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Non Faculty Application Form

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Bharat Kumar
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55 views

Non Faculty Application Form

Uploaded by

Bharat Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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1

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Indian Institute of Technology (Indian School of Mines), Dhanbad
Dhanbad – 826 004 (Jharkhand), India

Application for the post of ……………………………...on ………………………………………….basis


(Please fill name of post) (Mode of recruitment)
(Regular/Deputation/Deputation-cum-Absorption/Contract)

(Please Fill in BLOCK LETTERS)

Advertisement No. Affix here


recent passport
Post Applied for size
photograph
Department

Bank Draft No.& Date

1. Name in Full (First Surname)

Marital Status: Gender:

Married Single Male Female

(Please tick)
2. Name of Father:

3. Address:

Present

Permanent

FAX
E-mail
Telephone / Mobile Office: Residence:
2

4. Date of Birth 5. Nationality:


Day Month Year

5. Present Employment:

Designation
Organization
Date of joining
Scale of Pay (Rs).
Basic Pay (Rs.)
Total Emoluments
(Per month)(Rs.)
6. Basic Pay expected (Rs.) ______________________________________________

7. (a) Tick-mark the appropriate box if you belong to reserved category


(Please attach necessary caste certificate issued by an authorized officer only.)

SC ST OBC GEN PH

8. Total years of the experience after attaining essential qualification

9. Areas of Specialization

10. Academic Record starting with secondary education (Please attach Xerox copies of Degree Certificate)
Examination Branch/ College/University Year Percentage Class/
Specialization /Institute /Grade Division

11. Employment: (particular of your past position (s))


Employer Position held Date of Joining Date of Leaving Pay with Scale
of pay
3

12. Have you ever been discharged/suspended during your earlier employment?
If yes, state reasons:

13. Special Awards/Honours received, if any:

Year Name of Award/Honour Name of Organisation

14. Names and addresses of three Referees (at least one of them should be familiar with your recent works)

Name

Occupation or
position
Address

Fax

E-mail

Phone No.
4

15. Statement of Objectives (to be filled up in Candidate’s own hand writing)

a) Please indicate as to why you wish to join IIT(ISM), Dhanbad.


b) How in your opinion do you meet the job requirements as advertised?

16. I hereby declare that I have carefully read and understood the instructions and particulars
supplied to me, and that all entries in this form as well as attached sheets are true to the best
of my knowledge and belief.

There are attached sheets along with this form.

Date:

Place:
(Signature of Applicant)

Note: Use separate sheet if necessary for any of the above items.
5

INDIAN INSTITUTE OF TECHNOLOGY


(INDIAN SCHOOL OF MINES), DHANBAD

SUMMARY SHEET

Advt. No. _________________________ Dated: __________________

1. TITLE SURNAME FIRST NAME

2. Date of Birth 3. Age 4.Category

5. Mobile No.: _____________________________ Email ID: ________________


6. Educational Qualifications:

Examination Branch/ Collge/ Univrsity/ Year of Percentage/ Class/


Passed Speciaisation Institute passing Grade Division

7. Experience with pay scale and present basic:

Employer Position held Date of Date of Pay with Scale of Pay


Joining leaving

8. Total experience (in years/months) :

9. Details of Research/Consultancy Projects (Completed/Ongoing) :


6

10. Any other (Awards, Prizes, Achievements etc.) :

Date:

Place:
(Signature of Applicant)

Note: Use separate sheet if necessary for any of the above items.

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