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Recent Passport

size self attested


photograph to be
APPLICATION FORMAT

pasted here

(TO BE FILLED IN BOLD ENGLISH CAPITAL LETTERS BY THE CANDIDATE IN


HIS OWN HANDWRITING)
1

Name of the Post

Name of the Candidate

Father / Husbands name

Date of Birth

Age as on last date of application

Category (SC/ST/OBC/Genl)
(self-attested copies of caste
certificate issued by the competent
authority to be enclosed)

7.a

Permanent Address

7.b

Address for Correspondence

Contact Details

Years -

Months -

Days -

Mobile NO.______________________
Tel. No.:________________________
E-mail: _________________________
Fax No.:________________________
9

Details of Educational Qualification (from matriculation onwards)


Exam
Passed

Institute / Duration
University & Year of
Passing

Subjects
taken

Marks
obtained /
% of marks

Division

10

Details of marks / score of GATE


Examination 2015
(copy of GATE Score card to be
enclosed)

11

Details of experience, if any


(in chronological orders)

I hereby declare that the particulars furnished above are true. I understand that may
candidature will be cancelled if the information found to be false or incorrect.

Date:____________
(Signature of the Candidate)
Place:___________

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