Application No.

_______

INDIAN INSTITUTE OF INTEGRATIVE MEDICINE

(Council of Scientific & Industrial Research)
Canal Road, Jammu- 180 001 (INDIA)
INFORMATION ABOUT THE CANDIDATE APPEARING IN WALK-IN-INTERVIEW
FOR PROJECT FELLOW/SR. PROJECT FELLOW/RA/JRF/SRF AND FIELD ASSISTANT
Advertisement No._____________

Name of the position_________________________

Date of Interv iew _____________

Post Code/S.No.____________________________

Passport
Size photograph

1. Name: Dr./Mr./Miss/Mrs.

: _______________________________________________

2. Fathers/Husbands Name

: _______________________________________________

3. Date of Birth

: _______________________________________________

4. Address for co mmunication : _______________________________________________________________

__________________________________________________________________________________________
5. Phone/Mobile No. ______________________

6. E-mail: __________________________________________

7. Relig ion : _______________________

8. Details of Educational Qualifications :
Examination
Subject

Board/University

Year

%age of marks

9. Co mputer proficiency : _____________________________________________________________________

10. Category {Whether SC/ST/ OBCPH/ GEN) : _________________ 11. Sex: MA LE/FEMA LE
12. Previous experience in IIIM/ CSIR Labs./Scientific Organizations:
Name of the CSIR Labs.

ID No.

Designation

From

To

Total experience ____________ years ____________months _____________ days _______________

Cont2/-

:- 2 :

13. If you have close relation to any IIIM/CSIR staff please give details _________________________
14. The source of information about this Post:IIIM Website/Newspaper (Please indicate: ____________)/
Friends(s).

DECLARATION:I hereby declare that the information given above is true and correct to the
best of my knowledge and belief. I understand that in the event of any
information being false or incorrect; my candidature is liable to be cancelled.

Dated : ________________

Signature : _________________

NB: 1. Interim Enquires will not be attended to

2. Incomplete application will be rejected summarily.