RSM 39-5

Page 1

htus„th rþûtý y™u

‚iÞth yhS…ºtftu Ërn‚ Ëhfthe y™u yÄo-Ëhfthe ™tufhe™e ònuht‚tu Ë{tð‚wk ™tufhe ðtkåAwytu™u W…Þtu„e Œh þ™ðthu ™ÞÂ{‚ he‚u «rËæÄ Út‚wk ËtÂÂtnf.

RNI Regd. No. : GUJGUJ / 11750 / 06 / 01 / 2006 Postal Reg. No. : GRJ-540 Valid upto 31.12.2012, Posting from RMS Office Rajkot on every Saturday

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Post Applied for Name (in block letters) Category (General / SC / ST / Physically Handicapped / Ex-Servicemen) Date & Place of Birth

2. 3. 4. 5.

Address for Correspondence (with Phone No. and Email ID) Permanent Address

8. 9.

Board / University

Stream

Year Passing

of

Division

16. Signature with Date

I hereby certify that the fore-going information is correct to the best of my knowledge and belief. I have not suppressed any material fact or factual information in the above statement. In case I have given wrong information or suppressed any material fact or factual information, then my services are liable to be terminated without giving any notice or reason thereof. I am not aware of any circumstances which might impair my fitness for employment under Government.

15. Any other relevant information

14. References

Scale of Pay and total salary drawn per month

Percentage of marks obtained

12

13. Have you been called for interview in past? If yes, provide details

12. Work Experience (in chronological order starting from present position backwards) Name of the Designation Nature of work Period organization in detail From To (DD/MM/YY) (DD/MM/YY)

Exam Passed

11. Qualifications (SSC onwards) Date of release of Mark sheet

Marital Status

7.

10. Nearest Railway Station

Nationality

6.

(35 years and relaxable by 5 years for SC / ST candidates, 3 years for Other Backward Class and 10 years for Physically Handicapped.)

Advertisement No. and Sl.No. of the Post

1.

APPLICATION FORMAT

Affix your recent passport size photograph here

INSTITUTE FOR PLASMA RESEARCH

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htus„th y™u rþûtý {t„oŒþo™ * ÷ðts{™t Œh * ðtŠ»tf (50 ykf) - 400-00 Yt. yÄoðtŠ»tf (25 ykf) - 200-00 Yt. rºt{trËf (12 ykf) - 100-00 Yt.

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H] G F V\ S M D[ / JJF DF8[ ,MU VMG SZM o www.jitesh-yadav.blogspot.com


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