State Commissioner Application

Personal Details

Full Name

(S/o,D/o,H/o,W/o)

Aadhaar Number

Mobile Number

Gender

Date of Birth

Age

Address

Disability

Disability Type

Educational Qualifications

Please enter your education history from SSC to Ph.D.

Qualification	Institution Name With board/ University	Course Details	From Year	To Year	Percentage

Other Details

Have you retired from the Service?

If Yes, please mention the retirement date:

If No, please mention the date of attainment of superannuation:

Any Awards/Citations received for outstanding work done for welfare of Persons with Disabilities?

Any Pending Disciplinary proceedings or Punishment imposed on you in the service?

Have special knowledge/practical experience/ Acheivement in respect of the matters relating to rehabilitation of Persons with Disabilities

Have at least 20 Years administrative experience either as Group A or Above cadre of Central Govt or Group I or above cadre officer of State Government

Have you been declared insolvent?

Have you been convicted and sentenced for imprisonment of an offence which in the opinion of the State Government involves moral turpitude and such conviction has not been reversed or he has not been granted full pardon in respect of such offence?

Have you been removed or dismissed from service of the Central Government or State Government or a body or corporation owned or controlled by the central Government or State Government?

Service Particulars

Name of the Organization/Department, Address, Phone Number	Position Held	From Date	To Date	Nature of Appointment	Appointing Authority	Duties / Job Responsibilities

Upload Certificates

Note: Allows only PDF File, All Files size should not exceed given values

Note: If there are more than one document, Please make it as a single PDF file

Upload Disability Certificate: (size below 500 kb)

Applicant Photo: (size below 500 Kb)

Applicant Signature: (size below 500 kb)

Proof of Age Certificate (SSC): (size below 500 kb)

Upload Aadhaar (size below 500 kb)

Qualification Certificates: (size below 5 MB)

Copy of Appointment Order: (size below 2 MB)

Copy of Retirement Order: (size below 500 kb)

Awards/Citations: (size below 10 MB)

Self Confirmation

I affirm that the information given in this application is true and correct. I also fully understand that if at any stage it is discovered that any attempt has been made by me to willfully conceal and misrepresent the facts, my candidature may summarily be rejected or employment terminated.

State Commissioner Recruitment

Department for Empowerment of PwD,SC&TGP

Application Form for the Position of State Commissioner for PwDs

Personal Details

Educational Qualifications

Other Details

Service Particulars

Upload Certificates