June 15, 2011 - Kerala Public Service Commission

Akm[mcW Kk‰v XobXn: 15.06.2011 Ahkm\ XobXn: 20.07.2011
cm-{Xn- 12 aWn hsc
stated in the certificate, as given above and vague statements
such as vision Normal etc. will not be accepted. Specification
for each eye should be stated separately. Special attention should
be directed to the distant vision. Required standard of vision are
as follows.
Right eye Left eye
(a) Distant vision 6/6 snellen 6/6 snellen
(b) Near vision 0.5 snellen 0.5 snellen
(c )Each eye must have full field of vision
KERALA PUBLIC SERVICE COMMISSION
FORM OF MEDICAL CERTIFICATE REGARDING
PHYSICAL FITNESS FOR THE POST OF DRIVER (LDV)
(To be filled up by a Medical Officer not below the rank of an
Assistant Surgeon)
1 What is the applicant’s apparent age?
2 Is the applicant to the best of your judgment, subject to epilepsy,
vertigo or any mental ailment likely to affect his efficiency?3
Does the applicant suffer from any heart or lungs
disorder which might interfere with the performance of his
duties as a Driver?
4 Does the applicant suffer from any degree of deafness,
which would prevent his hearing the ordinary sound
signals? Is his hearing perfect?
5 Has the applicant any deformity or loss of finger, which
would interfere with the efficient performance of his duties
as a driver?
6 State of Muscles and Joints (No paralysis and all joints with
free movements)
7 State of Nervous System (Perfectly normal and free from
any infectious diseases)
8 Does he show any evidence of being addicted to the
extensive use of alcohol, tobacco or drinks?
9 Marks of Identification
He is physically fit for the post of …………………………
I certify to the best of my knowledge and belief that the applicant
Shri. …………………. …………………… is the person herein
above described and that the attached photograph has a reasonably
correct likeness.
(The signature of the Medical officer shall be affixed to the
photograph leaving the face clear)
Signature:
Name
Place:
Designation &
Date:
Official Address
Ipdn∏v: 3) P-\-d¬- Hm-∏-¨- am¿-°-‰v- D-tZym-Km¿-∞n-I-fp-tSbpw-
sa-º¿- skm-ssk-‰n- Po-h-\-°m-cp-tS-bpw- dm-v- en-Ãp-Ifn¬-
\n-∂pw- D-tZym-Km¿-∞n-I-sf- H-∂n-S-hn-´v- b-Ym-{I-aw- \n-ba-\-
in-]m¿-i- \-S-Øp-∂-Xpw- B-Zy- \n-b-a-\- in-]m¿-i- P-\-
d¬- Hm-∏-¨- am¿-°-‰n¬-s∏-´- D-tZym-Km¿-∞n-Iƒ-°p- \¬-Ip-
