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2nd Floor, Karya Soudha, Gulbarga University Campus, Gulbarga 585 106 Phone (08472) 272057 Telefax : 272066 Website: www.cuk.ac.in Email: cukgulbarga@gmail.com
(No.6/2011)
APPLICATION FORM
Registration Fee Rs. 250/- only (by Hand) and ` 300/- for Downloaded Forms
Sl. No.
Notification No... Date DEMAND DRAFT PARTICULARS Name of the Bank D.D. Number Date GENERAL INFORMATION:
Value
1. 2. 3. 4. 5. 6. 7. 8. 9.
: : : : : : : : :
Fathers Name Husbands Name (in case of married Women) Date of Birth (As recorded in Matriculation or equivalent certificate) Age (as on the last date of advertisement) Nationality Sex (Male / Female) Marital Status (Married / Unmarried) Do you belong to Scheduled Caste (SC) or Scheduled Tribe (ST) or Other Backward Class (OBC) or Physically Handicapped (PH) category? If yes, write clearly and enclose a copy of certificate issued by competent authority (Encl. No. ). Permanent Address
10.
PIN CODE..
11.
PIN CODE..
12.
Contact Details
Phone No : E-mail :
Board/ University
Year of Passing
Class/Divn/ Merit
Obtained
Marks Out of
% of marks
Encl No.
Higher Secondary/
Intermediate (10+2)
Bachelors degree
(Give name)
Masters Degree
(Give name)
Technical Qualifications
* Wherever applicable.
DETAILS OF EXPERIENCE Designation Scale of Pay & Salary drawn Name of the University/Institution Period of service To No. of years Encl. No.
From
Total period of teaching experience: i) ii) Undergraduate (U.G) classes B.A., B.Sc., etc ........................ years ........................ months Post-graduate (P.G) classes M.A., M.Sc., M.Phil. etc .................... years .................. months
POST-DOCTORAL RESEARCH EXPERIENCE: (After obtaining Ph.D. degree) Period of work Position held Emoluments (per month) Name of the University/Institution From To No. of years Encl. No
RESEARCH GUIDANCE: Number of Candidates Sl.No. Course Awarded 01 02. M.Phil. Ph.D. Under-supervision
PUBLICATIONS (Give a list separately) Sl.No. 01 02. 03. Books Research Publications Other Publications Publications
RESEARCH PROJECTS CARRIED OUT : Duration Title of the Project Name of the Funding Agency From To
SEMINARS, CONFERENCES, REFRESHER COURSES ETC. ATTENDED: Name of the Seminar/Symposia/ Conference, etc. Duration Name of the Organizer From To Nature of Participation
LANGUAGES KNOWN:
i) ii) Spoken ........................................................................................................ . Written ........................................................................................................ .
PRESENT POSITION WITH PAY, PAY-SCALE ETC.: Position Basic Pay Rs. .p.m in the pay-scale / Pay Band of RsGrade Pay Rs..... Gross monthly salary as on..(date) Rs..Date of next increment
State whether you have been at any time (a) dismissed, removed or debarred from Service or (b) convicted by a Criminal Court. (Please tick YES/NO) State clearly how you satisfy the requirements of the advertisement in respect of qualifications and experience prescribed for the post.
Give the names of two responsible persons not related to you to whom a reference can be made about you. Also give their addresses 1.. .. .. 2.. .. ..
I HEREBY DECLARE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF: Place Date .
(The endorsement below is to be signed and forwarded by the Head of the Department/Employer in the case of the inservice candidates whether in permanent or temporary capacity failing which the application is liable to be rejected).
Ref. No
Date..
FORWARDED
The applicant (name) is holding the post of in this College/University/Institution/Organisation in a temporary/permanent capacity
since(date). His/Her present basic pay is Rsper month in the pay scale / pay band of RsGrade Pay Rs.. His/Her date of next increment will be There is no objection to his/her application being considered.
ACKNOWLEDGEMENT
Received one application form bearing Serial No. ________ from ___________________________ for the post of _______________________along with a D.D. bearing No. ______________