I. INDENTIFYING DATA:

1. Name in full (in block letters) Dr/Mr/Ms .
   
   
2. Date of Birth 3. Fathers Name ..
   
   

1. 1. Mailing Address .
      
      
   2. Pin Code Tel No.: Mobile No.E-mail
2. Pin Code
3. Marital Status .7. Nationality ...
   
   

8. State of Domicile .. 9. Religion :

10. Do you belong to SC ST

(in case of PWD category, please tick PWD-OH/PWD-HH/PWD-VH) (Please attach attested photocopy of Certificate)

II. MISCELLANEOUS DATA :

1. If selected for appointment, what notice period would you require for joining the post?
   
   
2. Names and Addresses of two Referees : (i).. (ii) . .. .
   
   

Recommendations from two Referees, not related to the applicant, who are scholars closely acquainted with the applicants academic training, accomplishments and capabilities, should preferably be obtained in sealed envelopes and attached with this application, or they be requested to send them directly to the Recruitment Cell of the University by post (not by e-mail)

(Application and Bio-Data forms are meant to obtain minimum information required for being considered for the post applied for. Candidates may furnish any additional relevant information that they consider necessary, on separate sheets.)

BRIEF BIO-DATA Post applied for: .. Name: .. Date of Birth: (DD/MM/YYYY)

Whether belonging to SC ST

Present Employer

1. EDUCATIONAL QUALIFICATION (Starting with highest degree obtained):
   
   
2. Details of Employment: (In chronological order starting with the most recent)
   
   

Sl. No.	Examination/Degree	Name of Board/College/University	Percentage of Marks/ Final Grade	Subject(s)	Year of Passing/ Award
1.	M. Phil or its equivalent (as per UGC Regulations)
2.	Masters Degree or its equivalent
3.	Bachelors Degree or its equivalent (Hons./Major)
4.	Higher Secondary or its equivalent
5.	Secondary or its equivalent

(Attach separate sheet if necessary)

Sl. No	Name of Employer/Status of Institute/ University (Govt./Quasi Govt./Autonomous etc.)	Post held/ Designation	Period of Employment		Basic salary last drawn, pay scale and Grade Pay	Nature of duties
			From	To

3. Mention briefly your experience/activities under the following heads, including the positions held, if any:

(a)

University administration

(b)

Extra-curricular activities of students

(c)

Residential life of students

1. Knowledge of languages, including Indian languages: (Underline mother tongue and indicate examination(s) passed, if any)
   
   
   1. List of Enclosures:
      
      
      1. Copies of Mark-sheets & certificate of educational Qualification : Yes/No
         
         
      2. Copies of other relevant certificate & documents : Yes/No
         
         
      3. Bank Draft : Yes/No
         
         

Bank Draft No. _____________________ Bank Draft Date __________

Bank Name ________________________ Branch _____________________

6. DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby declare that the information given by me in the Application is true, complete and correct to the best of my knowledge and belief and that nothing has been concealed or distorted. If at any time, I am found to have concealed / distorted any information or given any false statement, my application/appointment shall liable to be summarily rejected/terminated without notice or compensation.

Date: Signature of the Applicant Place:

Note: i. Candidates are required to enclose copies of Mark-Sheets & Certificates of Educational Qualification.

ii. Documentary Evidence in favour of other items mentioned above.

RABINDRA BHARATI UNIVERSITY Emerald Bower Campus: 56A B. T. Road, Kolkata-700050 Jorasanko Campus: 6/4 Dwarakanath Tagore Lane, Kolkata-700007 PHONE: (033) E. B. Campus: 2557-1028/3028/4028/7161, J. S. Campus: 2269-5241/5242/6601/6610 Website: www.rbu.ac.in e-mail: registrar.rbu@gmail.com

APPLICATION FORM (FOR RECRUITMENT)

Received an application from ______________________________________________________ for the post of ___________________________________________________________________

Superintendent / Receiving Assistant