F.No.7/2/2015-CS.I(A)
Government of India
Ministry of Personnel, Public Grievances \& Pensions
(Department of Personnel \& Training)
$* * * * * * *$
$2^{\text {nd }}$ Floor, Lok Nayak Bhawan, Khan Market, New Delhi -110003. New Delhi, the $9^{\text {th }}$ October, 2015.

To,
The successful candidates of CGLE, 2014
recommended to Assistants’ Grade of CSS
(As per list annexed)
Subject: Appointment to the Assistants’ Grade (Group B, Non-Gazetted) of Central Secretariat Service on the basis of Combined Graduate Level Examination, 2014 – completion of pre-appointment formalities thereof.

Sir/Madam,
I am directed to say that Staff Selection Commission has recommended candidates for appointment to the Assistants’ Grade of Central Secretariat Service on the basis of Combined Graduate Level Examination (CGLE), 2014. Dossiers of most of the recommended candidates have since been received in this Department, as per the annexure to this letter. Though utmost care has been taken while preparing the list annexed, candidates are however advised to cross check their particulars with their results declared by SSC.
2. All the successful candidates recommended to Assistants’ Grade of CSS are required to submit the following documents immediately:
(i) Willingness to join the post
(ii) Four sets of Attestation Form, all sets duly filled in ink.
(The candidates may take print out (back to back) of the Attestation Form attached and should carefully fill in the forms. No point in the form shall be left blank. The photograph pasted on all four sets should be signed by the candidate. Specific answers to each of the questions in point 12 of the form should be given by striking out ‘Yes’ or ‘No’ as the case may be and not by tick mark $\sqrt{ }$. The candidates should fill in the point 4 also even if it is same as in the point $2 \& 3$ of the form)

1. Candidates should ensure that the requisite documents reach the undersigned at the address mentioned hereunder, latest by 21st October, 2015.

The Under Secretary (CS.I-A)
CS.I Division,
Department of Personnel & Training,
2nd Floor, Lok Nayak Bhawan,
Khan Market, New Delhi -110003.

1. All the candidates are also advised to appear before the Civil Surgeon/Principal Medical Officer/Chief Medical Officer of the District where the candidates are presently residing, for the medical examination to determine their fitness for the Government service. The candidates are required to give a statement and declaration regarding his/her health in the attached form in the presence of Medical Officer, and a copy thereof shall also be furnished to this Ministry along with the medical certificate of fitness. The medical certificate of fitness should be in the prescribed format, a specimen of which is attached. In case any other letter is required by the Office of CMO concerned, the undersigned may be contacted. (Candidates residing in Delhi will be advised about their medical examination in due course.) However, if the candidate is already in government service, instead of obtaining a fresh medical report, they may produce this letter to their controlling authority to enable them to forward an attested copy of their medical examination report obtained at the time of appointment, to the undersigned.

2. The candidates on joining will be first imparted the mandatory Assistant Direct Recruit Foundational Training organised by Institute of Secretariat Training and Management (ISTM). The training would start tentatively w.e.f. 2nd November, 2015 at ISTM, Delhi and soon thereafter at MGSIPA, Chandigarh and at HPIPA, Shimla. Candidates, if they desire, may exercise option to undergo the training at any of the aforesaid Institute. It would be aim to nominate the candidates as per their choice, however, in case of lack of options for any particular Institute, this Department at its discretion will nominate candidates, irrespective of the options. In the case of candidates exercising the option, it will be presumed that they are prepared to join on the stipulated date and no request for any extension received thereafter will be entertained.

3. Mere submission of willingness and forms will not entitle any claim to appointment to the post which will be subject to fulfillment of stipulated terms and conditions.

Yours faithfully,

(Parminder Singh)
Under Secretary to the Government of India
Tel: 24642705
e-mail: parminder.edu@nic.in

To,
The Under Secretary (CS.I-A)
CS.I Division,
Department of Personnel & Training,
2nd Floor, Lok Nayak Bhawan,
Khan Market, New Delhi -110003.

Subject: Appointment to Assistants’ Grade of CSS- Submission of documents by candidates of CGLE, 2014

Sir,

I am to refer to letter No.7/2/2015-CS.I(A) dated _______ October, 2015 of Department of Personnel & Training on the subject mentioned above and hereby convey my willingness to join the Assistants’ Grade of Central Secretariat Service.

