APPENDIX
FORM
A
APPLICATION
FOR ENROLMENT
AS
A MEMBER
OF
THE
CIVIL
DEFENCE
SERVICES
[See
regulation
4( I
)]
I . Name
in
full
(in
Block
letters)
2.
Father's/husband's
name
3.
Date
of birth
4.
Nationality
5.
Permanent
address
6.
Occupation
and
Present
address
7.
Name and
address
ofpresent
employer
8.
Educationalqualification
9. Languages
known
(to
read/
write/ speak)
10. Are
you
a
member
of the
following?
(i)
Defence
Forces
(ArmyA''lavy/Air
Force) or
any
oftheir
reserves;
(ii)
Territorial
Army
orany
other
auxiliary
force
of
Defence
services;
(iii)
civilian
cadre
of Armed
Forces
of the Union,
subject
to Naval,
Army
or
Air Force
law,
other than
"Casual
emPloYees";
(iv)
Police
service:
(v)
Fire services
I l. Are
you
an
ex-service
person? lfso,
give particulars
I
2. Do
you
belong
to the
National
Volunteer
Force?
lf
so.
give particulars
13. Have
you
any
previous experience
in civil
Defence
corps?
Ifso,
give
particulars, including
date
14. Have
you
any
preference for any
particular
section ofCiviI
Defence
Corps?
Ifso, State
the
section
15.
Haveyou
any special
qualifications for enrolment
in the
section
chosen
by
you? Ifso,
give
detail
I 6.
In
case
of
preference for service
in
Mobile
Columns
or ambulance
trains,
are
you prepared to
serve
anywhere
in India,
should
an emergency
arise?
17.
For how
many hours
and
so
whal days ofthe
week
willyou be
available
for civil
Defence
duty
(for part-time
volunteers only)
18.
Do
you have any conveyance
(bicycle, motor car,
motor
cycle'
etc')?
19.
Are
you
suffering
from any
communicable
diseases?
lfso'
give
particulars
20.
Did
you
have small
pox? [fso,
when
2 L
Have
you
been
vaccinated?
If so,
when
22. Have
you
been
inoculated
for cholera/typhoid/T.
B,etc?
Ifso,
when
23.
Do
you know
First Aid/
motor
driving?
24. Signature
of applicant
DECLA RA'f ION
l. I have read the
"Civil
Defence Regulations,
1968".
2. As far as
I know, I am
physically
fit to render efficient
service as a
member
ofthe
Corps'
3.
lf my application
is
accepted,
I am
prepared
to serve as a
whole-time/part-time
member ofthe
Corps,
i.e., to undergo the appropriate
training and,
in the event of an emergency
occurring
whilst I remain a member of the Corps,
to carry out my obligations
a member thereof.
4.
I
undertake
as-
(i)
To carry out my duties
in the Civil Defence Corps
in accordance
with
the instructions
and orders issued by the authorilies
concerned;
(
ii) To return,
rvhen
I cease to
be
a
member of the Corps, any
articles of unifonn, badge
or other
personal
equipment
issued to me; and
(iii)
To abide by the
regulations ofthe Corps.
Signature of
the applicant
Place
Datc
This forrn duly completed should
be
submitted Io:
Name
and address of Enrolling Authority...............
FOR OFFICIAL USE
Recommendations
ofthe Head
of Corps/Staff officer
concerned
Signature...
...
Admitted
to
(Corps,etc.)
and
allotted
to
(posr
No.etc.).........................
Signature.
. . . . . . . .
Designation......
Date.
Designation...............
Date........................
FORM
B
FORM
OF OATH
ISee
regulation
5]
*son/daughter/wife
of...
...
swear/
solemnly
affirm
that
I will
faithful
and
bear
true allegiance
to India
and
to
the Constitution
of lndia
as
by'
law
established'
and
that
I
will
loyalry
carry out
the
duties
entrusted
to me
(so
herp
me
God*)
