APA REGISTRATION FORM - OFFICER
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Temporary Registration No with Date : ______________________________________
APA Registration Number with date
(will be filled by APA) : ________________________________________________
 
1.  Personal No :
Prefix
 
______________________
Suffix
 
2.   Rank : _________________________________
3.  Arms/Service : ____________________________       4.  SC/ST/OBC/Gen : ______________________________________
5. First Name: __________________   6. Middle Name : ___________________   7. Last Name/ Surname: _________________

    Decoration, if any : ___________________
    Day   Month Year     Day   Month Year
8. Date of Birth :
   
   
       
9. Date of Commission :
   
   
       
    Day   Month Year      
10. Date of Retirement :
   
   
       
11. Medical Category :
 
Shape 1
 
LMC
12. If LMC, Enter Details : (a) Medical Category : _____________________________________________________
 
(b) Details of Disability : _____________________________________________________

_____________________________________________________
 
(c) Physical Handicap, if any :
 
13. Important Appointments held during last ten years(Starting from latest) :   1.   ________________ 2.   ________________ 3.   ________________
4.   ________________ 5.   ________________ 6.   ________________
7.   ________________ 8.   ________________ 9.   ________________
________________________________________________________________
14. Marital Status :
 
Married
 
Unmarried 15. Gender :
 
Male  
 
Female
16. Academic Qualifications : _____________________________________________________________________________
17. Professional Qualifaction : ____________________________________________________________________________
18. Important Army Courses : _____________________________________________
19. Languages Known :- Read Write Speak
   (a)   Indian Languages : ______________________ ______________________ ______________________
   (b)   Foreign Languages : ______________________ ______________________ ______________________
20. Work Experience in civil (in years) :_____________________________________________________________________
21. Job Preference
      (select maximum five Job Titles) :
    		 (a) __________ (b) __________ (c) __________ (d) __________ (e) ___________
22. Place Preference
     (select maximum five stations) : 		(a) ___________________ (b) ____________________ (c) _____________________
  (d) ____________________ (e) ____________________  
23. Salary Expected (salary range) :           From : ____________________ pm      To : _______________________ pm
24. Currently employed in civil job :
 
Yes
 
No
  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. Details of Registration fees : (a) Bank Draft No : ___________________ (b) Date of Draft : ______________________
  (c) Name of Bank : ___________________ (d) Branch name: _____________________
Date       : (Signature of Applicant)