No.6/1/2021-CS-II(C)
Government of India
Ministry of Personnel, Public Grievances & Pensions
(Department of Personnel and Training)

$3^{\text {rd }}$ Floor, Lok Nayak Bhavan Khan Market, New Delhi Dated $15.03 .2021$

To,
The candidates as in Annexure
Subject: Non submission of willingness and attestation form Stenographers Grade ‘C’ \& ‘D’ Examination, 2018.

Sir / Madam,
I am directed to refer to this Department’s OM of even number dated 11.02.2021 which is available on the website of this Department at dopt.gov.in $\rightarrow$ About us $\rightarrow$ Central Secretariat $\rightarrow$ CSSS $\rightarrow$ Recruitment $\rightarrow$ Steno Grade D and to say that the candidates, as mentioned in the annexure, have not yet submitted their willingness and attestation form.
2. All these successful candidates of Stenographers’ Grade ‘C’ \& ‘D’ Examination, 2018 recommended for the grade of Stenographer Grade ‘D’ of CSSS 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 (Annexure-II) 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 self attested by the candidate. Specific answers to each of the questions in point 15 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 10 also even of it is same as in the points 2 or 3 of the form]
3. The candidate who in the point number 10 of the attestation form indicates his/her having resided in Delhi should additionally send duly filled-in Annexure-III along with self-attested copies of the following documents and the soft copies of the same by email at bhagirathjha.68@gov.in /ranjan.ak13@nic.in
(a) One passport Size photograph in JPEG format (less than 20 kb )
(b) One copy of photo identity proof in JPEG format (less than 200 kb ) (any one of the following)
(i) PAN card
(ii) Driving License
(iii) Election ID
(iv) Aadhar Card

(c) One copy of residential proof in JPEG format (less than 200 kb ) (any one of the following)
(i) Passport
(ii) Electricity Bill
(iii) Telephone Bill (landline)
(iv) Ration Card
(v) Passbook
(vi) Utility Bill
(vii) Rent Agreement
(viii) Others
4. Candidates as mentioned in annexure should ensure that the requisite documents reach the undersigned at the address mentioned hereunder, latest by $25^{\text {th }}$ March, 2021 failing which their candidature shall be processed for cancellation without any further notice.
“Department of Personnel & Training, CS-II Division
(Shri Bhagirath Jha, Under Secretary)
$3^{\text {rd }}$ Floor, Lok Nayak Bhawan,
Khan Market, New Delhi – 110003”
5. For further information/direction, if any, these candidates are required to follow the website of Department of Personnel \& Training (www.dopt.gov.in) regularly.

Yours faithfully

Bhagirath Jha
(Bhagirath Jha)
Under Secretary to the Government of India
Tele: 24654020
e-mail: bhagirathjha.68@gov.in

Annexure-II

To

The Under Secretary (CS-II)
CS-II Division
Department of Personnel & Training
3rd Floor, Lok Nayak Bhawan
Khan Market, New Delhi-110003

Subject: Appointment to the grade of Stenographer Grade ‘D’ of CSSS- Submission of documents by candidates of Stenographers Grade ‘C’ & ‘D’ Examination, 2018, conducted by SSC-reg.

Sir,

I am refer to letter No. 6/1/2021-CS-II(C) dated 11th February, 2021 of Department of Personnel & Training on the subject mentioned above and hereby convey my willingness to join the grade of Stenographers Grade ‘D’ of Central Secretariat Stenographers’ Service.

1. Three sets of Attestation Forms duly filled in my own handwriting, are also attached.
2. My details (in brief) are as under:
   i. Roll No. : ______________________________
   ii. Date of Birth : ______________________________
   iii. Email : ______________________________
   iv. Mobile No. : ______________________________
   v. Previous Employer (if any) : ______________________________
   (Name of Organization) : ______________________________
   vi. Full Address of previous employment : ______________________________

Yours faithfully

Signature:

Name: ______________________________
Rank (AIR): ______________________________
Date: ______________________________

| | Affix signed passport size ( $5 \mathrm{~cm}, \mathrm{X} 7 \mathrm{cms}$, approx.) copy of recent photograph | “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, convicted, debarred etc. subsequent to the completion and submission of the form, the details should be communicated immediately to CS.II Divison, DoP&T, failing which it will be deemed to be a suppression of factual/material information.
3. If, the fact that false information has been furnished or that there has been suppression of any factual/material 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” in accordance with the extant rules. |
| :–: | :–: | :–: |
| 1. (a) | Name in full (in block capitals) with aliases, if any, | |
| (b) | Have you ever added or dropped in any stage any part of your name or surname: Yes/No
(If Yes, provide details) | |
| 2. | Present address in full (i.e., Village, Thana, District, State and Pincode
or
House No., Lane/Street/Road \& Locality, City, State and Pincode) | |
| 3. (a) | Permanent address in full (i.e., Village, Thana, District, State and Pincode
or
House No., Lane/Street/Road \& Locality, City, State and Pincode) | |
| (b) | If originally a resident of Pakistan/Bangladesh (erstwhile East Pakistan) the address in that country and the date of migration to Indian Union. | |
| 4. | Aadhar Card No. | |
| 5. | Permanent Account Number (PAN) | |
| 6. | Nationality | |

| 11. | Name (in full & aliases if any) | Nationality (by birth \&/or by domicile) | Place of Birth | Occupation of employed – Give designation and Official Address | Present Postal Address (If dead, give last address) | Permanent
Home
Address |
| — | — | — | — | — | — | — |
| (a) Father | | | | | | |
| (b) Mother | | | | | | |
| (c) Spouse | | | | | | |
| (d) Brother(s) | | | | | | |
| (e) Sister (s) | | | | | | |

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

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

1. Educational Qualification showing places of education with years in Schools and Colleges since $15^{\text {th }}$ 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 any appointment under the Central or State Government or a Semi-Government or a Quasi-Government body, or an autonomous body, or a public 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 Govt. of India, a State Govt. / an undertaking owned or controlled by the Govt. of India or a State Govt. / an autonomous body / University / Local body.

If you had left service on giving a month’s notice under 5 of the central civil services (temporary service) rules, 1965, or any similar corresponding rules were any disciplinary proceedings initiated 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, before your services were actually terminated? 15. (i) (a) Have you ever been kept under detention? (b) Have you ever been arrested? (c) Have you ever been prosecuted? (d) Is any criminal case pending against you in any Court of Law at the time of filling up this Attestation form and charge-sheet in that case has been filed or not? (e) Have you ever been convicted by a court of law for any offence? (f) Whether discharged/expelled/withdrawn from any training/institution under the Government or otherwise? (g) Have you ever been rusticated by any university or any other educational authority / institution? (h) Have you ever been debarred / disqualified by any Public service commission from appearing at its examination / selection?

(ii) If the answer to any of the above mentioned questions 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 writing ‘Yes’ or ‘No’ as the case may be.

DECLARATION

I certify that the foregoing information is correct and complete to the best of my knowledge and belief.

I am fully aware that by providing false information or suppressing material information while filling this form, the authorities have full right to terminate my appointment and I am also liable for appropriate criminal/civil/legal action as a consequence.

I am not aware of any circumstances which might impair my fitness for employment under Government.

Date:
Place:
Signature of Candidate

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.II Division
Department of Personnel & Training,
$3^{\text {rd }}$ Floor, Lok Nayak Bhavan,
New Delhi-110003
(ii) Post for which the candidate is being considered:

Stenographer Grade ‘D’, ‘Group-C’, Non-Gazetted of Central Secretariat Stenographers’ Service.

FORM OF MEDICAL CERTIFICATE

I hereby certify that I have examined $\mathrm{Sh} / \mathrm{Smt} / \mathrm{Km}$. $\qquad$ a candidate for employment in the Central Secretariat Service in the Government of India and cannot discover that 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 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

CANDIDATE’S STATEMENT AND DECLARATION

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

1. Name in full (in BLOCK letters)
2. Age and place of birth
3. Have you ever had (a) small-pox, intermittent fever and other fever, enlargement suppuration of glands, spitting of blood, fainting attacks, rheumatism or appendicitis? OR (b) any other disease or accident requiring confinement to bed and medical or surgical treatment?
4. When were you last vaccinated?
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.

Candidate’s signature

Date: __________________________

Signed in my presence.

Signature of Medical Officer

Name: __________________________

& Designation: __________________________

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 forfeiting all claims to superannuation allowance or gratuity.

(Please take back to back print)

Candidate’s Details for Delhi Police Verification

Signature with Date

Rank No./Year of Exam.