∂-Xp-am-Wv.- K-h-¨-sa-‚ v- h-Ip-∏p-I-fn-te-bpw- s]m-Xp-ta-J-emÿm-]-\-ß-fn-te-bpw-
H-gn-hp-I-fn-te-bv-°v- I-Ωn-j-≥ \n-b-a-\-
in-]m¿-i- \-S-Øp-∂-Xp-t]m-se- sdm-t´-j-≥ Xp-S¿-®-bm-bn-´p-ff-Xm-bn-cn-°p-∂-Xm-Wv.-
(sa-º¿- skm-ssk-‰n-I-fn-se- Po-h-\-
°m¿-°p-th-≠n- X-øm-dm-°p-∂- dm-v- en-Ãn¬- D-tZy-Km¿-∞n-
I-fp-sS- Ip-d-hp-≠m-bm¬- B- H-gn-hp-Iƒ- Hm-∏-¨- am¿-°-‰v- D-
tZym-Km¿-∞n-I-fp-sS- dm-v-en-Ãn¬-\n-∂pw- \n-I-Øp-∂-Xm-Wv-).-
A-ß-s\- \n-I-Ø-s∏-Sp-∂- H-gn-hp-Iƒ- ]n-∂o-Sv- skm-ssk-‰nhn-`m-K-Øn-\v-
Xn-cn-sI- e-`n-°p-∂-X-√.- sI.-F-kv.-B-‚ v- F-kv.-
F-kv.-B¿-˛-se- P-\-d¬- dqƒ-kv- 14˛-17 {]-Im-c-ap-f-f- kw-h-c-Why-h-ÿ-Iƒ-
]m-en-®m-bn-cn-°pw- c-≠p- en-Ãn¬- \n-∂p-ap-f-f-
\n-b-a-\-߃.-
2) Cu- X-kv-Xn-I-bn-te-°v- A-t]-£n-°p-∂- sa-º¿- skmssk-‰n-I-fn¬-
\n-∂p-f-f- D-tZym-Km¿-∞n-Iƒ- A-t]-£- k-a¿-
∏n-°p-∂-Xn-\p-f-f- A¿-l-X- sX-fn-bn-°p-∂-Xn-\m-bn- k¿-∆o-kns\-
kw-_-‘n-°p-∂- hn-i-Z-hn-h-c-߃- tc-J-s∏-Sp-Øn-bn-´p-ff-
k¿-ho-kv- k¿-´n-^n-°-‰v- k-l-I-c-W- h-Ip-∏n-se- A-kn-Ã-
‚ v- c-Pn-kv-{Sm¿- (P-\-d¬-)- ¬- \n-∂pw- hm-ßn- kq-£n-t°-≠-
Xpw- I-Ωo-j-≥ B-h-iy-s∏-Sp-∂- k-a-b-Øv- lm-P-cm-t°-≠-
Xp-am-Wv. k¿-ho-kv- k¿-´n-^n-°-‰n¬- Xm-sg-]-d-bp-∂- hn-h-c߃-
D-≠m-bn-cn-t°-≠-Xm-Wv.-
k¿∆okv k¿´n^n°‰v
1. DtZymKm¿∞nbpsS t]cv :
2. DtZymKt∏cv, iºf\nc°v
(Ct∏mƒ tPmen sNøp∂
XkvXnIbpsSt]cpw, iºfhpw
Hmtcm XkvXnIbnepw ÿncambn
tPmen t\m°nbn´pff Imebfhpw) :
3. DtZymKm¿∞n tPmen sNøp∂ :
klIcW kwLØns‚ t]cpw
klIcW kwLw tIcf kwÿm\
klIcW luknwKv s^Utdj≥
enan‰Un¬- A^nentb‰v sNbvX
XobXnbpw.
4.- -Sn- kw-L-Øn¬- ÿn-c-tk-h-\w- B-cw-`n-®- Xo-b-Xn-bpw- X-
kv-Xn-I-bpw- C-t∏mƒ- tPm-en- sN-øp-∂- X-kv-Xn-I-bpw.- -
-ta¬-∏-d-- sa-º¿- skm-ssk-‰n-bn-se- ÿn-cw- Po-h-\-°m-c-
\m-b-/-Po-h-\-°m-cn-bm-b-{io-/-{io-a-Xn .......................................... s\-
kw-_-‘n-®p-f-f- hn-h-c-߃- Sn- D-tZym-Km¿-∞n-bp-sS- k¿-∆okv-
kw-_-‘-am-b- hn-h-c-ß-fp-am-bn- H-Øp-t\m-°n-b-Xn¬- B-
b-h- k-Xy-am-sW-∂v- F-\n-°v- t_m-≤y-am-bn-´p-f-f-Xm-bn- Rm-
≥ km-£y-s∏-Sp-Øp-∂p.-
H∏pw t]cpw
Akn v cPnkv{Sm¿(P\d¬)
klIcW hIp∏v.
ÿew:
(Hm^okv ap{Z)
XobXn:
Cu- X-kv-Xn-I-bn-te-°v- A-t]-£n-°p-∂,- sa-º¿- skm-ssk-
‰n-I-fn¬- \n-∂p-f-f- D-tZym-Km¿-∞n-Iƒ- A-t]-£- tI-c-f- ]-_vfn-Iv-
k¿-ho-kv- I-Ωn-j-\v- k-a¿-∏n-°p-∂-Xn-\v- ap-ºm-bn- Hm-
^o-kv- ta-e-[n-Im-cn-bn¬- \n-∂v- Xm-sg- sIm-Sp-Øn-´p-f-f- am-Xr-
I-bn¬- H-cp- c-ko-Xv- hmßnbncnt°≠Xpw IΩoj≥
Bhiys∏Sptºmƒ lmPcmt°≠XpamWv.
