APPLICATION FORM FOR DEPUTY DIRECTOR EXAMINATION POSITION

Advt. No. ..Date ..

Draft No. ____________________ Date ______________________ Amount_________________

1. Name in Full :

(in block letters) (as indicated in secondary school certificate)

1. Date of Birth : (DD/MM/YY)
   
   
2. Nationality :
   
   

1. Category (General/ SC/ST) :
   
   
2. Sex (Male/ Female) :
   
   
3. Marital Status (Married / Unmarried) :
   
   

1. Fathers Name/ Husbands Name :
   
   
2. Address for Correspondence :
   
   

(with email, fax & phone)

1. Permanent Address :
   
   
2. Academic Qualifications :
   
   

(from HSC onwards)

Sl No	Exam passed	University/ Board/ Institution	Month/ Year of passing	Subjects	Specialization	% of Marks/ CGPA*	Division	Rank/ Position
				In which degree awarded	If any
1
2
3
4
5
6

*

Please specify the percentage of marks upto two decimal place

*

In case of CGPA / CPI, please give marks in percentage along with the conversion formula

*

Enclose the Xerox copies of all the certificate, testimonials, and two recent color passport size photographs Separate sheets / certificate may be attached if, required.

1. Professional Training :
   
   
2. Employment Records :
   
   
3. Experience details pertaining to examination work:
   
   
4. Awards / Honours received
   
   
5. Other Academic Activities (Curricular/ co-curricula/ Examination/ Hostel/ Sports/ NSS/ NCC/ Scouts etc) :
   
   
6. Administrative Experience:
   
   
7. Have you been interviewed by any University during past year ? give detail
   
   
8. Any other information in support of your candidature :
   
   
9. Name of the two referees : Address/ Tel/ Email
   
   
10. Declaration :
    
    

Organization		Period			Training Area
	From			To

2

Name &	Period of service		Designation	Scale Pay	of	Work Description	Reason of leaving	Total period of employment
address of employer/ inst.	From	To

Name & address	Period of service		Designation	ScalePay	of	Work Description	Total period of employment
of employer/ inst.	From	To

	No. of Awards/ Honours	Year	Detail
International
National
State
Professional bodies
Any other

Sl. No.	Name of the activities	Date of activities held	Remarks
1
2

Sl. No.	Name of the organization / department	Post held	Remarks
1
2
3

Sl. No.	Name of the post & discipline	Date of interview	Result/ remarks
1
2
3

3

I declare that the foregoing information is correct to the best of my knowledge and belief and nothing has been concealed / distorted. If any time, I am found to have concealed / distorted any material information, my appointment shall be liable to summary termination without notice. I will, if and when required, take up duty in the discharge of Government assignment anywhere in India.

Place : Date : Signature of Candidate