quasi Administr ative office of Railways

Residents of Jammu & Kashmir

11.

Educational Qualifications Examination Year of University/Board/ passed passing School

Subject

Percentage Class/Division of Marks

(to be supported by attested copies of certificate)

12. Degree/Diploma/Certificate in the field of-----------------------------------------------------Name of the Year Name of the University/ Percentage of examination Board/Organization. Marks(obtained)

13.

(to be supported by attested copies of certificate) Two Personal Marks of Identification:(i) .. (ii) ..

14.

In case of serving employee:(i) Name of the organization where employed... (ii) Designation . (iii) Date of appointment .. (iv) Address of the employer.. Other Qualification/Extra curricular activities. Examination Fee:(i) Bank draft No. Date... (OR) (ii) IPO No.Date.. Amount.. Name of issuing post office.

15. 16.

17. Declaration: I hereby declare that all the statements made in this application are true, complete and correct. In the event of any information being found false or incorrect or my self being not eligible in terms of eligibility criteria, my candidature/appointment is liable to be cancelled/terminated without any notice. Place : Date : Signature of the applicant

No. of enclosures to be attached (compulsory) (i) Attested copies of certificates in support of age and community, academic qualification degree/diploma/ certificate in the field of any one of the relevant disciplines Viz., Classical Dance (Bharatnatyam/Kathak)/ Light Vocal as given in the application. Two passport size photograph (same as affixed in the application form) duly signed on the top should be clipped along with the application form. Two self addressed envelopes of size 23 cms x10 cms with name in full and complete present address should be written clearly there on . Examination fee envelope of Rs.40/- in Bank Draft/IPO (in case of candidate belonging to UR/OBC community).

(ii) (iii) (iv)

Annexure-B Details of Participation and National level Prizes secured by the applicant Name of the Applicant :--------------------------------------------------------------A:- Participation Sl. Events/Occasions in which participated No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Year

Position if any

Certificate No.

B:- National Level Prizes Secured Sl. Events/Occasions in which participated Year Position if Certificate No. No. any 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (Attested Xerox copy of each certificate to be enclosed) in serialize.

Place :--------------------------Date :---------------------------

Signature of the Applicant

Annexure-C FORMAT OF INCOME CERTIFICATE TO BE ISSUED ON LETTER HEAD OF THE ISSUING AUTHORITY INCOME CERTIFICATE FOR WAIVER OF EXAMINATION FEES FOR EXAMINATIONS 1. Name of candidate Fathers name Age Residential Address Annual Family Income (in words & figures) Date of Issue Signature :

2. 3. 4. 5.

: : :

: : : ------------(Name)

6. 7.

8.

Stamp of issuing authority :

Annexure D A candidate who claims to belong to one of the scheduled caste or scheduled tribe should submit in support of his/her claim a self attested copy of a certificate in the form given below from the district magistrate or the subdivisional officer or any other officer as indicated below of the district in which his/her parents(or surviving parents)ordinarily reside and who has been designated by the State Government concerned as competent to issue such a certificate. If both the parents are dead, the officer signing the certificate should be of the district in which the candidate himself/herself resides otherwise then for the purpose of his/ her own education. Wherever, photograph is an integral part of the certificate, the Railway Recruitment Cell would accept only self attested copies of such certificate and not any other attested or true copy. ( THE FORM OF CASTE CERTIFICATE FOR SC/ST CANDIDATES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA) This is to certify that Shri/Smt./Kum*__________________Son/Daughter* of ______________________Of village/town*______________________________in District/Division*___________________Of State/Union Territory* ____________ belongs to the ________________________________________Caste/Tribe* which is recognized as a Scheduled Caste/Scheduled Tribe* under: . The Constitution (Scheduled Caste) order, 1950*. The Constitution (Scheduled Tribes) order, 1950* . The Constitution (Scheduled Caste) (Union Territories) order, 1951 . The Constitution (Scheduled Tribes) ( Union Territories) order, 1951( as amended by the Scheduled Caste and Scheduled Tribes Lists Modification), Order, 1956 the Bombay Reorganisation Act 1960, the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970, the North Eastern Areas Re-organisation Act, 1971, and the Scheduled Tribes Order (Amendment) Act, 1976.) . The Constitution (Jammu and Kashmir ) Scheduled Caste Order, 1956@. . The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959@ as amended by the Scheduled Castes and Scheduled Tribes order(Amendment) Act,1976@. . The Constitution (Dadra and Nagar Haveli)Scheduled Castes Order, 1962.. The Constitution (Dadra and Nagar Haveli)Scheduled Tribes Order, 1962@ . The Constitution (Pondicherry) Scheduled Castes Order, 1964@ . The Constitution Scheduled Tribes (Utttar Pradesh) order, 1967@ . The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968@ . The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968@ . The Constitution (Nagaland) Scheduled Tribes Order, 1970@ . The Constitution (Sikkim) Scheduled Caste Order, 1978@ . The Constitution (Sikkim) Scheduled Tribes Order, 1978@ Shri/Shrimati/Kumari*_______________________and/or his /her* family, reside(s) in village town*_____________________ of*_____________________District/Division* of the State/Union Territory* of _______________________

