Please affix self-attested APPLICATION FORM color passport ____________________________________ size 1.

Category applied for: ________________________________________ photograph of self 2. Personal Details: NAME IN FULL . (IN BLOCK LETTER) First Middle Surname

FATHERS NAME . ..
(IN BLOCK LETTER) First Middle Surname

Permanent Address (will be considered as Emergency Address) ..... .... . City.. State . Pin Code . Tel No.

Address for Communication (fill only if this is different from permanent address) ..... .... . City.. State . Pin Code . Tel No.

Mobile Number: .. E-mail: . Marital Status: Gender : Date of birth (DD/MM/YY):

(Note: Kindly ensure that correct and full postal address with PIN code is filled in to enable correspondence)

3. Qualification Details Starting from highest qualification. (Insert additional rows if required):
Regular/ Correspondenc e % of Marks

Educational Qualification

Year of Passing

Institute

4. Experience Details from present/latest to earliest (Experience includes research, teaching & independent consulting experience):
Name of Organization From To Designation Nature of Responsibil ities

4.1 Provide suitable details about the relevance of your past experience, specific to the role you are applying for. Provide the details by making specific references to the experience asked for in the job description for the role applied for Line Item Reference Details

5. Details to be filled by all candidates: S. No 1 Parameters Details

Total last drawn monthly compensation from current job or previous job (if not employed currently) 2 Fixed Component 3 Variable Component (Inclusive of variable or bonus pay) 6. Details to be filled by retired Government personnel only: S. No 1 2 3 4 5 6 Required Information Designation at the time of retirement Office retired from Service, Cadre & Batch (from which retired) Pay band & grade pay (Revised) with Basic pay drawn at the time of retirement Whether the post at the time of retirement was held on regular/ deputation/ temporary/ permanent/ officiating or adhoc basis and since when Date of retirement Details

7. Kindly attach the attested copies of following documents: Identity proof Address proof Income Proof Educational qualification certificates (for all qualifications mentioned in this form)

Experience certificates (for all experience mentioned in this form)

Declaration: I hereby solemnly declare and undertake that all information furnished by me is true, correct & complete to the best of my knowledge & belief. I undertake that, if at any stage of selection or even after selection, any of the information furnished by me is found to be false, incorrect or misleading; my candidature/appointment/services will stand cancelled/terminated without assigning any reason thereof. Place: .. Date:. Signature: