APA REGISTRATION FORM - JCO
Paste your
latest Stamp
size
Photograph
(USE BLOCK CAPITALS ONLY)
Temporary Registration Number with date : __________________________________
APA Registration Number with date (will be filled by APA) : _______________________________________________
 
1.  Army No : JC - __________________
Suffix
 
2.   Rank : _______________ 3.   SC/ST/OBC/Gen : _____________
4.   Trade : __________________   5. Character ______________  
6. First Name: __________________ 7. Middle Name : _________________   8. Last Name/Surname: _________________  
      Decoration, if any : _______________
    Day   Month Year
9. Date of Birth :
   
   
       
    Day   Month Year
10. Date of Enrolment :
   
   
       
    Day   Month Year
11. Date of Retirement :
   
   
       
12.  Arms/Service : ____________________________   13. Medical Category :
 
Shape 1
 
LMC
14. If LMC, Enter Details : (a) Medical Category : _____________________________________________________
 
(b) Details of Disability : _____________________________________________________

_____________________________________________________
 
(c) Physical Handicap, if any :
 
15. Marital Status :
 
Married
 
Unmarried 16. Height : __________________ Cms
17. Academic Qualifications : _____________________________________________________________________________
18. Professional Qualifaction : ____________________________________________________________________________
19. Important Army Courses : _____________________________________________________________________________
20. Languages Known :- Read Write Speak
   (a)   Indian Languages : ______________________ ______________________ ______________________
   (b)   Foreign Languages : ______________________ ______________________ ______________________
21. Work Experience in civil (in years) : _____________________________________________________________________
22. Job Preference
(select maximum five Jobs titles) : 		(a) _____________________ (b) ____________________ (c) _____________________
  (d) _____________________ (e) ___________________  
23. Place Preference
(select maximum five stations) : 		(a) _____________________ (b) _____________________ (c) _____________________
  (d) _____________________ (e) ____________________  
24. Salary Expected (Salary range ) :             From : ____________________ pm             To ______________________ pm
  Permanent Address Present Contact Address
25. Address : ____________________________________ ____________________________________
26. State : ____________________________________ ____________________________________
27. District : ____________________________________ ____________________________________
28. Town / City : ____________________________________ ____________________________________
29. Pin Code : ____________________________________ ____________________________________
30. Telephone No. with :
        STD Code 		____________________________________ ____________________________________
31. Mobile No : ____________________________________ ____________________________________
32. E-mail ID : ____________________________________ ____________________________________
33. Passport Details, if any : (a) Passport Number : __________________ (b) Valid upto : ________________________
34. Driving Licence details, if any :     (a) Licence No: ___________________        (b) Valid upto : ________________________

                                                                     (C) Type of Vehicles : _____________________________________________________
35. Arms Licence details, if any :     (a) Licence No: ___________________        (b) Valid upto : _________________________

                                                                 (C) Type of Weapon : _______________________________________________________
36.   Registration No of Zila Sainik Welfare Office , if any : ______________________________
37.   Registration No of Employment Exchange, if any : ________________________________
Date       : (Signature of Applicant)
CHARACTER CERTIFICATE
                  This is to certify that No     _________________________________      Rank   ______________________________

Name       ___________________________________________________ bears   a     ________________________________

character and is recommended for the job applied for.

Date        : (Signature of Officer Commanding)            
or            
  (Secretery ZSB/Serving Officer of the rank of Col in case of retired personnel)
WILLINGNESS CERTIFICATE
            This is to certify that No _________________ Rank ________________________ Name _______________________
__________________________________ am willing to accept the terms & condition laid down by Army Headquarters letter No B/44963/INSTRS/AG/APA dated 26 Nov 98 as amended for my re-employment in civil after my retirement. The same has been explained to me, I have understood it.
Date : (Signature of Applicant)