Application form (Non-Teaching Positions)

For Contractual Engagement only

Applied for the post_________________________ Sl. No_____Under Category________ Advt. No. 4/2013-2014 (Contractual)
1

2
3

Full Name (Use Capital

Letters)

__________________________________________________________

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__________________________________________________________

Fatherss/Husband Name

__________________________________________________________

Mothers Name

__________________________________________________________

Affix Passport
size Photograph

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Address (Correspondence) _________________________

Address (Permanent) _________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

Mobile__________________Telephone_______________

Mobile__________________Telephone_______________

e-mail__________________________________________

e-mail__________________________________________

Date of Birth: ________________________________

Write your:

Place of birth:________________________________

Sex : Male/Female ______________________________

Age on the last date of this advertisement

Category: Gen./OBC/SC/ST_________________________

Years ________Months__________Days_________

PWD: VH/OH/HH________________________________

Marital Status : Married/Unmarried___________

8.

Academic Qualification (Commencing with the High School or an equivalent examination.

Examination/Degree

Board/College/
University

Passing year

Division
with %

Nationality____________________________________

Distinctions

Subject

9. Research Degrees
Degree

University

Specific date of
submission of thesis

Specific date of award

Title of the thesis

10. Appointments held (Work/teaching experience)

Employer*

Status of
Institute/University

Post held

Type of
employment

Salary (grade,
if any)

From

To

Reason for
leaving

Employer- Current working place, Type of Employment; Whether it is Permanent/Contract/Ad-hoc, Daily-wage or any other.
MKS

11. Prizes/Awards/Medals:
12. Extracurricular Activities (if any)
13. Have there any break in your academic career; if so, give detail.
14. Have you ever been punished during studies; if so, give detail.
15. Do you have any case pending against you in court of law; if so, give detail.
16. Declaration by the candidate
I hereby declare that the entries in this form are correct and true to the best of my knowledge and belief. If at any time, I am found
to have concealed/suppressed any material/information or given any false details, my appointment shall be liable to be summarily
terminated without notice or compensation.

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Date_________________
Place________________

Signature of the Candidate

(Name:____________________________________)

18. If already in service whether on permanent/contract/daily wage basis, please send your application, duly forwarded by current
employer
Forwarded from the current employer/ orZeku

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Forwarded with the remark that the institution/Organization has no objection to the candidature of the applicant being considered
for the post applied for, as above.

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Date_________________
Place________________

MKS

Signature of the competent authority with seal