1. Four sets of Attestation Forms duly filled in my own handwriting, are also attached.

Yours faithfully,

Dated _______ October, 2015

Signature:_____________________________

Name:_______________________________

Roll No. ______________________________

Date of Birth: ______________________________

e-mail:_______________________________

Contact No:_____________________________

CGLE, 2014 Rank (AIR):______________________________

Annexure to letter dated 9.10.2015

ATTESTATION FORM

WARNING:

1. The furnishing of false information or suppression of any factual information in the Attestation Form would be a disqualification, and is likely to render the candidate unfit for employment under the Government.
2. If detained, arrested, prosecuted, bound down, fined, convicted, debarred, acquitted etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the authorities to whom the attention form has been sent early, failing which it will be deemed to be a suppression of factual information.
3. If the fact that false information has been furnished or that there has been suppression of any factual information in the Attestation Form comes to notice at any time during the service of a person, his services would be liable to be terminated.
4. Name in full (in block capitals) with aliases, if any (Please indicate, if you have added or dropped in any stage any part of your name or surname.
5. Present Address in full (i.e. Village, Thana and District, or House No. Lane/Street/ Road and Town.)
6. a) Home address in full (i.e. Village Thana, and District or House No. Lane/Street/ Road and Town and name of Distt Headquarters.)
   b) If originally a resident of Pakistan/ Bangladesh (erstwhile. East Pakistan) the address in that country and the date of migration to Indian Union

1. Particulars of places (with periods of residences) where you have resided for more than one year at a time during the preceding five years. In case of stay abroad (including Pakistan), particulars of all places where you have resided for more than one year after attaining the age of 21 years should be given.

| From | To | Residential address in full
(i.e. Village, Thana and District, or House No. Lane/
Street/Road and Town). | Name of the District. Headquarters of the place mentioned in the preceding column. |
| — | — | — | — |
| | | | |
| | | | |
| | | | |
| | | | |

1. | | Name (in full \&
   aliases, if any) | Nationality
   (by birth \&
   or by
   domicile) | Place of Birth | Occupation (if
   employed give
   designation \&
   official address | Present postal address (if
   dead give last address) | Permanent
   Home
   Address |
   | — | — | — | — | — | — | — |
   | i) Father | | | | | | |
   | ii) Mother | | | | | | |
   | iii) Spouse | | | | | | |
   | jy)
   Brother(s) | | | | | | |
   | v) Sister(s). | | | | | | |

5(a) Information to be furnished with regard with regard to son(s) and/ or daughter(s) in case they are studying/living in a foreign country.

| Name | Nationality (by
birth \& or by Birth
domicile) | Place of Birth | Country in which studying/living
with full address | Date from which studying/
living in the country address
mentioned in previous col. |
| — | — | — | — | — |
| | | | | |
| | | | | |

1. Nationality:
2. a) Date of Birth: b) Present Age: c) Age at Matriculation:
3. a) Place of Birth, District and State in which situated: b) District and State to which you belong. : c) District and State to which your father originally belongs 9. a) Your religion b) Are you a member of a Scheduled Caste/ Scheduled Tribe? (Answer ‘YES or NO’.)
4. Educational Qualification showing places of Education with years in Schools and Colleges since 15th year of age.

| Name of School/
College with full Address | Date
of
Entering | Date
of
Leaving | Examination Passed |
| — | — | — | — |
| | | | |
| | | | |

1. (a) Are you holding or have any time held an appointment under the Central or State Government, or a Semi-Government or a Quasi-Govt. body, or an autonomous body, or a Public Sector Undertaking, or a private firm or institution? If so, give full particulars with dates of employment up-to-date.

1. b) If the previous employment was under the Government of India a State Government/an undertaking owned or Controlled by the Government of India or a State Government Autonomous body/University/ Local Body.

If you had left service on giving a month’s notice under the rule 5 of the Central Civil Services (Temporary Service) Rules, 1965, or any similar corresponding rules, were any disciplinary proceedings framed against you, or had you been called upon to explain your conduct in any matter at the time you gave notice of termination of service, or at a subsequent date(s), before your service actually terminated? (strike out ‘Yes’ or ‘No’ as the case may be) a) Have you ever been arrested? Yes / No b) Have you ever been prosecuted? Yes / No c) Have you ever been kept under detention? Yes / No d) Have you ever been bound down? Yes / No e) Have you ever been fined by a court of Law? Yes / No

f) Have you ever been convicted by a Court of Law for any offence?
g) Have you ever been debarred from any examination or rusticated by any University or any other educational authority/Institution?
h) Have you ever been debarred/ disqualified by any Public Service Commission/ Staff Selection Commission for any of its examination/ selection?
i) Is any case pending against you in any Court of Law at the Time of filling up this Attestation Form?
j) Is any case pending against you in any University or any other educational authority/Institution at the time of filling up this Attestation Form?
k) Whether discharged/expelled/withdrawn from any training institution under the Government or otherwise?
(ii) If the answer to any of the above mentioned question is ‘Yes’, give full particulars of the case/arrest/ detention/ fine/ conviction/ sentence/ punishment etc, and/ or the nature of the case pending in the Court/ University/ Educational Authority etc. at the time of filling up this Attestation Form.

