Application Form 1.
Post applied for ....................................................................................................
2.
Name in full (In Block Letters) Mr./Miss./Mrs........................................................................................................
3.
Gender:
4.
Marital Status: Married
5.
Category : GEN
6.
Father’s / Husband’s name..............................................................................................................
7.
Date of birth (According to high school/ metric certificate)………………………………………
8.
Age as on 28-12-2023
Male
Female
Years
Unmarried
OBC
Affix signed recent passport size photograph
SC/ST
Month
Any other
Days
9. Address: 9.1 Correspondence ................................... ...................................... ............................... ................. ...... ............ ................................. ........................ ............................ .............................. ......... .......... ....... ... ...... .............. .......... ................. ................. .................... ............... Pincode .............. ........ Tel./ Mobile No..................................................... Email....................................................................... 9.2 Permanent ......................................................................... ....................................... ................. ........ ............... ....................................................... ...................................................................... ................. ....................................................................................................... Pincode ........................ Tel./ Mobile No..................................................... Email....................................................................... 10. Educational/ Professional/ Technical Qualifications (Commencing with Highest qualifications upto matriculation/ 10th Board) Exam Passed
Division / Grade and % age of Marks
Year of passing
Duration of the Degree/ Diploma
1
Board/ University
Subject (S)
11. NET/GATE qualified If yes (Attach Proof and details ): 12. Details of employment (beginning with the latest):Organization
Post held
Exact dates to be given Date of joining
Date of leaving
Total period (in years)
Nature of duties
13. No of Research Papers (If any) Attach detail List and first page of Paper: 14. list of enclosures:…………….
DECLARATION I hereby declare that the statements made in the application are true, complete and correct to the best of my knowledge and belief and in the event of any of the information being found false or incorrect or any ineligibility being detected before or after the selection, my candidature is liable to be cancelled at any stage of Selection/appointment and action initiated against me.
Place............................... Date..................................
Candidates Signature………….. 2
Full Name………………………
3