Scribd
Upload
787 views5 pages

Deputation Application Form

The document is a bio-data proforma for applying to a post at AIIMS Jodhpur. It requests information such as name, address, contact details, date of birth, education and employment history. It asks for details of current and previous employment including pay scales and emoluments. It also asks for additional information relevant to the applied post.

Uploaded by

Aryan
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
787 views5 pages

Deputation Application Form

The document is a bio-data proforma for applying to a post at AIIMS Jodhpur. It requests information such as name, address, contact details, date of birth, education and employment history. It asks for details of current and previous employment including pay scales and emoluments. It also asks for additional information relevant to the applied post.

Uploaded by

Aryan
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
You are on page 1/ 5

अ खल भारतीय आयु व ान सं थान, जोधपुर

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, JODHPUR


ckluh f}rh; pj.k] जोधपुर & 342005 ¼राज थान½
Basni Phase-II, Jodhpur-342005 (Raj)
BIO-DATA-PROFORMA

Application for the post of (Name of the Post)


on deputation basis at AIIMS, Jodhpur.

01. Name in BLOCK Letters :

02 Address :

03. Contact No. :


04 E-mail ID :
05. Date of Birth :
06. Date of entry in service :
Date of Retirement under Central / State
07. :
Government Rules

i) :

08. Educational Qualifications ii) :

iii) :

Whether educational & other


qualifications required for the post are
satisfied. (if any qualification has been
:
treated as equivalent to the one
prescribed in the Rules, state the
authority for the same)
09.
Qualifications and Experience
Qualifications and Experience held by the applicant
required (As per Advertisement)

Essential

Page 1 of 5
Experience

Please state clearly whether in the light


of entries made by you above, you meet
10. the requisite essential qualification and :
experience of the post.

Details of employment, in chronological order. Enclose a separate sheet, duly authenticated by your
11.
signature, if the space below is insufficient.
Pay Scale of the post Nature of
Name of Post held Period of held on regular basis, appointment Nature of
office/ on regular Service Pay Matrix (7th CPC) (whether regular duties
organization basis From- to- and Grade Pay or ad-hoc or (in detail)
(6th CPC) deputation

Important: Pay Band and Grade Pay granted under MACP/ACP are personal to the employee and
therefore, should not be mentioned. Only the Pay in the Pay Band and Grade Pay/Pay Scale of the post
held on regular basis is to be mentioned.
Details of ACP/MACP with present Pay Band and Grade Pay, where such benefit have been drawn by
the candidate may be indicated as under
Pay, Pay Band and
Office/Organization Grade Pay drawn under From (old pay scale) To (new pay scale)
ACP/MACP Scheme

Page 2 of 5
Nature of Present employment i.e. ad hoc or
12. :
Temporary or Quasi-permanent or Permanent.
In case the present employment is held on Deputation
:
/ Contract basis, please state

(a) Date of initial appointment :

Period of appointment on deputation/


(b) :
contract
Name of the parent office/ organization to
(c) :
13. which the applicant belongs
Name of the post and pay scale of the post
(d) held in substantive capacity in the parent :
organization
Note: In case of officers already employed on deputation basis, the application of such
13.1 officers should be forwarded by the parent cadre/ Department along with cadre clearance
certificate, vigilance clearance certificate and integrity certificate.
Note: Information under column 13(c) and 13(d) above must be given in all cases where
13.2 a person is holding a post on deputation outside the cadre/organization but still
maintaining a lien in his parent cadre/ organization.

If any post held on deputation (including short-term


14. contract) basis in the past by the applicant date of :
return from the last deputation and details

Additional details about present employment


Please state whether working under (indicate the name
of your employer against the relevant Column):
(a) Central Government
:
15. (b) State Government
(c) Autonomous Organization
(d) Government Undertaking
(e) University
(f) Other

Please state whether you are working in the same


16. Department and are in feeder grade or feeder to feeder :
grade

Are your in revised scale of pay? If yes, give the date


17. from which the revision took place and also indicate :
the pre-revised scale

Page 3 of 5
:
Total emoluments per month now drawn
Basic Pay in Pay Grade Pay/ Cell in Pay Matrix Total emoluments
18. Band/ Pay Matrix

In case the applicant belongs to an organization which is not following the Central Government Pay
Scales, the latest salary slip issued by the organization showing the following details may be
enclosed
Basic Pay with scale Dearness Pay/ Interim relief/ other Total emoluments
19. of pay and rate of allowances etc. (with break-up details
increment

Additional information, if any, relevant to the post you


applied for in support of your suitability for the post (This
among other things may provide information with regard to
A (i) additional academic qualifications (ii) professional
training and (iii) work experience over and above that
prescribed in the vacancy circular/ advertisement. (Note:
Please enclose a separate sheet, if the space is insufficient)
Achievement:
The candidates are requested to indicate information with
20. regard to:
(i) Research publications and reports and special projects
(ii) Awards/Scholarships/ Official appreciation
(iii) Affiliation with the professional bodies/ institutions/
B
societies/ and
(iv) Any research/ innovative measure involving official
recognition
(v) Any other information
(Note: Please enclose a separate sheet, if the space is
insufficient
21. Whether belongs to SC/ST/OBC
I have carefully gone through the vacancy circular/ advertisement and I am well aware that the information
furnished in the Curriculum Vitae dully supported by the documents in respect of Essential Qualifications/
Experience submitted by me will also be assessed by the Selection Committee at the time of selection for
the post. The information/ details provided by me are correct and true to the best of my knowledge and no
material fact having a bearing on my selection has been suppressed/withheld.

Attach Recent
Passport Size
Photograph

Date:

Signature of the candidate


Name:-
Page 4 of 5
Countersigned
(Employer/ Cadre Controlling Authority with Seal)

Certification by the Employer / Cadre Controlling Authority


The Information/ details provided in the above application by the applicant are true and correct as per facts
available on records. He/She possesses educational qualification and experience mentioned in the vacancy
circular. If selected, he/she will be relieved immediately.
2. Also certified that
I. No vigilance or disciplinary case pending/ contemplated against Shri/
Smt.__________________________________________________________________________
II. His/Her Integrity is certified.
III. His/her APARs for the last five years are enclosed (in original)/ Photocopies of the APARs for the
last five years, each page duly attested by an Officer of the rank of Under Secretary to the
Government of India or above are enclosed.
IV. No major/ minor penalty has been imposed on him/her during the last ten years (or) a list of
major/minor penalties imposed on him/her during the last ten years is enclosed.

-------------------------------------------------------------
[Employer/ Cadre Controlling Authority with seal]
Name and Designation:……………………………
Phone No………………………………………….
FAX No. ………………………………………….
Office Seal………………………………………..

Place: ________________
Date: _________________

Page 5 of 5

You might also like