REGIONAL OFFICE (HARYANA)

EMPLOYEES' STATE INSURANCE CORPORATION

(Under Union Ministry of Labour and Employment, Govt. of India)

PANCHDEEP BHAWAN, SECTOR 16, FARIDABAD-121002

Tel. 0129-2222980, 2222981, 2284728

Website : www.esicharyana.org, email : rd-haryana@esic.nic.in

Recruitment of UDC/MTS -2012 Under Meritorious Sports Persons (MSP) Quota in the ESIC,

HARYANA REGION

Applications are invited from Indian Citizens (Meritorious Sports Persons) in the discipline of

Football, Volleyball, Badminton & Table Tennis for recruitment to the following posts in the Employees‟

State Insurance Corporation, Haryana Region, Faridabad under Meritorious Sports Person (MSP) Quota.

Sl.

No. Post Pay Band

No. of vacancies reserved for different Sports/Discipline

Total Football Volley

Ball Badminton

Table Tennis

Men Men Men Women Men Women

01. UDC

PB-1, Rs5200-

20200 with Gr.

Pay Rs2400/-

Nil Nil Nil 1 1 1 3

02. MTS

PB-1, Rs5200-

20200 with Gr.

Pay Rs1800/-

Nil 1 Nil NIL 1 1 3

The number of vacancies is provisional and may vary as per actual requirements.

RESERVATION: Applicable for SC/ST/OBC as per rule.

LAST DATE (normal closing date) FOR RECIEPT OF APPLICATIONS: 31-10-2012

1. Eligibility Criteria:

(a). Age: Minimum 18 years as on normal closing date.

Upper Age limit

For UDC 27 years as on normal closing date

For MTS 25 years as on normal closing date

Relaxation in upper age limit is applicable upto a maximum of 5yrs for sports persons and to

reserved category viz. SC/ST/OBC (Non-Creamy layer) in terms of Govt. of India rules, i.e., 10 yrs for

SC/ST & 8 yrs for OBC.

The concession in age relaxation will be available only to those sports persons who satisfy all

other eligibility conditions relating to educational qualification etc. and furnish a certificate from the

authorities in the form prescribed in ANNEXURE- III to this advertisement.

b. Educational & Other requisite Qualifications:-

Post E.Q. Essential

UDC Degree of a recognized University

or Equivalent.

Working knowledge of computer, including use

of Office Suites and databases.

MTS Matriculation or Equivalent Pass. -

Contd......2

:: 2 ::

Note: -

1. The Selected candidates on appointment will be on Probation for a period of two years.

2. During the Probation period, the candidates selected to the post of Upper Division Clerk

shall be required to pass Computer Skill Test.

c. Sports Qualifications : -

For the above posts, the candidates should have represented the country in an International competition/State

in a National Competition/University in an inter-University competition with distinction / State schools in the

National Sports / games of Schools etc..

List of Authorities empowered to award Certificate as per Govt. Of India instruction:

Sl.

No. Competition Authority Awarding Certificate

Form in which

certificate is

to be awarded

1. International

Competition Secretary of the National Federation of game concerned 1

2. National

Competition

Secretary of National Federation or Secretary of the State

Association of the game concerned 2

3. Inter-University

Tournaments

Dean of Sports or other Officer in overall charge of sports of

the University concerned 3

4.

National / Sports /

Games for

Schools

Director or Additional / Joint or Deputy Director in overall

charge of sports/games for Schools in the Directorate of Public

Instructions / Education of the state.

4

5. Physical

Efficiency Drive

Secretary or other officer in overall charge of Physical

Efficiency in the Ministry of Education & Social

Welfare, Govt. of India. 5

NOTE: Specimens of the forms 1, 2, 3, 4 & 5 referred to above are given in APPENDIX-III.

2. Selection Procedure:

a. All eligible applicants should apply in the prescribed format through Speed Post/Regd. post only

given (Annexure-I) on or before the last date for receipt of applications. So that applications must be

recieved on or before last date. Applications received after the last date will not be considered.

b. Selection will be made on the basis of the guidelines/instructions issued by Department of

Personnel & Training, Govt. of India.

