Wadia Institute of Himalayan Geology: Application Form For Scientific Posts

3rd DRAFT
WADIA INSTITUTE OF HIMALAYAN GEOLOGY

(An Autonomous Institution of Deptt. of Science & Technology, Government of India)
33, General Mahadev Singh Road

DEHRA DUN - 248 001
Application form for Scientific Posts
1.
Advertisement No. : General Recruit./WIHG/2014-15-Vol.-II/Estt.
2.
Post applied: (a) Name of Post:

(Please tick)
(b) Against Category:

(Please tick in anyone)
(c)Name of Post:
(Please tick)
(d) Against Category:

PB-3: `15,600 39,100 + ` 7,600 G.P.
GEN
B
Affix recent
passport size
colour
photograph duly
singed
LIEN VACANCY
PB-3: `15,600 39,100 + ` 5,400 G.P.
GEN*
SC
ST
OBC
PD
*One Post reserved under General Category for PD (Not less than 40 percent of relevant disability). Persons with Disabilities (PD)
including visual & hearing impairment, and locomotor disability or cerebral palsy.
(Note:- Please tick only one post in one application. Submit separate application, if applying for more than one post, failing
which application will not be considered for any post)
3.
Full Name (in Block letters) : ______________________________________________________

(Underline Surname)
4.
Father's/Husband's Name:________________________________________________________
5.
(a) Address For Correspondence
(b) Permanent Address
(give phone/fax number also, if available)
(give phone/fax number also, if available)
Telephone No(s) :
Fax No.(s) :
E-mail :
6.
Date of birth & Place of birth : _____________________________________________________

Age as on the date of advertisement: ....Years.....Months.....Days
Contd... on page2/-
:2:
7.
a. Sex : Male / Female
: ______________________________________
b. Marital Status
: ______________________________________
: ______________________________________
8.
c. Identification Mark
_______
Nationality
7.
(a) Do you belong to Scheduled Caste/Scheduled Tribe/OBC ? Yes / No
: ______________________________________
(b) If yes, please state category :

(Please enclosed attested copies of documentary evidences)
8.
Academic Qualifications:
(Commencing with the High School or an equivalent examination).
Examination/
Degree
9.
Subject/
Specialization
Year
Division
%
Marks/
Grade
University
/College/ Board
Distinctions/ Scholarships
(a) Has there been any break in your academic career ?

(If so, give details thereof with reasons).
(b) Have you been punished during your studies at College/university?

(If so, give details).
Contd... on page 3/-
:3:
(b) Have you been punished during your services or convicted by a court of Law?
(If so give details).
(c) Were you at anytime declared medically unfit or asked to submit your resignation or
discharged or dismissed? (If yes, give details in a separate sheet).
10.
Experience:
Sl.
No
11.
12.
Name of Organization (Give complete address)
Post held
From
To
Nature of duties
Publication:
(Give names of author, title of paper, name of journal, year , volume, pagination etc.)
(i)
Research Papers in Referred Journals:
(ii)
Papers in Conference/Symposia:
(iii)
Books edited and chapters in books:
(iv)
Popular articles:
(v)
Others:
Number of Theses supervised:

Awarded
Submitted
In Progress
(i) Ph.D.
(ii) M.Phil
(iii) M.Tech/M.Sc.
:4:
13.
Sponsored Research/Consultancy Projects:

Completed
In Progress
(i) Number of Sponsored Research Projects:

(ii) Number of Consultancy Projects:
14.
Prizes/ Medals / Awards / Honours:-
15.
Extra-curricular activities - give details, if any, of proficiency acquired in games, sports and part
taken in other extra-curricular or social activities such as NCC, public lectures debates and
social service etc.
(i) As a Student
(ii) After entering into service.
16.
Academic visits abroad:

Country Visited
17.
Purpose of Visit
Duration
Special Training/Assignment/ Any other Relevant Particulars:
:5:
18.
Specialization :
(a) Specialization in the degree preceding to Ph.D.
(b) Research specialization
19.
Present Salary per month:

