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 : [email protected]
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.