Signature___________________ **Designation_________________ (with seal of Office) State/Union Teritory** Place___________________ Date____________________ *Please delete the words which are not applicable. @ Please quote the specific presidential order. Note : The term ordinarily reside(s) ** used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. **Officers competent to issue Caste/Tribe certificates: ** District Magistrate/Additional District Magistrate/ Collector/Deputy Commissioner/ Additional Deputy Commissioner/ Deputy Collector/1st Class Stipendiary Magistrate /City Magistrate / Sub- Divisional Magistrate / Taluka Magistrate / Executive Magistrate/Extra Assistant Commissioner(not below the rank of 1st Class Stipendiary Magistrate) Chief Presidency Magistrate / Additional Chief Presidency Magistrate/ Presidency Magistrate/ Revenue Officers not below the rank of Tahsildar / Sub- Divisional Officer of the area where the candidate and/ or his/ her family normally reside(s). Note : ST Candidates belonging to Tamilnadu State should submit caste certificate ONLY from the REVENUE DIVISIONAL OFFICER.

Annexure -E FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POST UNDER THE GOVERNMENT OF INDIA This is to certify that Shri/Smt./Kum.* of village/town son/daughter* of Shri

. under: 1)

district

in

...state belongs to ..community which is recognised as backward class

Resolution No.12011/68/93-BCC@ dated 10th September 1993, published in the Gazette of India Extraordinary - part 1, Section 1, No.186 dated 13th September 1993. 2) Resolution No.12011/9/94-BCC dated 19th October 1994, published in the Gazette of India - Extraordinary part 1, Section 1, No.163, dated 20th October 1994. 3) Resolution No.12011/7/95-BCC, dated 24th May, 1995, published in Gazette of India - Extraordinary - part 1, Section 1, No.88, dated 25th May 1995. 4) Resolution No.12011/44/96-BCC, dated 6th December 1996, published in Gazette of India - Extraordinary part 1, Section 1, No.210, dated 11th December 1996. 5) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.129, dated the 8th July 1997. 6) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.164, dated the 1st Sept 1997. 7) Resolution No.12011/99/94-BCC, published in Gazette of India - Extraordinary - No.236, dated the 11th Dec 1997. 8) Resolution No.12011/13/97-BCC, published in Gazette of India - Extraordinary - No.239, dated the 3rd Dec 1997. 9) Resolution No.12011/12/96-BCC, published in Gazette of India - Extraordinary - No.166, dated the 3rd Aug 1998. 10) Resolution No.12011/68/93-BCC, published in Gazette of India - Extraordinary - No.171, dated the 6th Aug 1998. 11) Resolution No.12011/68/98-BCC, published in Gazette of India - Extraordinary - No.241, dated the 27th Oct 1999. 12) Resolution No.12011/88/98-BCC, published in Gazette of India - Extraordinary - No.270, dated the 6th Dec 1999. 13) Resolution No.12011/36/99-BCC, published in Gazette of India - Extraordinary - No.71, dated the 4th April 2000. Shri/Smt./Kum.*.and/or his/her family ordinarily reside(s) in the.. District of the ..State. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in column 3 (of the Schedule of the Government of India, Department of Personnel & Training OM NO.36012/22/93 Estt (SCT), dated 8.9.1993 and modified vide Government of India, Department of Personnel and Training O.M. 36033/3/2004-Estt.(Res) dated 09.03.2004.