FORM OF RECEIPT
(To be obtained from the Head of Office)
Certified that a copy of application dated ……………… for selection
to the post of ……………………………… on Rs.
……………….. in the ……………………… (here enter the name
of Co-operative Institution) notified in the Gazette dated
………………… has been received by me from
………………………..(here enter the name of the applicant and
the post held by him/her) and that objections if any to the entertainment
of the application will be communicated to the Office
of the Kerala Public Service Commission within one month
from the last date fixed for receipt of applications.
Signature:
Name and Designation of
Head of Office
Place :
Date :
(Office Seal)
8. Cu- sXcsSp-∏n-\v- Fgp-Øp-]co-£ /H.-Fw.-B¿- ]co-
£ \SØp-∂]£w- A¿-lXs∏´ DtZym-Km¿-∞n-Iƒ-°p-≈
AUv-an-j≥- Sn-°‰v- Hm¨-sse≥- kw-hn-[m-\Øn¬- IΩojs≥-d
Hu-tZym-Kn-I sh_v-ssk‰n-eq-sS \¬-Ip-∂Xpw,- DtZym-
Km¿-∞n-Iƒ- AXv- \n-¿-t±im-\p-kcWw- Uu¨-tem-Uv- sNbv-
X {]n≥-dv- FSp-t°≠Xp-am-Ip-∂p.-
9. ]co-£,- Im-bn-I£aXm- ]co-£,- {]m-tbm-Kn-I ]co-£,-
C≥d¿-hyq- ap-Xem-bhbv-°v- lm-Pcm-Ip-∂ thfbn¬- lmƒ-
Sn-°‰n-t\m-sSm-∏w- DtZym-Km¿-Xv-Yn-Iƒ- t^m-t´m- ]Xn-∏n-® Xncn-®dn-b¬-
Im¿-Upw- (Voter ID, Driving Licence, Passport,
km-aq-ly-t£a hIp-∏v- hn-Iemw-K¿-°v- \¬-Ip-∂ Xn-cn-
®dnb¬- Im¿-Uv,- tZikm¬-Ir-X _m-v- \¬-Ip-∂ t^m-t´m-
]Xn-® ]m-kv- _p-°v,- ]m≥- Im¿-Uv,- k¿-°m¿- DtZym-Kkv-Y¿-
°v- _‘s∏´ hIp-∏v- \¬-Ip-∂ Xn-cn-®dn-b¬- Im¿-Uv), AXns≥-d
kz-bw- km-£y-s∏Sp-Øn-b icn-∏I¿-∏pw- lm-Pcm-
t°≠Xm-Wv.-
10. At]£ Abbvt°≠ ta¬-hnemkw:
www.keralapsc.org
Im‰Kdn \º¿ : 143/2011
dnk]vj\nÃv Iw sSet^m¨ Hm∏td‰¿
t^mw am‰nwKvkv (C≥Uym) enan‰Uv
1. ÿm]\Øns‚ t]cv : t^mw am‰nwKvkv
(C≥Uym) enan‰Uv
2. DtZymKt∏cv : dnk]vj\nÃv Iw
sSet^m¨ Hm∏td‰¿
3. iºfw : `1675˛2975
4. HgnhpIfpsS FÆw : 1 (H∂v)
5. \nba\coXn : t\cn´p≈ \nba\w
6. {]mbw. : 18˛-35.- "-D-tZym-Km¿-∞n-Iƒ- 02.-01.-
1976˛-\pw- 01.-01.-1993\pw- C-S-bn¬- P-\n-®-h-cm-bn-cn-°-Ww.- (c-
≠v- Xo-b-Xn-I-fpw- Dƒ-s∏-sS-).- a-‰v- ]n-t∂m-°- hn-`m-K-Øn¬-
Dƒ-s∏-´-h¿-°pw- ]-´n-I-Pm-Xn-/-]-´n-I-h¿-§- hn-`m-K-Øn-ep-≈-h¿-
°pw- \n-b-am-\p-kr-X- C-f-hp-≠m-bn-cn-°pw.-
Ipdn∏v: {]-kv-Xp-X- ÿm-]-\-Øn¬- s{]m-hn-j-W-em-bn- tPmen-
t\m-°n-bn-´p-≈-h¿- B-Zy-sØ- s{]m-hn-j-W¬- \n-b-a-\-
°m-e-Øv- \n-›n-X- {]m-b-]-cn-[n- I-gn-n-cp-∂n-s√-n¬- A-hcp-sS-
s{]m-hn-j-W¬- k¿-ho-kn-s‚- ssZ¿-Ly-tØm-fw- D-b¿-
∂- {]m-b-]-cn-[n-bn¬- C-f-hv- A-\p-h-Zn-°p-∂-Xm-Wv.- F-∂m¬-
]-c-am-h-[n- A-©p- h¿-j-°m-ew- am-{X-ta- Cu- B-\p-Iq-eywe-`n-°p-I-bp-≈q.-
Sn- ÿm-]-\-Øn¬- d-Kp-e¿- D-tZym-Kw- h-ln-
°p-∂-h¿-°v- ho-≠pw- a-s‰m-cp- \n-b-a-\-Øn-\v- Cu- B-\p-Iq-eywe-`n-°p-∂-X-√.-
s{]m-hn-j-W¬- k¿-ho-kp-≈-h¿- k¿-ho-kn-s‚-
ssZ¿-Lyw- Im-Wn-°p-∂- k¿-´n-^n-°-‰v- hm-ßn- ssI-h-iw- kq-
£n-t°-≠-Xpw- I-Ωo-j-≥ B-h-iy-s∏-Sp-tºmƒ- lm-P-cm-t°-
≠-Xp-am-Wv.- A-h¿- d-Kp-e¿- k¿-ho-kn-e-√- tPm-en- t\m-°n-bncp-∂-sX-∂v-
k¿-´n-^n-°-‰n¬- {]-tXy-Iw- ]-d-n-cn-°-Ww.-
7. tbmKyXIƒ :
(i) _n.-F-/-_n.-F-kv.-kn-/-_n.-tImw- A-s√-n¬- H-cp- Aw-Ko-
Ir-X- k¿-∆-I-em-im-e-bn¬- \n-∂pw- e-`n-®- X-Øp-ey-am-b- {Xnh-’-c-
_n-c-pZw.
(ii) Hcp AwKoIrX ÿm]\Øn¬- \n∂pw Fw.Fkv
Hm^oknepw, Un.‰n.]n. bnepw (Cw•ojv & aebmfw) e`n®
k¿´n^n°‰v.
(iii) k¿°m¿ hIp∏pIfntem, C≥Uy≥ Iº\okv BIvSv
{]Imcw cPnÿ sNbvX Iº\nIfntem sSent^m¨ kzn®v
t_m¿Uv (EPABX) {]h¿Øn∏n°p∂Xnepff Hcp
h¿jsØ ]cnNbw.
3 DtZymKm¿∞nIƒ sXmgn¬- ]cnNbw sXfnbn°p∂Xn\v
lmPcmt°≠ k¿´n^n°‰v Xmsg sImSpØncn°p
amXrIbnembncn°Ww.
