JSSAcademyofHigherEducation&Research
(Deemed-to-be-University)
AccreditedA+GradebyNAAC SriShivarathreeshwaraNagar,Mysuru-570015,Karnataka,India.
PhoneNo.:0821-2548392/93 FaxNo.:0821-2548394,mail: registrar@jssuni.edu.in web:www.jssuni.edu.in
No.________
Applicationforthepostof:_______________________________________
A. NameinFull(inblockletters):
Father/HusbandName: D D M M Y Y Y Y
DateofBirth :
Nationality : Religion:
Caste : Sex:
MartialStatus : Homestate:___________________
Affixrecent passportsize photograph Married Unmarried
MotherTongue:
B.Address : _____________________________________________________________________________ _____________________________________________________________________________
PinCode:__________________Phone/MobileNo.:_________________________________
E-Mail:_______________________________________________________________________
C.EducationalQualifications (Pleaseattachonesetofattestedcopiesalongwiththisapplication) Examination passed University Board Duration Class& percentage Specialization From To
E.WorkExperience (Pleaselistyourpreviousemploymentdetailsstartingwiththelatest)
F.languagesknown (Ticktheappropriatebox)
G.IndicateyourwillingnesstoworkanywhereinIndia/abroad
H.ListofEnclosures:
Iattachattestedcopiesoftheabovecertificates/degrees,insupportofage,category, qualificationandexperienceetc.
I.ApplicationFeesRs.________ ReceiptNo./DDNo.____________date____________ (Receipt/DDshouldbeenclosedwiththeapplication)
Declaration:-Theinformationgivenaboveistrue&correcttothebestofmyknowledge.
Place:
Date: (Nameandsignatureofthecandidate)