The successful candidates will be posted initially in the offices of ESI Corporation in Haryana Region.

They are liable to be transferred anywhere in India.

3. (i) Application Fee (Non refundable): -

For candidates belonging to Application Fee

For UDC

Application Fee

For MTS

a) SC/ST/PWD/Women Candidates/ Govt./ESIC

employees/Ex-Servicemen Nil

Nil

b) For all other categories Rs. 225/- 125/-

(ii) Mode of payment: - The requisite Demand Draft / Bankers‟ Cheque (as applicable) in favour of

“The Regional Director, E.S.I. Corporation, Faridabad” drawn on any scheduled bank payable

at Faridabad has to be submitted along-with the application.

Note:-

i. Fees once paid will not be refunded under any circumstances.

ii. Only Demand Draft/Bankers‟ Cheque drawn on any scheduled bank will be accepted.

Application Fee paid by any other mode will not be accepted.

iii. The Demand Draft / Bankers‟ Cheque must be drawn only after the publication of the

advertisement.

Contd. .......3

:: 3 ::

4. How to apply: -

Application in an envelope super scribed “Application for the post of UDC /MTS under MSP Quota

mentioning discipline of sports/games”, as the case may be, should be sent by Speed/Registered post at the

following address: -

Regional Office,

Employees' State Insurance Corporation,

„Panchdeep Bhavan‟, Sector - 16,

Faridabad-121002 (Haryana)

The following testimonials should be attached with duly filled-up application form in all respects:

a) Two copies of recent passport size photographs duly attested by a Group “A”/Group “B”Gazetted

Officer with one photograph firmly pasted on the application form. Applicants should write their name

on the reverse of the other copy of photograph to be enclosed.

b) Attested copies of certificates and testimonials in support of proof of age, Educational qualification,

Sports Qualification, Experience (if any) etc.

c) Participation certificate in the Sports event as prescribed by DOPT, Govt. of India. (Specimens of the

form-1,2,3,4 & 5 referred to above are given in ANNEXURE-III

d) Attested copy of Community Status Certificate in the prescribed format in case of candidates belonging

to SC/ST/ OBC (Non-creamy layer) category in the proforma enclosed in ANNEXURE-II. The OBC

candidates will also ensure that their caste is listed in the State-wise Central List of OBC as notified by

Govt. of India, Ministry of Social Justice & Empowerment.

Those candidates who are working under Govt. should send their applications “Through Proper

Channel” in such a way that the application must reach the given address on or before the closing date.

However, an advance copy of application along-with all requisite documents can be sent before the last date.

Note 1:- The application and other documents should be arranged in the following order, one below the other

and tightly tagged or stapled on the left hand side top corner.

1. Application Fees (If required) 2. Additional Photograph.

3. Application Form. 4. Attested copies of certificates.

5. Participation certificates in Sports events in prescribed format.

6. Two self addressed envelope of sizes 23cms x 10 cms.

Note 2:- The Demand Draft should not be tagged or stapled, but should be clipped at the top of the

Application form. The name and address of the candidates should be written on the reverse side of the

Demand Draft.

General Conditions:-

1. The crucial date for determining the age limit and other eligibility criteria shall be the closing date for

receipt of applications from candidates i.e. 31-10-2012 and not the closing date prescribed for those in

Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division

of Jammu and Kashmir State, Lahul and Spiti District and Pangi Sub-Division of Chamba District of

Himachal Pradesh, Andaman and Nicobar Islands or Lakshsdweep

2. Mere submission of application does not confer/guarantee any right to be called for field trial/selection.

3. A candidate should submit one application for one post only. Submission of more than one

application for the same post shall lead to rejection of all the applications submitted.

4. Application should be submitted in the prescribed format only, annexed to this advertisement, which may

be downloaded from the official website of ESIC. Any other format of application shall summarily be

rejected. The application form should be filled up in his/her own handwriting by the candidates. LTI

& RTI both imputes on the application form should be complete & Clear otherwise the candidature will

be treated as cancelled.