]cnNb k¿´n^n°‰ns‚ amXrI
ÿm]\Øns‚ t]cv :
(Kh¨sa‚ v Un∏m¿´vsa‚ v/
C≥Uy≥ Iº\okv
BIvSv {]Imcw cPnÿ sNbvX Iº\n)
cPnÿ \º¿ :
(cPnkvt{Sj≥ \ºcpw cPnÿ
sNbvX XobXnbpw)
cPnkvt{Sj≥ \¬-Inb A[nImcn :
]cnNb k¿´n^n°‰v
{io/{ioaXn ...................................-.... (DtZymKm¿∞nbpsS t]cpw
ta¬-hnemkhpw)...............................- ap-I-fn¬- ]-d-n-cn-°p-∂-
- Bƒ- Cu- ÿm-]-\-Øn¬- .........................-....- (X-kv-Xn-I-bpsS-
t]-cv-/- tPm-en-bp-sS- kz-`m-hw- C-h-bn-te-sX-n-epw-)- B-bn-
..............-cq-]- am-k-i-º-f-Øn¬- -/-Zn-h-k- i-º-f-Øn¬- ...................-
ap-X¬........- h-sc-........- h¿-jw-........- am-kw............-- Zn-h-kw- tPmen-t\m-°n-bn-´p-≠v-/-
tPm-en- t\m-°n- h-cn-I-bm-Wv- F-∂v- C-Xn-
\m¬- - k¿-´n-ss^- sN-øp-∂p.-
k¿´n^n°‰v \¬-Ip∂ hy‡nbpsS
XobXn klnXapff H∏v, t]cv,
ÿew : HutZymKnI ]Zhn,
XobXn :
ÿm]\Øns‚ t]cv
(Hm^okv ko¬- )
km£y]{Xw
.......................-F-∂- \n-b-a-Øn¬- -/-N-´-Øn¬- hy-h-ÿ- sN-øp-
∂- {]-Im-cw- ÿm-]-\- D-S-a-ÿ-≥/-sXm-gn-ep-S-a- \n¿-_-‘-ambpw-
kq-£n-°p-hm-≥ _m-≤y-X-s∏-´.........................c-Pn-ÿ- ]-
cn-tim-[n-®v- (_-‘-s∏-´- c-Pn-Ã-dn-s‚- t]-cv-)- ta¬- ]-cn-N-b- k¿-
´n-^n-°-‰n¬- ]-cm-a¿-in-°p-∂ Po-h-\-°m-c-≥ C-Xn¬ ]-d-ncn-°p-∂-
Im-e-b-f-hn¬- Sn- ÿm-]-\-Øn¬..........................B-bntPm-en-
sN-bv-Xn-cp-∂p-/- tPm-en- sN-øp-∂p-sh-∂v- C-Xn-\m¬ -
km-£y-s∏-Sp-Øp-∂p.- Rm-≥ tI-c-f-/-tI-{µ- k¿-°m¿- ]p-d-s∏-
Sp-hn-®n-´p-f-f- -F-∂- N-´-{]-Im-cw- Sn- ÿm-]-\-Øn-se- Po-h-\-
°m-cp-sS- tk-h-\- hy-h-ÿ-I-sf- kw-_-‘n-®v- ÿm-]-\-ap-S-akq-£n-t°-≠-
c-Pn-ÿ- ]-cn-tim-[n-°p-hm-≥ A-[n-Im-c-s∏-Sp-
Øn-b- D-tZym-K-ÿ-\m-Wv.
N´{]Imcw/\nba{]Imcw ÿm]\Ønse
Poh\°mcpsS tkh\ hyhÿIƒ
km£ys∏SpØphm≥ A[nImcs∏SpØnb
ÿew : DtZymKÿs‚ XobXn klnXapff
XobXn :
H∏v, t]cv, DtZymKt∏cv, B^okv
(Hm^okv ko¬-)
Ipdn∏v:˛(1) tPm-en- sN-bv-Xn-cp-∂ X-kv-Xn-I-bp-sS- t]-cv- A-
s√-n¬-- - tPm-en-bp-sS- kz-`m-hw- A-Xm-b-Xv- Im-jz-¬- - sXmgn-em-fn-
A-s√n-¬ i-º-f-tØm-Sp- Iq-Sn-tbm- A-√m-sX-tbm- D-
f-f- A-{]-‚o-kv- A-s√n¬ ÿn-c-tam- Xm¬--°m-en-I-tam- B-
b- sXm-gn-em-fn- C-h-bn-te-Xm-tWm- A-Xv- kq-Nn-∏n-°-Ww.-
(2)F-√m- ]-cn-N-b- k¿-´n-^n-°-‰p-I-fpw- k¿-°m-cn-‚- _-‘-s∏-´-
\n-b-{¥-Wm-[n-Im-cn-/-ta-e-[n-Im-cn-sb-s°m-≠v- km-£y-s∏-Sp-tØ-
8 ]nFkvkn _p≈¡n≥ 2011 Pq¨- 15