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Annexure-I DMRC Web site:www.dmrcjodhpur.nic.in Email :
[email protected]
DESERT MEDICINE RESEARCH CENTRE (Indian Council of Medical Research) New Pali Road, Jodhpur – 342005
APPLICATION FORM FOR THE POST OF SCIENTIST ‘D’ MEDICAL Note: 1. All answers must be given in words and not by dashes and dots. 2. No columns should be left blank.
Name of the post applied for_______________________________________________________ Scale of Pay____________________________________________________________________ Name of the Institute/Centre: Desert Medicine Research Center, Jodhpur________________ Demand Draft No.______________________________ Date____________________________ Name of the Bank:__________________Amount______________________________________ 1. Name in Full: Mr/Ms/Dr._____________________________________________________ (IN CAPITAL LETTERS) _____________________________________________________________________________ 2. Gender:__________________________________________________________________ 3. Father/Husband Name:_______________________________________________________ 4. Mother Name: ______________________________________________________________ 5. Address i) Present:___________________________________________________________ __________________________________________________________ __________________________________________________________ (ii) Permanent:_________________________________________________________________ __________________________________________________________ __________________________________________________________ (iii) Contact Telephone No.________________& Mobile No. ____________________ (iv) Email: ______________________________________________________
Affix recent Passport Size Photograph duly signed
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6. Date of Birth: (In words)_____________________________________________________ 7. Marital Status: Married/Un-married: __________________ 8. Nationality:___________________ 9. Are you a member of Scheduled Caste/Scheduled Tribe/OBC/Aboriginal Community/PH/Ex-servicemen (Answer: Yes or No):__________ If the answer is Yes, give particulars and attach a certificate in prescribed format for appointment to the post of Government of India. _________________________________________________________________________________ _________________________________________________________________________________ 10. Particulars of all examinations passed and degree and technical qualifications obtained (commencing with the Matriculation or equivalent examinations). Attach attested copies of all certificates. Examination or Degree obtained 1.
Name of School /College
Name of Board /University
Year of Passing
Subjects
Class / Merit/ Division Position & Percentage
Matric
2. 10+2/Pre-Med/ Pre- Engg. 3. M.B.B.S. 4. MD/DNB 5. Ph.D. 6. Any other Exam. (Please specify) 11. If registered for M.D/Ph.D. degree, give details:
i. ii. iii. iv.
Degree for which registered: Subject of thesis: Date of registration: When degree is likely to be awarded:
12. Any, additional qualification or Major Achievement may be mentioned here or on separate sheet.
3 13. What language(excluding Indian languages) can you read or speak. State any examination passed in each: Read only
Speak only
Read and speak
Examination passed
14. Give particulars of Employments held in chronological order, starting with latest job (Attach experience certificate of employer): Sr. Name & Address of Post Held Salary Total Nature of work Date of No. Employer/Institution by (excluding Duration performed or Applicant allowances) being perform Joining Leaving Y M D last drawn & scale of pay 1. 2. 3. 4. 5.
15. Published Papers in Journals (Attach attested copies of all): Sr.No. Name of ISSN/ Title First Author/ Whether Journals ISBN Corresponding Indexed or No. Author/ not? Co-author 1. 2. 3. 4. 5. 6.
Indexed With
Impact Factor
No. of Citation
4 16. Extra-Mural Grants: Grant from DBT,DST,ICMR,CSIR, Industry or any other National or International Agency during the last 5 year should be considered Sr. No.
Title of duration
Project
& Funding Agencies
Amount
Level of Participation PI
Co-PI
Coordinator etc.
1.
2.
17. Awards received (National/International Recognition etc.)(Attach attested copies of all): Sr. No. Name of Award/Fellowship Number of Award/ Year Awarded by/Name of Membership/Fellowship Journal Any National Award 1. (ICMR/DBT/CSIR/DST, etc.) 2.
Membership of Editorial Board Journals of impact factor greater than 1
3.
Fellowship of National Academies (NAMSC, MNASI)
4.
Other (Please specify)
18. Research Guidance : Sr. No.
Guidance as Supervisor
Ph.D/MS/MD /MPH
Co-Supervisor
Number Enrolled
Thesis Submitted
Degree Awarded
5 19. Checklist for document should be enclosed (Please tick in the box): 1. Proof of Date of Birth 2. Educational Qualification 3. Experience Certificates/Testimonials 4. First page of all Published Papers in Journals 5.All Award/Grant Received Certificate 6. ID Proof 7. Other (Please specify) 20. Has the candidate applied earlier for any post in the Council or elsewhere? If so, give details.
