Application Format

1. 2. 3. 4. Name of the position applied for Position Code Advertisement no Date and Name of newspaper in which advertisement appeared Name in full [ in BLOCK LETTERS] Nationality Place of Birth Date of birth and Age as on .. Name of parent / spouse Category [ mark ] [Must be supported by documentary evidence] Permanent Address with Pincode [BLOCK LETTERS]

: PROJECT SCIENTIST/ PROJECT ENGINEER ON CONTRACT

: : :

Affix Photo

5. 6. 7. 8. 9. 10.

: : : : : : UR OBC SC ST PWD

11.

12.

Address for communication with Pincode [BLOCK LETTERS]

13.

Telephone Number Residence Mobile : : : :

14. 15.

Email id Nearest Railway Station

16. Educational / Professional Qualification [beginning with SSC /SSLC Examination] [Enclose attested copies of relevant certificates and mark lists] Exam passed University/ Board Year of Passing Class & % of marks* Subject / Specialization

*Aggregate of all semesters

-217.Experience [Details of experience may be furnished in chronological order starting from present position to backwards.] Period of service From To Name of office / organization with full address Nature of work

Post held

Pay Scale

18. If your replies to Col 16 and 17 do not cover all the period : from school leaving till date, briefly state how you spent the uncovered period 19. If selected, minimum time required to join the position 20. Whether applied for any other post in ISRO/DOS 21. If Yes, furnish following details Name of the Centre Advt no: Post no: Name of the post : : : Date of interview Result of interview

22. Any other information 23. References Sl no Name and Designation

: : Address Contact Number

1.

2.

Declaration I affirm that the information given in this application are true and correct. I also fully understand that if at any stage it is discovered that any attempt has been made by me to willfully conceal or misrepresent the facts, my candidature may be summarily rejected and my employment terminated. Name: Date: Signature of the Candidate