APPLICATION FORM FOR RESEARCH ASSOCIATE

Please use BLOCK LETTERS to help speedy processing

1.
Full
Name..
Sex : .
First
Middle
Last
2.

Present Address.

3.

Permanent Address in India(Leave blank if same as(2)

..
4.

Contact

Phone

No.:

..

Mobile

No.:

.
E-mail

address:

.
5.
a) Date of Birth*: (b) Birth Place: (c)
Domicile
*Please attach self attested copy of Certificate indicating date of birth.

State of

6.
Citizenship: (a) Self :..(b) wife/Husband:
..
7.
Fathers name and
Citizenship
.
1

8(a)
Academic and Professional qualifications (starting from matriculation
onwards):
(Please send copies of all degrees and diplomas along with mark
sheets/grade cards, transcripts, duly attested by notary public, first class
magistrate, or gazetted officer with his official seal)
Name of
the
examinati

Percentage of
Marks or
Grade*

Subject

Name of
Univ./Institutio
n

Duration
of Course

Month &
year of
passing

* Formula to convert grades into percentage (%) may

please be given

8 (b)

If studying, Course
Institution..
Expected date of
completion

9.

Title of Thesis (accepted): (a)

Master

(b) Doctorate:

...
2

10.

Specializations, in terms of Broad Area of Specialization and Exact Area of

Specialization:

Subje
ct

11.
Publications and Patents: (Please attach list with full references with
impact
factor
of
the
Journal and reprints or photocopies bearing serial numbers corresponding
with
those
in
the
list)
(a) No. of Papers (i) Published..(ii) Accepted..
(b) No. of Books published.(c) No. of patents: (i) Filed:..(ii)
Granted:
12.

Prizes, Honours, Awards, Distinctions, if any:

13.

Fellowships held:

Name of fellowship

Organization

Dates
To

From

14.
(a) Chronological record of employment/fellowship/training (in India and
abroad):
(Use additional sheets, if necessary, and attach documentary proof of each
experience)
Date/Month/Ye
ar From
To

Designation Nature of
work

Name and
Address of

Employmen Salary
t/ Training
Last
drawn

(b) If not employed, since when? Month..Year

15.

Countries visited (for Study, Research, Training or Employment only if any):

Country

Date From
To

Purpose

Sponsored by

16. Additional Information if any :

.

I hereby declare that all the information given above are true to the best of my
knowledge. In case it is found at any stage even after appointment that I have
furnished any incorrect/false information or have suppressed any fact in this regard,
my candidature /service is liable to be rejected/terminated without any notice.

Date :
Signature.