PARLIAMENT OF INDIA
RAJYA SABHA SECRETARIAT
(Application Form)
(To be filled by the candidate after carefully reading the general instructions as laid down in the advertisement no.1/2016 [English/Hindi])
(All fields are mandatory)
01 Post Group : 
02 Post(s) applied for (Select the post/posts applied for) : 
03 Preference of Examination Centre:
(* Examination will be held at the listed centre(s) only if the number of candidates opting for that centre as 1st preference exceeds 300.)
1st preference   

2nd preference   

3rd preference   

4th preference   

5th preference   
04Name of Candidate (in full) :
(Abbreviate, only if characters exceed the provided limit.)
   
Generate Your Password
(Password length 8. Alphanumeric Only)  
Confirm Password  
05 Date of Birth:
(As per your Matriculation certificate)
 (dd-mm-yyyy)
06 Gender
07 Category:
08 Whether you are an Indian Citizen ?
Yes No   
09Father's Name (in full) :
(Abbreviate, only if characters exceed the provided limit.)
   
10Mother's Name (in full):
(Abbreviate, only if characters exceed the provided limit.)
   
11 Address for Correspondence : Address :  

  District :  

     State:  

       Pin :  
12 Contact details :           Phone No. :    

          Mobile No. :  

              Email Id :  

Confirm E-mail id :  
13 Whether an Ex-Serviceman ?
Yes No
14 Whether a Persons with disabilities ? Yes No
15 Whether presently an employee of Govt./Lok Sabha Secretariat with atleast 3 years of combined regular and continuous service in Govt./ Lok Sabha Secretariat/ Rajya Sabha Secretariat ? Yes No
15a Whether presently in regular service of the Rajya Sabha Secretariat? Yes No
16 Are you claiming any age relaxation ? Yes No
17 Do you possess on the last date of submission of application all essential qualifications prescribed for the post(s) applied for ? Yes No
18 Are you eligible in all respects (viz. age, qualifications, skill & physical standards etc.) for the post(s) applied for ? Yes No
19 Are you exempted from payment of fee ? Yes No
20 Upload Scanned Passport Size Photograph of Applicant :
(Allowed file size: 20-50KB, Allowed File Type: jpeg/jpg)
Please ensure that the uploaded photograph is clear failing which the application shall be rejected
21 Upload Scanned Signature of Applicant :
(Allowed file size: 10-30KB, Allowed File Type: jpeg/jpg)
Please ensure that the uploaded signature is clear failing which the application shall be rejected
Declaration
I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. I understand that the Rajya Sabha Secretariat may cancel/ terminate my candidature/appointment in case any information given in this application form is found to be false or incorrect at any time. I also understand that on the basis of self declaration made by me in this form of my eligibility in all respect including the category applied for and relaxations availed by me, for the post (s) for which I am applying, I shall be provisionally admitted to the various stages of the recruitment process and the Rajya Sabha Secretariat shall undertake detailed scrutiny of my eligibility only at the final stage of the recruitment process/ at the time of joining the post(s) in case I reach that stage. I fully understand that if at any stage of the recruitment process or thereafter, I am found not to be eligible for post(s) or for any reservation/concession availed by me, Rajya Sabha Secretariat shall be at liberty to cancel my candidature/ appointment. I further declare that I have not submitted more than one application for the post(s) for which this application is made.
Agree       Disagree