5. Application should be sent in a cover super-scribed “Application for the post of UDC/MTS under

MSP Quota”, mentioning discipline of sports/games as the case may be by Registered Post/Speed Post

so as to reach at the address mentioned above on or before the stipulated date i.e. till 07-11-2012 (upto 5

pm).

Contd......4

:: 4 ::

6. Incomplete or unsigned application, or applications received without certified/attested copies of

marksheets, certificates of educational qualification, proof of age, Sports

Qualification/participation certificate in sports, caste certificates and photographs and those

received after the last date of receipt of application will summarily be rejected without any

communication to the candidate.

7. Wrong declaration/submission of false information or any other action contrary to law shall lead

to cancellation of the candidature at any stage.

8. The E.S.I. Corporation has the discretion not to fill any vacancies and the vacancy position shown may

also increase or decrease.

9. Applicants are required to attach recent (not taken before three months) coloured photograph with the

application and the same photograph should be used through out the process of recruitment.

10. Candidates selected shall be liable to be posted anywhere in India. However, presently, they will be

posted in Haryana Region.

11. The Corporation takes no responsibility for any delay in receipt or losses in postal transit of any

application or communication. Applicants are advised to Intimate their Mobile No. and E-mail ID for

correspondence.

12. Before applying for the post the candidate should ensure that he/she has fulfilled the eligibility

criteria mentioned above. The Corporation would be free to reject any application at any stage of

selection process if the candidate is found ineligible for the post for which he has applied. The decision

of the Corporation regarding eligibility of the candidates at the stage at which scrutiny of eligibility is to

be undertaken, qualifications, experience and other eligibility norms, the documents to be produced for

the purpose of conduct of selection/interview and any other matter relating to recruitment of players will

be final and binding on the candidates. No correspondence or personal enquiries shall be entertained

by the Corporation in this behalf.

13. Canvassing in any form will be considered as disqualification.

NOTE: Application without signature, without thumb impression, without handwritten declaration,

incomplete applications or the applications or the applications received without the supporting

documents, Participation certificate in prescribed format, application fee, caste certificate, without

photographs and those received after the last date of receipt of applications will summarily be

rejected without any communication to the candidate.

DISQUALIFICATON - No Person:-

1. who has entered into or contracted a marriage with a person having a spouse living; or

2. who, having a spouse living, has entered into or contracted a marriage with any person; shall be

eligible for appointment to the said posts.

Provided that the Director General may, if satisfied that such marriage is permissible under the

personal law applicable to such person and the other party to the marriage and that there are other grounds

for so doing, exempt any person from the operation of this Regulation.

Last date of receipt of application is 31-10-2012.

For candidates from Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim,

Ladakh Division of Jammu and Kashmir State, Lahul and Spiti District and Pangi Sub-Division of Chamba

District of Himachal Pradesh, Andaman and Nicobar Islands or Lakshsdweep, the last date of receipt of

application will be 07-11-2012

Contd. .........5

:: 5 ::

The application form can be downloaded from the website www.esicharyana.org/www.esic.nic.in

See ANNEXURE –I for application format,II- proforma for community certificates & III-for

sports certificates.

N.B.:

No such appointment can be made unless the candidate is, in all respects, eligible for appointments to the

post applied for and in particular in regard to age, educational or experience, qualification referred under

1 (a) (b) (c) except to the extent to which relaxation thereof have been permitted in r/o class, category of

persons to which the applicant belongs.

“Centre of Examination /Selection will be ‘FARIDABAD’ or 'CHANDIGARH'

REGIONAL DIRECTOR

Disclaimer: The contents of this page are informatory in nature. Kindly verify the same from the

Corporation Office.

