Page 1 of 10

FOR USE OF CASHIERAmount_________________

Date____________________

FORM NO._______________

GOVT. ENGINEERING COLLEGE BIKANER

(An Autonomous Institution of Govt.of Rajasthan)
Karni Industrial Area, Pugal Road, Bikaner

APPLICATION FORM FOR APPOINTMENT

Name of the Post applied for:___________________________________________
Department / Field of Specialization:_____________________________________
Advertisement No. ___________________________________________________
D.D. / IPO No.___________________
Dated:__________________________
Bank Name:_____________________

FOR OFFICE USE ONLY

Form Received on: ____________
Registration No. : _____________

PART-1 : PERSONAL INFORMATION

1. Name (In Block Letters) : ___________________________________
2. Fathers/Husbands Name : __________________________________

Recent

3. Date of Birth : ____________________________________________

Self Attested

4. Place of Birth : ____________________________________________

PHOTOGRAPH

5. Age (As on 1st July of the Year) : _____________________________

6. Sex (Male/Female) : ___________ 7. Marital Status :_____________
8. Nationality: _________________ 9. Religion: __________________
10. (a) Do you belong to Scheduled Cast/Schedule Tribe/Physically Handicapped ? YES/NO (Proof
Enclosure No.

(b) Do you belong to Other Backward Class of Rajasthan? YES/NO (Proof Enclosure No.

11. Address:
For Correspondence:___________________

Permanent Address:___________________

____________________________________

___________________________________

____________________________________

___________________________________

PIN Code:__________Tel.No. ___________

PIN Code:__________Tel.No. __________

Page 2 of 10

PART II : ACADEMIC ACHIEVEMENTS

12. Academic Qualifications (Secondary School Examination Onwards)
Examination/

Board/

Subjects/

Year of

Division/

Marks

Proof Encl.

Degree

University

Specialization

Passing

CGPA

in %

No.

High School/
Secondary School
Exam.
Sr. Secondary
School Exam.
B.E. / B. Tech/ B.
Arch. / B.Sc./B.A.
M.E. / M. Tech/
M. Arch. /
M.Sc./MCA/M.A.

Ph.D.

Others

13. Have you, as a student, participated during co-curricular events/conferences/symposia? If so, give details:
____________________________________________________________________________________
____________________________________________________________________________________
14. Have you been punished during your studies at College/University? If so, give details with reasons:
____________________________________________________________________________________
____________________________________________________________________________________
15. Have you, as a student, been recipient of any scholarship/reward/honor? If so, give details thereof:
____________________________________________________________________________________
____________________________________________________________________________________
16. Any other information about your academic achievement, as a student, that you may like to give:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Page 3 of 10

PART III : PROFESSIONAL ACHIEVEMENTS

17. Details of appointments (in chronological order):
(A) Teaching & Research Appointments:
Post Held

Organization

Pay Scale/
Annual
Emoluments

Period
Basic Pay

From

To

Proof Encl.
No.

To

Proof Encl.
No.

(B) Industrial Field Appointments:

Post Held

Organization

Pay Scale/
Annual
Emoluments

Period
Basic Pay

From

18. Have you been punished during your service or, convicted by court of Law? If so, give details:
____________________________________________________________________________________
____________________________________________________________________________________
19. Were you, at any time, declared medically unfit or discharged/dismissed from service? If so, give details:
____________________________________________________________________________________
____________________________________________________________________________________

Page 4 of 10

20. Academic Achievements:

(A) Other Participation/Experience:
(i) Participation in production of Educational Programmes (If yes, give details):________________
___________________________________________________________________________________
___________________________________________________________________________________
(ii) Conducting Short Term/ Continuing Education/ Specialist courses (If yes, give details):_______
___________________________________________________________________________________
___________________________________________________________________________________
(B) Courses developed (Nos.): Under-Graduate _______________ Post- Graduate_________________
(C) Publication (in numbers):
No.

Description

(i)
(ii)
(iii)
(iv)

No. of Authors

Published

Accepted

Communicated

Remarks

Papers in Referred Journals:

Papers in Conferences/Symposia:
Books:
Review/Research/Feasibility Reports:

(D) Thesis Supervision (in numbers):

No.

Description
(i)
(ii)
(iii)

Awarded

Submitted

In progress

Remarks

Ph.D.
M.E./M.Tech./M.Sc.
Others

(E) Sponsored Research/ Consultancy:

S.No.

