UNIVERSITY OF KALYANI

1) Whether applying through

proper channel: Yes / No

Self attested
stamp size
photograph

2) Advance copy: Yes / No

(Please tick whichever is applicable)

APPLICATION FORM

(For Non-Teaching posts)

(To be filled by the candidate in his/her own handwriting)

(Space for Office use only)

To
The Director
Directorate of Recruitment
University of Kalyani
Kalyani, Nadia, West Bengal
Pin: 741235

(Candidate must not write above this line)

Ref. Adv. No. .. Dated : .

Sir,

I beg to apply for the post of ..

Particulars required are furnished below.
Yours faithfully,

Date : ..
1. Name in full:
(In BLOCK letters)

(Signature of the Candidate)

Surname

Name

2. Date of Birth:
(According to S.F. / H.S. certificate)
(Attested copy to be enclosed)
3. Citizenship :
4. Address :

(a) Present :

(b) Permanent :
(C) Phone/E-mail:
5. Fathers

(a) Name
(b) Occupation
(c) Address:

6. Mothers

(a) Name
(b) Occupation
(c) Address:

7. Husbands

(a) Name
(b) Occupation
(c) Address:

8. Whether registered with Employment Exchange?

YES / NO
(if YES, mention the Exchange Name and Card Number : .
ContdP/2

(2)

9. SBI Branch Name ..Journal No... Date..... Amount Rs...

(2nd copy of the challan to be attached with the application)
10. Whether belonging to SC/ST/OBC/PH/UR(EC)/SC(EC)/OBC(EC)/Ex-Serviceman
(Certificate from competent authority S.D.O./A.D.M./D.M.to be enclosed)

( mark as applicable)

11. Marital Status:

( mark as applicable)

SINGLE/MARRIED

12. Dependents, if any, mention name(s), age and relation:

13. Details of Academic and Technical Qualifications: (Attested copy of certificates to be attached)
Examination
Passed

Board/University

Year of Passing

14.
Post(s) previously held and Name of

Date of Joining

Subjects

Divn./Class
& % of
marks

Date of Leaving

Distinction if
any

Reason for Leaving

15. Additional Qualification (if any):

16. Certificates enclosed with the application:

(a)
(b)
(c)
(d)
(e)
17. Basic knowledge of computer/DTP:

I declare that the above statements are true to the best of my knowledge and belief. If selected, I will never indulge in
any such activity that goes against the reputation of the Institution. If the University of Kalyani finds me
(Name): ..involved in any such activity I shall accept any punishment
served to me by the University.

Dated : ..

(Full Signature of the Candidate)

N.B. : All the testimonials/Certificates are to be self attested.