SPEED POST/REGD. POST APPLICATION FOR RECRUITMENT OF MERITORIOUS SPORTS PERSON UNDER SPORTS QUOTA IN

ESIC, Haryana Region. Name of the post :

Sports Discipline :

Category of candidate :

From, To

Name of candidate: ______________________ Regional Office,

Address of candidate: ____________________ Employees' State Insurance Corporation

______________________________________ Panchdeep Bhawan, Sector 16

______________________________________ Faridabad-121002 (Haryana)

Pin Code: ______________________________

ANNEXURE-I

APPLICATION FORM FOR RECRUITMENT TO THE POST OF UDC/MTS-2012

in E.S.I. Corporation in Haryana Region

under Meritorious Sports Person (MSP)Quota (To be filled in ENGLISH)

01. Post applied for [Mark a 'tick' (√) in the appropriate box]

(I) U.D.C. (Upper Division Clerk)

Paste your recent

passport size

photograph attested by a

Group -„A‟/

„B‟/ Gazetted Officer

(ii) MTS(Multi Tasking Staff)

02.

(a) Discipline / Sports applied for

['tick' (√) appropriate box]

Volleyball

(Men)

Badminton

(women)

T.T

(men)

T.T

(women

(b) Gender: Indicate [Tick (√) mark)]in the

Box MALE FEMALE

3 Mode of Payment :

Demand Draft No. ...............................................................

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

Date and amount ...............................................................

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

Name of issuing Bank ...............................................................

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

4 Name in full

(in Block Capital letter

5 Father‟s/Husband‟s Name:

(in Block Capital letter

6(i) Date of Birth in Christian era(in figures D D M M Y Y Y Y

1 9

(In words) ------------------------------------------------------------------

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

(ii) Age as on ................. ...........years ............months ...........days

7

Permanent Address (In Block

Capital Letter) With PIN Code

number

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

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

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

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

............................................................PIN

CODE.....................

8 Mailing Address (in Clock Capital

Letters) with PIN Code number

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

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

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

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

.............................................................PIN

CODE....................

9

Mobile No.

------- :: 2 :: ------

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

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

Email Id ..................................................................................

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

10 Are you a citizen of India by birth and/or

domicile?

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

.........

11 Category you belong to Code of Category (UR-01, SC-02, ST-03, OBC-

04)

0

12 Educational qualification (from Matriculation onwards including computer knowledge)

Sl.

No

Qualification University/Board Subject studied %age of

Marks

obtained

Remarks

13. (a)Sports Qualification/Achievements:

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

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

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

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

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

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

(b) Sports Representation Certificate attached: Write Yes/No in the appropriate Box. ( In case of non -

submission of certificate in proper format, candidature shall lead to be canceled)

( as per specimen of forms at Annexure-III):

FORM-1

International

Competition

FORM-2

National

Competition

FORM-3

Inter-University

Competition

FORM-4

National Games for

School

------- :: 3 :: ------

14 Experience/particulars of previous and present employment Sl.

No Name & full address of Employer Designation Scale of pay Period of employment

From

To

1

2

3

4

15. DECLARATION

I hereby declare that the information furnished in the application are true, complete and correct to

best of my knowledge and belief. I understand that in the event of any information being found

false or incorrect at any stage, my candidature/appointment is liable to summary

cancellation/termination without notice or any compensation in lieu thereof.

16. List of enclosures :-

1. .............................................. 2 ............................................... 3.

.............................................. 4. ...............................................

5. .............................................. 6. ................................................

Candidates Thumb

Impression (LTI ) Candidates Thumb

Impression (RTI )

Date : ........................... Signature of Candidate : ......................................

Place : ........................ Name : .................................................................

ANNEXURE-II FORMAT FOR SC/ST CERTIFICATE

A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should submit in

support of his claim an attested/certified copy of a certificate in the form given below, from the District

Officer or the sub-Divisional Officer or any other officer as indicated below of the District in which his

parents (or surviving parent) ordinarily reside who has been designated by the State Government concerned

as competent to issue such a certificate. If both his parents are dead, the officer signing the certificate should

be of the district in which the candidate himself ordinarily resides otherwise than for the purpose of his own

education. Wherever photograph is an integral part of the certificate, the Commission would accept only

attested photocopies of such certificates and not any other attested or true copy.