Scale of Pay/Pay Band
` ___________________
Present Basic Pay/Band Pay
` ___________________
Grade Pay
` __________________
Present Dearness Allowance
` ___________________
Other allowances, if any,
` ___________________
Total Salary per month
` ___________________
Next increment due on : _______________

20.
(a) Membership/Fellowship of Professional Societies :
(b) Knowledge of foreign language :
(c) Other Activities/Responsibilities:

(Applicant may mention any special qualification/experience which have not been included under the
heads given above).
:7:
(d) Are you willing to accept the initial salary of the post?
(If no, state what is the minimum salary acceptable or expected, with justifications thereof)
(e) If appointed, what notice would you require before joining the post?
(f) Any other relevant information, not given above.
21.
Give name, designation and address of three referees not related to you.
(Referees should be persons with or under whom you have worked, or who have intimate knowledge
of your work).
i.
ii.
iii.
22.
List of enclosures :
:8:
23.
Declaration to be signed by the candidate

I hereby declare that the entries in this form are 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
appointment shall be liable to be summarily terminated without notice or compensation.
Dated :
24.
Signature of applicant
Forwarded with the remarks that the Institute/Organization has no objection to the candidature of the
applicant being considered for the post applied for as above.
Dated:
Signature
(Head of the Institution/Organization)
Designation
Address:
Telephone/Fax No.
(with STD Code)
3rd DRAFT
33, General Mahadeo Singh Road

DEHRA DUN - 248 001
APPLICATION PERFORMA
(Read the advertisement notice in website carefully before start filling up the application performa)
1. Advertisement No.
: General Recruit/WIHG/2014-15-Vol-II/Estt.
2. Post applied for
: ARTIST CUM MODELLER

(PB-1: 5,200 20,200 + 2,800 G.P.)
3. Name in capital letters
: ________________________________________
Affix recent
passport size
colour
photograph duly
singed
As appearing in High School Certificate
4. Fathers / Husbands name
: ________________________________________
5. Date of birth
: ________________________________________
6. Age as on the date of advertisement:7. Marital Status
Years _____ Months_____Days _____
: ___________________________________
8. Complete postal address for communication

with Pin Code (In block letters).
: ______________________________________
_______________________________________
_______________________________________
_______________________________________
9. Complete permanent address

: _______________________________________
________________________________________
________________________________________
________________________________________
10. Contact No. with STD code:

Landline:
: _______________________________
Mobile No.:
: _______________________________
Email ID.:
: _______________________________
11. Qualifications (from High School onwards):Examination/

Degree
Subject/
Specialization
Year
Division
%
Marks/ Grade
University /College/
Board
Distinctions/
Scholarships
:2:
12. Details of previous and present employment:Sl.

No
Name of Organization
(Give complete address)
Post held
From
To
Pay scale/
emoluments
Nature of
duties
(Details of previous employment and experience in the relevant field (Attested true copy
to relevant experience certificate must be submitted with the application).
13. Whether belong to reserved category (SC/ST/OBC) : _______________________________________
14. Additional information, if any
: _____________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
15.
: _____________________________________________
No. of enclosures attached
Declaration to be signed by the candidate:I hereby carefully gone through the advertisement notice and declare that the entries in this form are 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 appointment shall be liable to be summarily terminated without notice or compensation.
Dated:
3rd DRAFT

DEHRA DUN - 248 001
2. Post applied for
: TECHNICAL ASSISTANT
(PB-1: 5,200 20,200 + 2,800 G.P.)
3. Against Category
Lien Vacancy only in OBC

Category
GEN
Affix recent
passport size
colour
photograph duly
singed
: ________________________________________
: ________________________________________
6. Date of birth
: ________________________________________
: ___________________________________

: ______________________________________
_______________________________________
_______________________________________
_______________________________________

: _______________________________________
________________________________________
________________________________________
________________________________________

Landline:
: _______________________________
Mobile No.:
: _______________________________
Email ID.:
: _______________________________

Degree
Subject/
Specialization
Year
Division
%
Marks/ Grade
Board
Distinctions/
Scholarships
:2:

No
Post held
From
To
Pay scale/
emoluments
Nature of
duties
: _____________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
16.
: _____________________________________________
Dated:
3rd DRAFT