Note: i) Please also see the ‘WARNING’ at the top of this Attestation Form.
ii) Specific answers to each of the questions should be given by striking out ‘Yes’ or ‘No’ as the case may be.
13. Name and address of two responsible persons of i) your locality or two references to whom you are known.
ii)

I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am not aware of any circumstances which might impair my fitness for employment under Government.

Date : $\qquad$
Place : $\qquad$

IDENTITY CERTIFICATE

(Certificate to be signed by any one of the following)
i) Gazetted officers of Central or State Government
ii) Members of Parliament or State Legislature belonging to the Constituency where the candidate or his parent/ guardian is ordinarily resident.
iii) Sub-Divisional Magistrates/ Officers
iv) Tehsildars or Naib/ Deputy Tehsildars authorized to exercise Magisterial powers,
v) Principal/Head Master of the recognized School/College/ Institution where the candidate studied last.
vi) Block Development officer
vii) Post Masters
viii) Panchayat Inspectors.

Certified that I have known Shri/ Smt/ Kumari $\qquad$

Son/daughter of Shri $\qquad$
for the last $\qquad$ years $\qquad$ months and that to the best of my
knowledge and belief the particulars furnished by him/ her are correct.
Date : $\qquad$
Signature $\qquad$

Place : $\qquad$ Stamp Designation or status \& Address

TO BE FILLED BY THE OFFICE

(i) Name, designation and full address of the authority forwarding the form

Under Secretary to the Government of India, CS.I Division, Department of Personnel \& Training, $2^{\text {nd }}$ Floor, Lok Nayak Bhawan, New Delhi-110003
(ii) Post for which the candidate is being considered.

Assistant’s Grade, ‘Group-B’, Non-Gazetted

CANDIDATE’S STATEMENT AND DECLARATION

(The candidate must make the following statement and must sign the declaration below it before his/her medical examination. Attention is specially invited to the WARNING in the ‘Note’ at the bottom of page 2.)

1. Name in full: $\qquad$
   (in BLOCK letters)
2. Age \& place of birth : $\qquad$
3. Have you ever had
   a) small-pox, intermittent fever or and other fever, enlargement or suppuration of glands, spitting of blood, fainting attacks, rheumatism or appendicitis?
   OR
   b) any other disease or accident requiring confinment to bed and medical or surgical treatment?
4. When were you last vaccinated ? $\qquad$
5. Have you or any of your relatives been afflicted by consumption, scrofula, gout, asthma, fits, epilepsy or insanity?
6. Have you suffered from any form of nervousness due to overwork or any other cause?
7. Have you been examined and declared fit for Govt. service by a medical officer/ Medical Board within the last three years?
8. Furnish the following particulars :
   

DECLARATION

I declare that all the above answers are true and correct to the best of my knowledge and belief. I also solemnly affirm that I have not received any disability certificate/ pension on account of any disease or other condition.

Date: $\qquad$
Candidate’s Signature

Signed in my presence.

Signature of Medical Officer

Name : $\qquad$
\& Designation : $\qquad$
$\qquad$
$\qquad$
$\qquad$

Note: The candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing any information he will incur the risk of losing the appointment and, if appointed, of forteiting all clasims to superannuation allowance or gratuity.

FORM OF MEDICAL CERTIFICATE

I hereby certify that I have examined Shri/Smt./Kum. $\qquad$ a candidate for employment in the Central Secretariat Service in the Government of India and cannot discover the he/she has any disease (communicable or otherwise), constitutional weakness or bodily infirmity, except $\qquad$ . I do not consider this a disqualification for employment in the Central Secretariat Service in the Government of India.

The age of Shri/Smt./Kum. $\qquad$ according to his/her own statement is $\qquad$ years, and by appearance is about $\qquad$ years.

(Signature/thumb impression of the candidate)

Date $\qquad$
(To be signed in the presence of the examining Medical Officer)

Signature of Medical Officer
Name $\qquad$
Address $\qquad$
Official Seal
(Seal should be spread over form and the photograph)

Note: The officer making this certificate should be a Civil Surgeon or a District Medical Officer of equivalent status of a Government Hospital