APPLICATION FORM FOR NON-TEACHING AIDED POSTS (2014)

** APPLICATION FOR THE POST OF : Laboratory Attendant

Please (Tick mark) whichever is
applicable
Peon

Library Attendant

Name:- Mr./Mrs./Kum. ________________________________________________________________________

(in block letters)
(Surname)
(First Name)
(Middle Name)
Correspondence Address: ______________________________________________________________________
_____________________________________________________________________
_________________________________________________ Pin Code: __________
Contact No. (Landline)

: 1. _____________________________

2. _______________________________

Mobile No. (Compulsory) : 1. _____________________________

2. _______________________________

Date of Birth (dd/mm/yyyy):_____ /_____ /19_____

Gender : Male

Age completed : _____ Yrs, _____ Months, _____ Days.

(Upto 30th April, 2014)

Female

Whether belongs to Reserved Category : Yes

No

If Yes mention Category : _______________________ Category : SC/ST/NT/VJ/SBC/OBC

(Attach documentary Proof, if belongs to Reserved Category)
Handicapped : Yes
No
if yes (give details) : _______________________________________
(Attach documentary Proof, if belongs to Handicapped Category)
Educational Qualification : (Please do not attach any documents)
Examination
Std. :
S.S.C. or Equivalent
H.S.C. or Equivalent

Month & Year of Passing

Examination
Graduation
Post Graduation

Month & Year of Passing

Other Qualifications/
Exams passed if any
Work Experience : (if any) Attach separate sheet if space provided below is insufficient.
Sr.
No.

Name of the
Organization /Company

Designation

Nature of Work

Period
From - To

Total exp.
in years

1.
2.
I, hereby declare that the information submitted above by me is true and correct.
Date :
Place :

/2014
_________________
Signature

Note:- ** If the candidate is willing to apply for more than one Post he/she should Tick mark against the post in the
same application form.
* The Date of Written Test/Interview will be displayed only on our website www.mithibai.ac.in in the month of
June, 2014.