Place: Date

DISTRICT MAGISTRATE/DY.COMMISSIONER ETC. *Strike out whichever is not applicable (With seal of office)

NB : The term 'ordinarily' used here will have the same meaning as in section 20 of the Representation of Peoples Act., 1950. (b) The authorities competent to issue Caste certificates are indicated below : (i) District Magistrate/Additional District Magistrate/ Collector/Deputy Commissioner/ Additional Deputy Commissioner/ Deputy Collector/1st Class Stipendiary Magistrate /Sub-Divisional Magistrate / Taluka Magistrate / Executive Magistrate/Extra Assistant Commissioner(not below the rank of 1st Class Stipendiary Magistrate) (ii)Chief Presidency Magistrate / Additional Chief Presidency Magistrate/ Presidency Magistrate. (iii) Revenue Officers not below the rank of Tahsildar and (iv) Sub- Divisional Officer of the area where the candidate and/ or his/ her family reside(s).

Annexure-F Proforma for declaration to be submitted by Other Backward Class Candidates alongwith the application while applying for the posts against Employment Notice No. P-HQ/RRC/761/201314 of Railway Recruitment Cell/South East Central Railway/Bilaspur. DECLARATION I, ______________________________son/daughter of Shri________________ resident of village /town/city_______________________district______________

State_______________________hereby declare that I belong to the__________ (indicate your sub-caste) community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No. 36012/22/93-(SCT) dated 08.09.1993. It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred Office Memorandum dated 08.09.1993 and its subsequent through O.M. No. 36033/3/2004-Estt. (Res.) dated 09.03.2004.

Place :

Signature of the candidate

Date :

Name of the candidate

ANNEXURE-G FORM OF MEDICAL CERTIFICATE FOR PERSONS WITH DISABILITIES (PWD) NAME & ADDRESS OF THE INSTITUTE/HOSPITAL Certificate No.. Date

DISABILITY CERTIFICATE
1. This is certified that Shri/Smt/Kum*. Son/Daughter* of Shri age.sex Male/Female having identification marks as below. is suffering from permanent disability of following category. Locomotor or cerebral palsy : (i) BL-Both legs affected but not arms. (ii) BA-Both arms affected (a) Impaired reach (b) Weakness of grip (iii) OL-One leg affected (right or left) (a) Impaired reach (b) Weakness of grip (c) Ataxic (iv) OA-One arm affected(right or left) (a) Impaired reach (b) Weakness of grip c) Ataxic (v) BH-Stiff back and hips(can not sit or stand) (vi) MW- Muscular weakness and limited physical endurance Blindness or Low Vision C. Hearing Impairment (i) B-Blind (i) D- Deaf (ii) PB- Partially Blind (ii) PD- Partially Deaf (Delete the category whichever is not applicable) This condition is progressive likely to improve not likely to improvement for discharge of this case is not recommended /is recommended after a period of .years.months. Percentage of disability in his/her case is percent. Shri/Smt./Kum.*.meets the following physical requirement for discharge of his/her duties: (i) F-can perform work by manipulating with fingers Yes No (ii) PP-can perform work by pulling and pushing Yes No (iii) L- can perform work by lifting Yes No (iv) KC-can perform work by kneeling and crouching Yes No (v) B-can perform work by bending Yes No (vi) S-can perform work by sitting Yes No (vii) ST- can perform work by standing Yes No (viii) W-can perform work by walking Yes No (ix) SE- can perform work by seeing Yes No (x) H-can perform work by hearing /speaking Yes No (xi) RW-can perform work by reading and writing (Signature of Doctor) Name: Registration No. Member, Medical Board Place : Date : Countersignature of the Medical Superintendent/CMO Head of Hospitals(with seal) Yes No (Signature of Doctor) Name: Registration No. Member/Chairperson Medical Board Paste here your recent colour photograph showing the disability (The photograph should be attested by the Chairperson of the Medical Board.)

A.

Signature of candidate in the above box below the photograph

B.

2. 3. 4.

(Signature of Doctor) Name: Registration No. Member, Medical Board

* Please delete the words which are not applicable.

Note: (i) According to the Persons with Disabilities)Equal Opportunities. Protection of Rights and Full Participation) Rules, 1996 notified on 31.12.1996 by the Central Government in exercise of the poers conferred by sub-section(1) and (2) of 73 of the Persons with Disabilities (Equal opportunities, Protection of Rights and Full Participation) Act. 1995(1 of 1996), authorities to give disability Certificate will be a Medical Board duly constituted by the Central or Sate Government. The State government may constitute a Medical Board consisting of at least three members out of which at least one shall be a specialist in the particular field for assessing locomotor hearing and speech disability, mental retardation and leprosy cured, as the case may be (ii) The certificate would be valid for a period of 5 years for those whose disability is temporary. For those who acquired permanent disability, the validity can be shown as permanent.

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