INSTRUCTIONS FOR FILLING THE OMR APPLICATION FORM.

(This page is not to be submitted)

1. Candidates should fill the application form with blue/black ball point pen.
2. Candidates should make sure that they darken the appropriate circles properly as shown below.

3. Candidates should print the application form in a Letter size paper (8.5x11 inches) and DO NOT alter the size
of the sheet while printing the application form. While printing the form, kindly make sure to adjust the page in
the printer to avoid printing Page Sizing & Handling should be set as FIT. Default Printing is advised; as shown
below:

4. Candidates are advised not to staple the application forms together and submit it separately.
5. If the name of the candidate is more than 25 (twenty five) letters, as below:
Eg: (Full name: Bhaichung Tenzing Denzongpa)
The candidates are advised to fill the form as shown leaving a gap after every name:
Eg:

B H A I C H U N G T D E N Z O N G P A
 E
PL
STA M S
T
NO O R
DO E F SIKKIM PUBLIC SERVICE COMMISSION
TH GANGTOK 737101, SIKKIM Roll No. (For Office Use Only)

APPLICATION FORM FOR THE POST OF

UNDER SECRETARY & EQUIVALENT
Name of the Applicant as in the Certificate of Class X Board Examination.

A A A A A A A A A A A A A A A A A A A A A A A A A

B B B B B B B B B B B B B B B B B B B B B B B B B

C C C C C C C C C C C C C C C C C C C C C C C C C Affix your recent

photograph
D D D D D D D D D D D D D D D D D D D D D D D D D
within the box
E E E E E E E E E E E E E E E E E E E E E E E E E

F F F F F F F F F F F F F F F F F F F F F F F F F
Do Not Staple

G G G G G G G G G G G G G G G G G G G G G G G G G

H H H H H H H H H H H H H H H H H H H H H H H H H

I I I I I I I I I I I I I I I I I I I I I I I I I

J J J J J J J J J J J J J J J J J J J J J J J J J

K K K K K K K K K K K K K K K K K K K K K K K K K
WRONG METHODS CORRECT METHOD
L L L L L L L L L L L L L L L L L L L L L L L L L

M M M M M M M M M M M M M M M M M M M M M M M M M

N N N N N N N N N N N N N N N N N N N N N N N N N
Date of Birth
O O O O O O O O O O O O O O O O O O O O O O O O O
D D M M Y Y Y Y
P P P P P P P P P P P P P P P P P P P P P P P P P

Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 1 1 1 1 1 1 1 1

R R R R R R R R R R R R R R R R R R R R R R R R R 2 2 2 2 2 2 2

S S S S S S S S S S S S S S S S S S S S S S S S S 3 3 3 3 3 3 3

T T T T T T T T T T T T T T T T T T T T T T T T T 4 4 4 4 4 4

U U U U U U U U U U U U U U U U U U U U U U U U U 5 5 5 5 5 5

V V V V V V V V V V V V V V V V V V V V V V V V V 6 6 6 6 6 6

W W W W W W W W W W W W W W W W W W W W W W W W W 7 7 7 7 7 7

X X X X X X X X X X X X X X X X X X X X X X X X X 8 8 8 8 8 8

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 9 9 9 9 9 9

Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z 0 0 0 0 0 0 0 0

Age Mobile Number Gender Details of fee remitted from State Bank of Sikkim
Date Month Year
Male D D M M Y Y Y Y
Bank Receipt No.
Female
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Category
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 GEN 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 OBC (CL) Amount 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 OBC (SL) 6 6 6 6 6 6

7 7 7 7 7 7 7 7 7 7 7 7 BL 7 7 7 7 7 7

8 8 8 8 8 8 8 8 8 8 8 8 SC 8 8 8 8 8 8

9 9 9 9 9 9 9 9 9 9 9 9 ST 9 9 9 9 9 9

0 0 0 0 0 0 0 0 0 0 0 0 PT 0 0 0 0 0 0 0 0

Father's Name :

If Married; Husband's Name:

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1. Address for communication (do not repeat name)

2. EMAIL ADDRESS: __________________________________. 3. RELIGION: ____________________________.

4. Details of qualification: (to be submitted during scrutiny)

Sl.No Name of the Board/University Certificate Serial Year of Issue No & Date
Number passing
(i) Secondary School
(ii) Senior Secondary/Intermediate (+2)
(iii) Graduation

5. Details of documents: to be submitted later on by the candidates who qualify for main written examination.
Sl. Particulars of Certificates submitted Certificate Serial Issue No & Date
No. Number
(i) Sikkim Subject/Certificate of Identification
(ii) BL/ST/SC/PT/OBC(CL)/OBC(SL)/General
(iii) Certificate of BPL issued by DESME, Government of Sikkim
(iv) Renewed Employment Card
(v) NOC from the HOD if employed (MR/Adhoc/Substitute/ Regular)
(vi) (a)Unmarried Certificate in case of unmarried female candidates
(b) Marriage Certificate and Husbands COI in case of married
female candidates
(vii) PWD-Certificate issued by Social Justice Empowerment & Welfare
Department, Government of Sikkim
(viii) SPAE- State and National Certificates certified by Sports & Youth
Affairs Department/Culture & Heritage Department/Directorate
of Handicrafts & Handlooms
(ix) ESM-Certificate/Office Order of Service Deployment

6. Have you ever been convicted by a Court of Law for any offence? ( Tick) Yes ( ) No ( )
If Yes, give details:-

7. Have you ever been debarred/ disqualified by any Public Service Commission or Staff Selection Commission for
any of their examination/selection? ( Tick) Yes ( ) No ( )
If Yes, give details:-

DECLARATION
1. I, being in sound mind, hereby wilfully declare that all the information given above by me is true and correct.
2. If the fact that false and fabricated documents, which have been tampered with or for suppressing material/information,
comes to the notice of the Sikkim Public Service Commission at any stage of examination, I am liable to be disqualified and
debarred permanently or for specific period of time for admission to any examination held by the Sikkim Public Service
Commission in the future.

Date:
Place: Signature of the applicant

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