APPLICATION FOR POST OF COMPUTER PROJECT ASSISTANT

INSTITUTE OF PHYSICS, BHUBANESWAR

1) Name (BLOCK letters):_________________________________________
_________________________________________
2) Sex:

Male

Female

( tick one)

Affix latest color

passport size photo
here

3) Father's/Husband's Name: ______________________________________

4) Permanent Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Pin: ____/____/____/____/____/____/

Phone: ________________________

5) Address for correspondence

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
___________________________________________ Pin: ____/____/____/____/____/____/
Phone: _________________________

E-mail: ____________________________

6) Date of Birth: Date: ____/____/ Month: ____/____ Year: ____/____/____/____/

(Attested copy of proof of age to be attached)
7) List of professional / technical qualifications

Sl

Examination
th

10 (Matriculation)

12th (+2): (Science/Arts/Commerce)

Bachelor's Degree

Master's Degree

Any other degree

Year of passing Percentage Division/Class/Grade

8) Work Experience / Training Course)

Sl Position / Course

Nature of Job / Course

Date (from)

Date(till)

9)

List of enclosures
1.
2.
3.
4.
5.
6.

Declaration:
I hereby declare, that all the statements made in this application, are true and if any of the
particulars furnished by me are found to be incorrect or suppressed, my candidature is liable to be
rejected at any stage of selection process. Further, I understand that, if it is found after my
appointment that the particulars furnished by me are incorrect or suppressed, my service are
liable to be terminated without any notice.
Place:_______________
Date:________________

Signature of the candidate