DEHRA DUN - 248 001
2. Post applied for
: DRAFTSMAN
(PB-1: 5,200 20,200 + 2,400 G.P.)
: ________________________________________
Affix recent
passport size
colour
photograph duly
singed
: ________________________________________
5. Date of birth
: ________________________________________
: ___________________________________

: ______________________________________
_______________________________________
_______________________________________
_______________________________________

: _______________________________________
________________________________________
________________________________________
________________________________________

Landline:
: _______________________________
Mobile No.:
: _______________________________
Email ID.:
: _______________________________

Degree
Subject/
Specialization
Year
Division
%
Marks/ Grade
Board
Distinctions/
Scholarships
:2:

No
Post held
From
To
Pay scale/
emoluments
Nature of
duties
: _____________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
15.
: _____________________________________________
Dated:
3rd DRAFT

DEHRA DUN - 248 001
2. Post applied for
: FIELD-CUM-LABORATORY-ATTENDANT
(PB-1: 5,200 20,200 + 1,800 G.P.)
: ________________________________________
Affix recent
passport size
colour
photograph duly
singed
: ________________________________________
5. Date of birth
: ________________________________________
: ___________________________________

: ______________________________________
_______________________________________
_______________________________________
_______________________________________

: _______________________________________
________________________________________
________________________________________
________________________________________

Landline:
: _______________________________
Mobile No.:
: _______________________________
Email ID.:
: _______________________________

Degree
Subject/
Specialization
Year
Division
%
Marks/ Grade
Board
Distinctions/
Scholarships
:2:

No
Post held
From
To
Pay scale/
emoluments
Nature of
duties
: _____________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
15.
: _____________________________________________
Dated:

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3rd DRAFT

WADIA INSTITUTE OF HIMALAYAN GEOLOGY

33, General Mahadev Singh Road

Advertisement No. : General Recruit./WIHG/2014-15-Vol.-II/Estt.

Post applied: (a) Name of Post:

(b) Against Category:

(d) Against Category:

PB-3: `15,600 39,100 + ` 7,600 G.P.

PB-3: `15,600 39,100 + ` 5,400 G.P.

Full Name (in Block letters) : ______________________________________________________

(a) Address For Correspondence

(b) Permanent Address

(give phone/fax number also, if available)

(give phone/fax number also, if available)

Date of birth & Place of birth : _____________________________________________________

a. Sex : Male / Female

(a) Do you belong to Scheduled Caste/Scheduled Tribe/OBC ? Yes / No

(b) If yes, please state category :

(a) Has there been any break in your academic career ?

(b) Have you been punished during your studies at College/university?

Contd... on page 3/-

Name of Organization (Give complete address)

Books edited and chapters in books:

Number of Theses supervised:

Contd... on page 4/-

Sponsored Research/Consultancy Projects:

(i) Number of Sponsored Research Projects:

Prizes/ Medals / Awards / Honours:-

(ii) After entering into service.

Academic visits abroad:

Special Training/Assignment/ Any other Relevant Particulars:

Contd... on page 5/-

(b) Research specialization

Present Salary per month:

Present Basic Pay/Band Pay

Present Dearness Allowance

Other allowances, if any,

Total Salary per month

Next increment due on : _______________

(a) Membership/Fellowship of Professional Societies :

(b) Knowledge of foreign language :

(c) Other Activities/Responsibilities:

Contd... on page 7/-

(f) Any other relevant information, not given above.

Contd... on page 8/-

Declaration to be signed by the candidate

33, General Mahadeo Singh Road

2. Post applied for

: ARTIST CUM MODELLER

3. Name in capital letters

As appearing in High School Certificate

4. Fathers / Husbands name

6. Age as on the date of advertisement:7. Marital Status

Years _____ Months_____Days _____

8. Complete postal address for communication

9. Complete permanent address

10. Contact No. with STD code:

11. Qualifications (from High School onwards):Examination/

Contd... on page 2/-

12. Details of previous and present employment:Sl.

No. of enclosures attached

33, General Mahadeo Singh Road

2. Post applied for

Years ___ Months_Days ___

Years ___ Months_Days ___

Years ___ Months_Days ___

Years ___ Months_Days ___