Application Form

Sep 30, 2014 - APPLICATION FORM. (TO BE FULLY TYPED IN CAPITAL LETTERS). 1. Advt.No. : R&D/93. 2. Post applied for: ... 5. Date of Birth: (dd/mm/yyyy) ...
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1. Advt.No. : R&D/93 2. Post applied for:

2. (a) Post Code:


3. Name of the applicant: ____________________________________________________________________ 4. Father’s/Husband’s Name: _________________________________________________________________ 5. Date of Birth: (dd/mm/yyyy) _____________Day _______________ Month ____________________ Year 6. Age as on 30.09.2014: ____________Days ____________ Months __________________________ Years 7. Nationality: _________________ 8. State of Domicile (state belongs to): ___________________________ 9. Category (SC/ST/OBC/PH (if PH, indicate degree of disability): _____________________________________ 10. Sex (Write M or F): ______________________________________________________________________ 11. Complete Correspondence Address: __________________________________________________________ ______________________________________________________________________________________ District: ___________________________ State: _____________________Pin ______________________ 12. Interview Centre in case of Preliminary Interview (Delhi/ Mumbai/ Kolkatta/ Bangalore):________________ 13. Qualification (Secondary School onwards): Name of Exam. Passed

Name of Institute/University

Duration of Course

Full Time/ Correspondence

Date of Passing

Major Subjects

# Percentage of marks obtained (cumulative of all semester/years)

# in case of CGPA/OGPA or Grade, mention equivalent percentage of marks as per University / Institute norms. Percentage of marks not to be rounded off. 14. Date of Successful defense of Ph.D (Mandatory for candidates with Ph.D): ____________________ 15. Date of completion of M.Tech degree (Mandatory for candidates with M.Tech): ____________________


16. Work Experience: Name & Address of the organization/employer

Post held


Period To

Nature of Job (in detail)

Salary drawn

Reason for leaving

17. M. Tech Dissertation/ Ph. D Thesis Topic*: Name of Guide: * Elaborate thesis/dissertation details (Ph.D/M.Tech.) with name of the guide should be provided as enclosure (Mandatory). 18. Demand Draft details: Draft No.____________ Date of Issue ____________ Issuing Bank _________ 19. Whether Applied Earlier: If Yes (State Advertisement No. & Post) 20. E-mail id : ___________ 21. Phone No. : ___________ 22. Source of Advertisement: ________________ (Name of Newspaper or Journal or Website or Other sources I hereby declare that the above information is true to the best of my knowledge. I understand that my candidature will be cancelled, if the information is found to be false or incorrect or my application is incomplete.

Place & Date: ________________________


Signature: ______________________