(The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates applying

for appointment to posts under Government of India)

This is to certify that Shri/Shrimati/Kumari* ________________________________________ son/daughter

of ____________________________________________ of village/town/* in District/Division

*_______________________ of the State/Union Territory* ________belongs to the

Caste/Tribes_______________ which is recognized as a Scheduled Castes/Scheduled Tribes* under:-

The Constitution (Scheduled Castes) order, 1950 ___________________

The Constitution (Scheduled Tribes) order, 1950 ________________

The Constitution (Scheduled Castes) Union Territories order, 1951 * _______________ The Constitution

(Scheduled Tribes) Union Territories Order, 1951*______________

As amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) order, 1956, the Bombay

Reorganization Act, 1960 & the Punjab Reorganization Act, 1966, the State of Himachal Pradesh Act 1970,

the North-Eastern Area(Reorganization) Act, 1971 and the Scheduled Castes and Scheduled Tribes

Order(Amendment) Act, 1976.

The Constitution (Jammu & Kashmir) Scheduled Castes 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) (Uttar Pradesh) Order, 1967 @

The Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968@

The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @

The Constitution (Nagaland) Scheduled Tribes Order, 1970 @

The Constitution (Sikkim) Scheduled Castes Order 1978@

The Constitution (Sikkim) Scheduled Tribes Order 1978@

The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@

The Constitution (SC) orders (Amendment) Act, 1990@

The Constitution (ST) orders (Amendment) Ordinance 1991@

The Constitution (ST) orders (Second Amendment) Act, 1991@

The Constitution (ST) orders (Amendment) Ordinance 1996

%2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from one

State/Union Territory Administration.

This certificate is issued on the basis of the Scheduled Castes/ Scheduled tribes certificate issued to

Shri/Shrimati ______________________Father/mother ____________________________________

of Shri/Srimati/Kumari*___________________________ of village/town*____________

___________________ in District/Division* ______________________of the State/Union

Territory*______________________________ who belong to the

_________________________________ Caste/Tribe which is recognized as a Scheduled

Caste/Scheduled Tribe in the State/Union Territory* issued by

the_______________________________ ____dated____________________________.

%3. Shri/Shrimati/Kumari and /or * his/her family ordinarily reside(s) in

village/town*________________________________________ of ________________

District/Division* _________________of the State/Union Territory of

____________________________

Signature__________________________

** Designation________________________

(with seal of office)

Place______________

Date_______________

* Please delete the words which are not applicable

@ Please quote specific presidential order

% Delete the paragraph which is not applicable.

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.

** List of authorities empowered to issue Caste/Tribe Certificates:

(i) District Magistrate/Additional District Magistrate/Collector/Deputy

Commissioner/Additional Deputy Commissioner/Dy. Collector/Ist Class Stipendiary

Magistrate/Sub-Divisional Magistrate/Extra-Assistant Commissioner/Taluka

Magistrate/Executive Magistrate.

(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.

(iii) Revenue Officers not below the rank of Tehsildar.

(iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.

NOTE: ST candidates belonging to Tamil Nadu state should submit caste

certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR

APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri/Smt./Km. _________________________ son/daughter of Shri/Smt.

_____ _____ ____ ______ ______ ____ ___ ____ ____ ___________ of village/town _____

____________ ____ ___ _____________ ______ _________ _____ ___________ _______

District/Division ______ _______ ________in the ___________________ community which is

recognized as a backward class under :

i) Resolution No.12011/68/93-BCC© dated the 10th September, 1993, published in the Gazette of India

Extraordinary –

Part I, Section I, No.186 dated 13th September, 1993.

ii) Resolution No.12011/9/94-BCC dated the 19.10.1994 published in the Gazette of India Extraordinary –

Part I Section I

No.163 dated 20th October, 1994.

iii) Resolution No.12011/7/95-BCC dated the 24th May 1995, published in the Gazette of India

Extraordinary – Part I,

Section I No. 88 dated 25th May, 1995.

