Advertisement No: .................................. ........................................................ Date: .......................

Name of the post applied for: ..........................................................................

Name of the Department in which post applied for: .........................................................................................

Directions: Please use Capital Letters & write clearly. Use separate Forms for applying to two or more posts.

A. PERSONAL
NAME
SEX	Male/ Female	DATE OF BIRTH	dd/mm/yyyy
CATEGORY	Gen/ SC/ ST/ OBC/ PC	NATIONALITY	Indian/
Fathers Name
Mother s Name
RELIGION	(For Government Statistical Report only)
EMERGENCY CONTACT DETAILS	Phone: Mobile:
B. COMMUNICATION INFORMATION
	MAILING ADDRESS		PERMANENT ADDRESS
PLOT/HOUSE NUMBER
ROAD
TOWN OR CITY
DISTRICT
STATE
PIN CODE
PHONE NUMBER CELL NUMBER	STD code: No: FAX:
EMAIL

C. ACADEMIC
Exam Passed	Name of Institution & University/Board	Subject &/ Thesis Title	Degree/ Examination	Year	Marks %
Ph.D. or Equivalent
NET
SLET
M.Phil/ M.Tech/ equivalent
M.Com/ M.A./ M.Sc./ B.Tech/ equivalent
Special Paper
B.Com/ B.A./ B.Sc./ equivalent		MAJOR
10+2 or equivalent
Matric or eqvivalent
Certificates/ Diplomas

D.

Total number of years of work experience: years

D. WORK EXPERIENCE
Designation	Employer	Pay Scale	Total Emoluments p.m. (Rs.)	No. of Years (From To)
1
2
3
4
5
6
7
8

If required, attach additional table in same format. Please Tick : Attachment: Yes/ No

E. Did you represent India or your State in any Game or Sport? Yes/ No

If Yes, name the Game or Sport ....

F. Important Awards, Patents, Scholarships, prizes and other distinctions obtained
Name of Award & Institution	Year	Reason for Award

G. Any other information on why you should be considered for the post:

H. Names & Addresses of two Referees
Name:	Name:
Address:	Address:
City: PIN:	City: PIN:
Phone:	Phone:
Email:	Email:

DECLARATION

I hereby declare that, the information furnished above is true to the best of my knowledge and belief. Further, I hereby declare that no criminal / vigilance case is pending / contemplated against me and I have never been punished or any disciplinary action has been taken by in any court of law / the organization I have been working/have worked.

Date:

Place: Signature of Applicant

Enclosures with the Application Form

1. Birth Certificate photocopy

2. SC/ST/OBC/PH Certificate photocopy, if applicable

3. Photocopies of Degrees & Mark Sheets, experience/publication etc.

GENERAL

Please write how you can contribute to the Department and the University in its academic activities

(not more than 150 words):

Date: Signature of the applicant

Annexure - I

(On the letter head of the University/Institute)

Applicable for those candidates registered for Ph.D. Programme prior to 11th July, 2009

TO WHOMSOEVER IT MAY CONCERN

This is certify that Dr. _______________________________________(Name) registered for Ph.D programme on _______________________ (Date) has successfully completed Ph.D. programme in the Subject __________________________________________, Faculty of _________________________________________during the year . The Ph.D. degree awarded to him/her is essentially fulfilling the following conditions:

a) Ph.D. degree has been awarded in regular mode only;

b) Ph.D. thesis has been evaluated by at least two external examiners;

c) He/She has published two research papers out of which at least one in a refereed journal from out of his/her Ph.D. work;

d) He/She has presented two papers in seminars/conferences from out of his/her Ph.D. work;

e) Open Ph.D. viva-voce of the candidate has been conducted

Seal & Sign of the Vice-Chancellor/

Pro-Vice Chancellor/

Dean (Academic Affairs/University Instructions)

No....................................

Date: ...............................

Annexure - II

(On the letter head of the University/Institute)

Applicable for those candidates registered for Ph.D. Programme prior to 11th July, 2009

TO WHOMSOEVER IT MAY CONCERN

This is certify that Dr. _______________________________________(Name) registered for Ph.D programme on _______________________ (Date) has successfully completed Ph.D. programme in the Subject __________________________________________, Faculty of _________________________________________during the year . The degree has been awarded strictly in compliance with UGC (Minimum standards and procedure for awards of M.Phil/Ph.D. degree) Regulation 2009, and I/we have the read the regulations & certify accordingly.

Competent Authority of

the University/Institution

No....................................

Date: ...............................