No. of ad& date __dvertisemen___________nt _____________________ ___

Post applied for with discipline -

_________________

DD.D. No. __________________

AAmount ___________________

CClosing date _______________

1. Naame in fulll (in Block letters)

2. Adddress: a) Presennt

b) Perrmanent

c) Email ID

d) Telephhone No.

3. Poost appliedd for

4. DDate and place of birth: (i) Date :

(ii) Place :

5. AAre you* (a) a citizen of IIndia by birth and/oor by domicile? YES/NO

OR

(b) a person haaving migrrated from Pakistan or YES//NO

Baangladesh or other countries wwith the inten-

tioon of permmanently settling inn India or a

suubject of Nepal?

6. Naame of the State to wwhich you bbelong.

7. Fathers Name :

Adddress :

Occcupation :

8. Is (orr was) your father:

(a)

(b)

other counttries with the intentiion of permmanently ssettling

inn India or a subject of Nepal?

9. Statte your (a) Reeligion

(b) Arre you a mmember of SSchedules Caste or TTribal YEES/NO

or Aborigginal Commmunity or BBackward Class?

Answer Yess or No aand if the aanswer is Yes

giive particuulars and aattach a ceertificate from the

Regional Authoritiees in support of yourr claim.

(c) AAre you an Anglo Indian? YES/NO

(d) AAre you physically haandicappedd? If yes, ggive YEES/NO

details

10 . Passsport No. if any, :

11. PAN no. if anny, :

12.

Particulars of all Examinations passed and degrees and technical qualifications obtained at the University or other places of higher technical education (Enclose all relevant documents commencing with the Secondary or equivalent examination.)

Examination/

Degree/ Diploma

Name of Board/ University

Percentage of Marks obtained

Class or

Division obtained

Major subjects taken

Year of passing

13.

Any additional qualifications such as membership of

Scientific Societies may be mentioned here

14.

Have you been outside India? If so, give following particulars:

Country visited

Date of visit

Duration of visit

Purpose of visit

15.

If you are /were a full time researcher, give the following particulars:

(Please attach testimonials)

Name of the Institution

Date of Joining

Date of Leaving

Area of research

Stipend/

Scholarship

No. of papers published

16.

What language (including Indian Languages) can you read, write or speak. Give particulars and state any examinations passed in each language.

Read only

Speak only

Read & Speak

Read, Write and Speak

Examination passed

`

17.

Details of previous employment. Give particulars below along with testimonials.

Name of Organization

Date of Joining

Date of Leaving

Designation & Nature of work

Salary & Grade

18.

Are you employed in a Govt./PSU/ Autonomous organization at present? (Answer Yes or No. If Yes, the application has to be routed through proper channel)

19.

Are you willing to accept the minimum initial pay offered? If not, state what is the lowest initial pay that you would accept in the prescribed scale

20.

If selected, how much time would you require to join? (Give tick mark)

Immediate/one month/

Two months/three months

21.

Choice of Examination Centre (Tick the preference)

1) Kolkata 2) Mumbai

3) Delhi 4) Bangalore

22.

Willingness to work anywhere in India:

23.

Reference:

(They should be residents in India and holders of responsible positions. They should be intimately acquainted with the applicants character and work but must not be relations. When the candidate has been in employment, he/she should either give his/her present or most recent employer or immediate superior as referee or produce testimonial from him/her in regard to the candidates fitness for the post for which he/she is an applicant)

(i)

Name

:

Occupation or position

:

Address with e-mail

:

(ii)

Name

:

Occupation or position

:

Address with e-mail

:

(iii)

Name

:

Occupation or position

:

Address with e-mail

:

24.

List of enclosures:

1.

4.

2.

5

3.

6.

Date-------------------------------- Candidates signature ----------------------------

Candidate already employed should get the following endorsement signed by his/her present employer.

ENDORSEMENT BY THE HEAD OF THE DEPARTMENT OR OFFICE

No.---------------------------------- Date ----------------------------------------------

Full signature -------------------- Designation --------------------------------

Name & Address of Office with seal .

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