iv) Resolution No.12011/96/94-BCC dated the 9th March, 1996.

v) Resolution No.12011/44/96-BCC, dated the 6th December, 1996, published in the Gazette of India

Extraordinary – Part

I, Section I, No.210 dated 11th December, 1993.

vi) Resolution No.12011/13/97-BCC dated the 3rd December, 1997

vii) Resolution No.12011/99/94-BCC dated the 11th December. 1997..

viii) Resolution No.12011/68/98-BCC dated the 27th October, 1999..

ix) Resolution No.12011/88/98-BCC dated the 6th December, 1999, published in the Gazette of India

Extraordinary –

Part I, Section I, No.270 dated 6th December, 1999.

x) Resolution No.12011/36/99-BCC dated the 4th April, 2000, published in the Gazette of India

Extraordinary – Part I,

Section I, No.71 dated 4th April, 2000.

xi) Resolution No.12011/44/99-BCC dated the 21.9.2000, published in the Gazette of India Extraordinary –

Part I,

Section I, No.210 dated 21.9.2000

Shri/Smt./Km__ ________ ___________ ______ ___and/or his family ordinarily

reside(s)____________ ____________ _____________ __________________ in the____ ______

_____ _____ ____ ______ District/ Division __________ ______ _____of the ______ _______

______ State.

This is also to certify that he / she does not belong to the persons/section ( Creamy Layer)

mentioned in column 3 of the Scheduled to the Government of India, Department of Personnel

& Training OM No 36033/3/2004 – Estt. (Res.) dated 09.03.2004 & OM No.36033/3/2004-Estt.(Res.)

dated 14.10.2008.

Dated:

District Magistrate or

Deputy Commissioner etc.

Seal

Note :( a) The term ‘Ordinarily’ used here will have the same meaning as in Section 20

of the Representation of the people Act, 1950.

(b) The authorities competent to issue Caste Certificate are indicated below:-

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy

Commissioner/Deputy Collector / I st Class Stipendiary Magistrate/ Sub-Divisional Magistrate/ Taluka

Magistrate /Executive Magistrate./Extra-Assistant Commissioner (not below the rank of Ist class

stipendary Magistrate)

(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.

(iii) Revenue Officers not below the rank of Tehsildar

(iv) Sub-Divisional Officers of the area where the candidate and/or his family resides.

ANNEXURE-III

List of authorities empowered to award certificate as per Govt. of India.

Sr.

No.

Competition Authority awarding Certificate Form in which

certificate is to

be awarded

1 International Competition Secretary of the National Federation of

game concerned

1

2 National Competition Secretary of National Federation or

Secretary of the State Association of the

game

2

3 Inter-University

Tournament

Dean of sports of other officer in overall

charge of sports of the University

concerned

3

4 National/Sports/Games for

Schools

Director or Additional/Joint or Deputy

Director in overall charge of

sports/games for Schools in the

Directorate of Public

Instructions/Education of the State.

4

5 Physical Efficiency Drive Secretary or other officer in overall

charge of Physical Efficiency in the

Ministry of Education & Social Welfare,

Govt. of India.

5

NOTE : Specimen of the forms 1,2,3,4 & 5 referred to above are given in Appendix-III

Appendix-III

(FORM 1 TO FORM 4)

FORM 1

(For representing India in an International Competition in one of the recognized Games/ Sports)

NATIONAL FEDERATION/NATIONAL ASSOCIATION OF ------------------------

Certificate to meritorious sportsman for employment to

Group „C‟ and „D‟ services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri_________

resident of _________________________________ _______ _______ _______ ______ ______ ___

(complete address) represented the country in the game /event of ___________________ in________

____________________ _____________ ____competition/Tournament held at _________________

_________________ ___________ _____ from ________________ to_____________________.

The position obtained by the individual /team in the above-said Competition/Tournament was________.

The Certificate is being given on the basis of record available in the Office of National Federation/ National

Association of _________________.

