Serial No………

JAN NAYAK CH. DEVI LAL VIDYAPEETH

Application form for Teaching Posts
Price : Rs. 100/-
(on counter)
IMPORTANT NOTE: (i) The candidate is required to fill this
Form and attach Xeroxed attested Passport
Copies of his testimonials alongwith Size
Bio-data. Photograph
(ii) The Vidyapeeth reserves the right to
short list candidates before they are
called for interview on the basis if
criteria to be adopted by the appointing
authority.

1. Post applied for …………………………..Subject……………………………….

(Advt. No. and Sr. No. of Post)…………………………………………………….
2. Name of the Candidate…………………………………………………………….
(In Capital Letters)
3. Father’s Name………………………………………………………………………
4. Man/Woman……………………….. Nationality…………………………………..
Fee remitted Rs………………………..........
No. and date of Demand Draft……………...
5. Are you physically handicapped?..............................................................................
6. Whether you belong to SC/ST/BC………………………………………………….
7. Married/Unmarried…………………………………………………………………
8. Date of birth & place………………………………………………………………
9. Address for Correspondence………………………………………………………..
(in capital letters)………………………………..Phone No……………………….
10. Educational Qualifications: (Strike off which is not applicable).
Exam. Passed University Year of % age Division Subjects Awards/Medals/
/Board Passing of studied Prizes Merit, if
marks including any
option
Matric
Hr. Sec./Pre.uni./
10+2/ Inter
B.A./B.Sc./B.Tech.
B.Com./BDS/MBBS
/BPT/B.Pharma
M.A./M.Sc./M.Tech.
MDS/MS/MPT/
M.Pharma or any
other Master’s
Degree (Name the
Subject)
NET
M.Phill.
Ph. D. Subject ………………………………….
Topic of Thesis………………………….
Name of Guide………………………….
Year of award of Degree…………………
Any other exam.
Field(s) of
Specialization
11. Total teaching experience in College/University:-
Under-graduate……………………………Post-graduate………………………..
12. Total Research Experience…………………………………………………………
Institution Server:-

Name of institution Designation From To

(i)
(ii)
(iii)

14. If you are presently employed, state position and address…………………….........

………………………………………………………………………………………
………………………………………………………………………………………
15. Language(s) known Read Write Speak
…………………… ………………. ……………… ……………....
…………………… ………………. ……………… ……………….
…………………… ………………. ……………… ……………….
16. Present Pay………………………………..Pay scale……………..DA………….
17. Pay acceptable…………………………………………………………………….
18. Period required for joining, if selected……………………………………………
19. List of major publication: Please attach the list with Xerox copies there of:-
Publications Published In Press Accepted Communication In
for for publication preparation
publication
Books
Independently/Jointly
Paper
Independently/Jointly
Patents
Independently/Jointly
20. List of enclosures:-
1. ……………………. 2. …………………………
3. ……………………. 4. …………………………
5. ……………………. 6. …………………………
7. ……………………. 8. …………………………

I certify that the foregoing information given by me is correct and complete to

the best of my knowledge and belief. I am not aware of any circumstances, which
may impair my fitness for employment.

Date:……………………..
Permanent Address

Signature of Candidate
………………………………
………………………………
………………………………
……………..PIN……………
Phone No……………………
Fax No………………………