21. References: (These should be persons, resident of India and holders of responsible position. They should be intimately acquainted with the applicant’s character and work, but must not be relatives. Where the candidate has been in employment, he would either give his present or most recent employer or immediate superior as a reference or produce testimonials from him in regard to the candidate’s fitness for the post for which he is an applicant. At least Two Testimonials obtained from these referees be attached to the application form). Sr. No. 1.
Name
Occupation/Position Address
E-mail id
Mobile Number
2.
DECLARATION 1. I hereby declare that the entries in this form and the additional particulars, if any, furnished herewith are true to the best of my knowledge and belief. 2. I have informed my Head of Office/Department in writing that I am applying for this post and shall produce "No objection" certificate at the time of the interview. Signature of Candidate Place:
Date:
(Name of the Candidate)
6 CERTIFICATION BY THE EMPLOYER/CADRE CONTROLLING AUTHORITY The information/details provided in the above application by the applicant are true and correct as per the facts available on records. He/ She possesses educational qualification and experience mentioned in the advt. If selected, he/she will be relieved as per rules: Also Certified that: i) There is no vigilance or disciplinary case pending/contemplated against Shri/Smt.________________________ ii) His/her integrity is certified. iii) No major/minor penalty has been imposed on him/her during last 10 years Or A list of major/minor penalties imposed on him/her during last 10 years is enclosed (as the case may be )
Dated:
__
Countersigned (Employer/Cadre Controlling Authority with Seal)
7 GENERAL CONDITIONS 1. Application received after the closing date for whatever reason is liable to be rejected. 2. If the fact that false information has been furnished or that there has been suppression of any material information in the application form comes to notice at any time during the service of a person, his service would be liable to be terminated. 3. Application not signed by the candidate is liable to be, rejected 4. The candidates who are employed should submit a ‘No Objection’ certificate from their employer at the time of interview. In case they do not furnish the same for some reasons or other, their candidature will straight away be rejected and they will not be entitled to any claim including T.A. from the Council. 5.
The candidates must attach all the relevant documents
6. The number of vacancies to be filled may vary at the time of actual selection. In the event of non-availability of suitable candidates for the advertised posts, the positions can be filled up at lower level. Allowances as per Central Government rules are admissible on the prescribed pay scales. Benefits of new restructured defined contributory Pension system are admissible as per the provision contain need in the Ministry of Finance, Department of Economic Affairs (ECD & PR Division), Notification No.5/7/2003-ECD & PR dated 22.12.2003 effective from 1.1.2004. 7. Candidates called for interview for the post of Scientist-D will be paid 1st class/III AC rail fare by shortest route on production of documents. No TA/DA is admissible for joining the post or on termination of appointment. 8. Demand Draft of Rs.500/- (Rupees five Hundred only) payable in favour of “The Director, Desert Medicine Research Centre, payable at Jodhpur should be enclosed along with application and should reach to this office on or before closing date. The SC/ST/Women/physically handicapped candidates (PH) and Ex-Serviceman are exempted from the application fee. All other / ICMR employees are not exempted from the payment of application fee. On the over leaf of demand Draft, the candidate must mention his/her name and post applied for. Fee once paid will not be refunded under any circumstances. Any other mode of payment viz. cash, money order and cheque will not be accepted. 9. Application from employees working in Centre/State Government Department/Public Sector Undertakings & Government funded research agencies must be forwarded through proper channel along with the certificate of the employer that the applicant will be relieved within three months of his/her receipt of appointment orders. Advance copies of application will be considered subject to the conditions that a ‘No Objection Certificate’ from the employer is produced at the time of personal discussion. Application received after the closing date will not be considered. Candidates called for personal discussion/interview have the option to answer in Hindi. 10. Since it is not possible to call all the eligible candidates for the Interview/Personal Discussion, the applicants will be short-listed for this purpose. The decision of the Director General, ICMR/Director DMRC will be final in this regard. Any canvassing by or on behalf of the candidates or to bring political or outside influence with regard to selection/recruitment shall be treated as disqualification. (Guidelines for the selection of Scientist-D are available at ICMR website – https://icmr.nic.in/circular/2017/154.pdf). 11. Any Addendum/Corrigendum in respect of above vacancy notice shall be issued on our websites www.dmrcjodhpur.nic.in . Applicants are requested to regularly visit our website to keep themselves updated. 12. The envelope containing applications should be super scribed – Application for the post of Scientist ‘D’. 13. Last Date for submitting completed applications in hard copies 13 th August 2018 up to 5:30 pm.
(For further Information/Details please see DMRC’s Website: www.dmrcjodhpur.nic.in)