Signature: _________________________

Place:________________

Name:____________________________

Date: __________________

Designation:_______________________

Name of National Federation/Association ________________________________________

Address:-______________________________________________________

______________________________________________________

Seal: ____________________________

NOTE: This Certificate will be valid only when signed personally by the Secretary, National Federation/

National Association.

FORM 2

(For representing State in India in a National Competition in one of the recognized Games/ Sports)

STATE ASSOCIATION OF _____________

IN THE GAME OF ______________________

Certificate to meritorious sportsman for employment to

Group „C‟ and „D‟ services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri_________

resident of ________________________________ _________________________________________(complete

address) represented the State of _________ ____________ in the game /event of ________ ______________ in

National competition/Tournament held at__________________________________________________________

from________________ to_____________________

The position obtained by the individual /team in the above-said Competition/Tournament was ___________.

The Certificate is being given on the basis of record available in the Office of State Association of ___________.

Signature: _________________________

Place:________________

Name:____________________________

Date: __________________

Designation:_______________________

Name of State Association ________________________________________

Address:-______________________________________________________

______________________________________________________

Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally by the Secretary of the State Association.

FORM 3

(For representing a University in the Inter-University Competition in one of the recognized Games/Sports)

UNIVERSITY OF_______________________

Certificate to meritorious sportsman for employment to

Group „C‟ and „D‟ services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________

__________-resident of __________ _________ ________________ ____________ (complete address) student

of_________________________________________represented the University of _____________ in the game /event of

__________________ in Inter-University competition/Tournament held at _____________ __________

from ________________ to_____________________ .

The position obtained by the individual /team in the above-said Competition/Tournament was ________________.

The Certificate is being given on the basis of record available in the Office of Dean of Sports or Officer in Overall

charge of sports in the University of _______________________.

Signature: _________________________

Place:________________

Name:____________________________

Date: __________________

Designation:_______________________

Name of University ________________________________________

Address:-______________________________________________________

______________________________________________________

Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally by Dean/director or other Officer in overall charge

of sports in the University.

FORM 4

(For representing a State School Team in the National Games for School in one of the recognized Games/Sports. )

DIRECTORATE OF PUBLIC INSTRUCTIONS/EDUCATION OF THE STATE OF __________

Certificate to meritorious sportsman for employment to

Group „C‟ and „D‟ services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________

________ ______________-resident of ____ ________________ _____________________________________

(complete address), student of _____________________________________________________ represented the

_____________________State School team in the game /event of ___________________ in National Games for Schools held

at _________ __________ _______________________________________________________ from ________________

to_____________________ .

The position obtained by the individual /team in the above-said Competition/Tournament was ______________

The Certificate is being given on the basis of record available in the Office of Directorate of Public Instructions/ Education of

________________________________.

Signature: _________________________

Place:________________

Name:____________________________

Date: __________________

Designation:_______________________

Name of State Association ________________________________________

Address:-______________________________________________________

______________________________________________________

Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally Director or Additional/Joint or Deputy Director in

overall charge of sports/games for schools in the Directorate of public Instruction/Education of the State.

FORM 5

(For the awardees in Physical Efficiency performances conducted by the Ministry of Education and Social Welfare)

GOVERNMENT OF INDIA/MINISTRY OF EDUCATION AND SOCIAL WELFARE

Certificate to meritorious sportsman for employment to

Group „C‟ and „D‟ services under the Central Government

Certified that Shri/Smt./Kumari ______________________ son/wife/daughter of Shri ________ ________

________ ______________-resident of ____ ________________ _____________________________________

(complete address), represented the__________________________________________________ School team in the

game/event of _____________________ in National Competition held at _________ __________

_______________________________________________________ from ________________ to_____________________ .

The Certificate is being given on the basis of record available in the Ministry of Education and Social Welfare .

Signature: _________________________

Place:________________

Name:____________________________

Date: __________________

Designation:_______________________

Address:-______________________________________________________

______________________________________________________

Seal: ____________________________

NOTE : This Certificate will be valid only when signed personally by the Secretary or other officers in overall charge

of sports/games for schools in the Directorate of public Instruction/Education of the State.