St.

B Berchm mans Co ollege

Af ffiliated to Ma ahatma Gandh University, Kottayam, Kerala hi K NAAC reaccredited Co ollege at A leve College wit Potential fo Excellence el, th or

Changa anassery, Kerala, India 686101 a Ph hone: 0481-2420025, 30 012345, Fax 0481-2401 x: 1472 E-m mail: sbc@sb bcollege.org Website: w g, www.sbcoll lege.org App plication No. . 1. Post applied for: 1 2. Name (in block letters : 2 n s)
Affix Pho otograph

3. Gender: 3 5. Religion: 5

M/F

4. .

Marital s status: Married/Unmarrie ed Denomin nation: Par rish: 8. Date of B Birth: 10. Ad ddress for communication

6. If Cathol 6 lic, Diocese e: 7. Age as o 01 January 2012: 7 on y 9. Permane address 9 ent

e Pin code 11 Phone: C 1. Code 12 E - mail: 2. 13 Name of Parent/Gua 3. f ardian and relationship: 14 Educatio qualifica 4. onal ations Sl l. Exam/Course No o. i. SSLC ii. PDC/Plu Two i us ii Degree: ii. iv PG: v. v. v vi. v vi ii. NE ET/JRF MPhil PhD Ins stitution Board/U University No. .:

n Pin code Mob. No.:

Ye ear

S Subject

Marks (%)

Class

15 Experien 5. nce: Teac ching Rese earch

Period d

16. Number of Publications (attach list): 17. Are you employed at present: If Yes, address of the institution

National:

International:

18. Name and address of two reference 1) 2)

19.

Extracurricular activities with position

NCC: NSS: Student organisation:

Any other information the candidate 20. wish to add in support of the application 21. List of enclosures (please tick) i. Copies of SSLC book front page and marks ii. Copy of PDC/Plus two mark list iii. Copy of Degree mark list and certificate iv. Copy of PG mark list and certificate v. Copy of MPhil certificate vi. Copy of PhD certificate vii. Copy of JRF/NET certificate viii. Copy of experience certificate teaching ix. Copy of experience certificate research x. List of publications xi. Proof of any other qualification

Declaration
I hereby declare that the above furnished details are true. Signature of the candidate Place: Date: Instructions
Application is to be filled by the candidate. Those in service should apply through proper channel. Incomplete application will be rejected.