Name of Project

Completed

In progress

Remarks

Page 5 of 10

(F)

Special Training/ Assignments/ Others Information: _________________________________________

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

(G)

Membership/Fellowship of Professional Societies/ Bodies: ___________________________________

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

PART- IV : OTHER ACHIEVEMENTS

21. Administrative Responsibilities Held:
Period
S.No.

Position Held

From

To

Nature of Responsibility

Page 6 of 10

PART V : GENERAL INFORMATION

22. Give name, designation, and addresses of at least three referees, not related to you but. well acquainted
with your academic performance and conduct :
(a) _____________________________________
(b) ______________________________________
________________________________________

_________________________________________

________________________________________

_________________________________________

PIN Code ____________ Phone _____________

PIN Code ____________ Phone ______________

(c) _____________________________________

(d) ______________________________________

________________________________________

_________________________________________

________________________________________

_________________________________________

PIN Code ____________ Phone _____________

PIN Code ____________ Phone ______________

23. Name and Address of your Present employer

24. Present Pay-Scale ____________________

________________________________________

25. Present Basic Pay ____________________

________________________________________

26. Other Allowances ____________________

________________________________________

27. Total Emoluments ____________________

PIN Code ____________ Phone _____________

28. Date of Increment ____________________

29. Nature of post you presently hold : Permanent/Temporary/Ad-hoc/Contract Appointment.

30. Is minimum basic pay; in the pay scale offered,
acceptable to you? If not, your expectation :
31. If appointed, what notice of time will you require to join the post?
32. Is there any information you wish to give? (Attach extra sheet)

DECLARATION TO BE SIGNED BY THE CANDIDATE

I, ___________________________________ hereby, declare that the information given by me in this form is
true to the best of my knowledge and belief. If, at any time, I am found to have concealed any material
information, or given any false details, my candidature/ appointment may be summarily rejected /terminated
without any notice or compensation.
_____________________________
Signature of the Applicant
Place: _______________________

Address: _____________________________

Date: ________________________

______________________________
______________________________

Page 7 of 10

CERTIFICATE FROM THE EMPLOYER

(This certificate must be signed by the Head of Department/ Employer in case of the candidate already in
service whether in permanent of temporary capacity)

No. ______________________________

Dated: __________________

Forwarded, Shri/Smt./Dr. _________________________________ bearing the designation

of _________________________________, holds the post in our Institution/ Organization in permanent /
temporary capacity.
He / She, at present, draws the basic pay of Rs_______________ per month in the pay-scale of
Rs __________________.
This Institution / Organization has no objection to the candidature of the applicant being
considered for appointment to the post applied for in this application.

Place:____________________________
Date: ____________________________

____________________________________
Signature of the forwarding Authority
Name__________________________
Designation_____________________
Seal of the Institution / Organization

Page 8 of 10

GOVT. ENGINEERING COLLEGE BIKANER

(An Autonomous Institution of Govt. of Rajasthan)
Karni Industrial Area, Pugal Road, Bikaner
BRIEF PARTICULARS OF THE CANDIDATE

1.Name : Shri/Smt./Km./Dr. _____________ 4. Present Pay Scale __________

2. Date Of Birth: ___________________
3. Age
________________________
7. Qualification:
Examination/
Degree
%
High School/
Secondary
School Exam.
Sr. Secondary
School Exam.
B.E./B.Tech./
B.Arch./B.Sc.
/B.A.
M.E./M.Tech./
M.Arch./M.Sc.
/MCA/M.A.
Ph.D.

Board/
University

5. Present Basic Pay __________

6. Total Emoluments__________

Subjects/
Specialization

Year of
Passing

Division/
CGPA

Marks
in

Other

8. Experience
Period
Post Held

Organization

From

9. Course Taught (a.)Under-Graduate _______________________________________

__________________________________
__________________________________
(b.) Post Graduate _______________________________________

__________________________________
__________________________________

To

Page 9 of 10

10. Administrative positions held:

S.No.
Position Held
Period
Nature of Responsibility
_______________________
From
To
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
11. Publications:
No. Description
Published
(i)
Papers in Refereed Journals :
a) Single/Double Authors
b) Multiple Authors
(ii) Papers in Conferences/Symposia :
a) Single/Double Authors
b) Multiple Authors
(iii) Books :
a) Single/Double Authors
b) Multiple Authors
(iv) Review/Research/Feasibility Reports :
a) Single/Double Authors
b) Multiple Authors

Accepted

Communicated

Remarks

12. Participation in extra curricular activities (as a student) :____________________________________________

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
13. Summary
S. No.
Nature of Work
1
Experience

Teaching / Industry

Administrative Experience as Head, Students

affairs, academic affairs
Paper Published

Journals

Conference

Seminar/Conference/Workshop attended

Seminar

Details

Page 10 of 10

Conference

Workshop
4

STTP /Summer School/Winter School attended in

subject / interdisciplinary area

Conducting/ Organizing Summer/Winter school

courses/ training programmes/ Short term courses

Development of Course material/Monographs/ Books

Course material/Monographs

Books

Projects/ Ph.D. Guided

B.Tech

M.Tech.

Ph.D.

Other information, if any :____________________________________________________________________

_____________________________________________________________________________________________
_____________________________________________________________________________________________

14. Address for Correspondence:

__________________________
__________________________
__________________________
__________________________
Telephone__________________

Permanent Address
___________________________
___________________________
___________________________
____________________________
Telephone___________________

(Signature of Applicant)