Saturday, July 26, 2014


Annexure – A – OPTION FORM
Information Required for Allocation of State Services Personnel
{Vide section 77 in Part VIII of the Andhra Pradesh Reorganization Act, 2014}
Name of the Department
Category of post to which the

Government Servant belongs


Name of the Service
Departmental unit / unit officer in

respect of the category of the

Government Servant


Name of the Government Servant

(As given in the Service Register)

Date of Birth
Place of Birth (village / town & district)
Home District
Home town ‘/declared for LTC

(Place and district)

Social Status: SC / ST / OBC / Woman


7.Marital Status: Single / Married / Widowed / Separated
Year of entry into Government Service
Designation and Place of first posting
If you are a local candidate in terms of the
Andhra Pradesh Public Employment Order, 1975, specify the local area of which you are a local candidate, together with the name of the State in which the local area now forms a part
11.Name the institutions, period of study and the places where you studied for a period of 7 years immediately preceding the qualifying examination /Matriculation examination or where no educational qualification has been prescribed for the post, name the place / places where you resided for a period of 7 years immediately preceding the date of notification for the post
(Please attach Study Certificates or residence certificate as applicable in your case along with this form)
12.Have you been confirmed in the post in : which you were first appointed
Post currently held
Office Address
15. Method of appointment to the post : D R / Promotee / Transferee currently held
16.Please state whether you have been : regularly appointed or temporarily appointed or kept in charge only to the category of post which you presently hold
17.Are you holding the present post in a : Substantive capacity
18.If you have been promoted from a local cadre, indicate the name of the local cadre and the name of the State of which the local cadre is now a part, to which you belonged and the places and completed years of service where you worked in the past
19. If currently working on tenure / deputation : / leave / suspension, provide details
I prefer to be allocated to the State of Andhra Pradesh / State of Telangana
The reason why I prefer to be allocated to the state of AP / Telangana is the following:
I solemnly declare that information given above is correct to the best of my knowledge and belief and nothing has been concealed.

Verification certificate by the Head of Department
I certify that I have verified the details submitted above by the employee with reference to records and have found them to be correct.

Head of the department