(To be filled up by the Candidate, if applicable)

Demand Draft No
DatedAmount: ........
Name of the Bank

(For office use)

Application Form No....
Deposited Cash Rs....................
Sign. of official ..

Asstt. Registrar (Estt.)

DEENBANDHU CHHOTU RAM UNIVERSITY OF SCIENCE & TECHNOLOGY,

MURTHAL (SONEPAT), HARYANA
1.
2.

Name of Post applied for

Discipline/ Department

3.

Advertisement No.

4.

7.
8.
9.

Name of the candidate in block letters (as

per Sr. Sec. School Certificate
Fathers./Husbands Name (block letters)
a) Date of Birth
b) Place of birth with state
Nationality
Marital Status
Present Postal Address

10.

Contact Telephone No.

11.
12.

E-Mail I.D.
Permanent address

5.
6.

13.
Sr.
No.
i
.

Passport
size recent
Photograp
:_________________________________
h to be
:_________________________________
pasted
:________ _____________________________
:_____________________________________

:_____________________________________
:_____________________________________
:_____________________________________
:_____________________________________
:_____________________________________
:_____________________________________
______________________________________
______________________________________
:______________________________________

:______________________________________
:_____________________________________
______________________________________
______________________________________
Academic/Professional Qualification (Attach attested copies of mark sheets & certificates)
Examination passed
Board/
Year of % age of Division/ Subject/
University passing marks
Class
Specialization
obtained
Matric/Hr. Sec.

i
i
.

10+2/Inter/Pre. Engg.

i
i
i
.

B.A./B.Sc.

i B. E./B. Tech./ B.Sc.

v (Engg.)/B. Arch.
.

v M.A. /(M.Sc./ M.
. Com/MBA
v M.E./M.Tech./M.Arch.
i
.
v M. Phil
i
i
.
v Ph. D.
i
i
i
.
i Any other
x
.
14.

15.

16.

17.
Sr.
No.

a) Topic of M. E. / M. Tech. / MBA / M.

Phil/Thesis/Dissertation
b) Topic of Ph.D. Thesis
c) Field of Specialization

:_____________________________________
:_____________________________________
:_____________________________________

Details of Research Publication (Attach

reprints of research papers)
a) International Journals
:_____________________________________
b) National Journals
: _____________________________________
c) International Conference
:_____________________________________
d) National Conference
:_____________________________________
e) Seminar
:_____________________________________
f) Workshop.
: _____________________________________
Total
:_____________________________________
Do you belong to any reserved category
: Yes/No
(Scheduled Caste/Scheduled
Tribes/Backward Class/ Ex-Serviceman/
Physical Handicapped). If yes, state the
category and attach the attested copy of
certificate issued by the competent
authority.
Experience (Attach attested copies of relevant certificates):Organization/
Dept.

Post
Held

Basic Pay
& Pay
scale
drawn/
being

From

To

Total
Experience

Reason
for
leaving

drawn
1
2
3
4
18.

Details of present employment (Attach Employers Certificate)

a) Name of the organization
:_____________________________________
b) Designation
: ____________________________________
c) Pay Scale
:____________________________________
d) Basic Pay
:____________________________________
e) Date of Next increment
:____________________________________
Basic pay acceptable
:____________________________________
Minimum joining period required
:____________________________________
Reference from the two responsible persons of the field and not related to you

19.
20.
21.

22.

(i)______________________________

____________________________________

(ii)______________________________

____________________________________

Any other relevant information

:___________________________________

Certified that the above information furnished by me in this application form is correct and true
and nothing has been concealed in it. I also undertake to accept the liability for any action under the rules
for any wrong-statement or concealment of facts on my part.
Place:
Date:

Signature of applicant

DEENBANDHU CHHOTU RAM UNIVERSITY OF SC. & TECHNOLOGY MURTHAL

(SONEPAT)
IMPORTANT INSTRUCTIONS FOR ADVERTISEMENT

Candidates must go through the following instructions before filling up the application form:
1. Name of the post applied for must be super-scribed at the top of the envelope as under:Application for the post of ___________________________.
2. Those who are already in employment should submit their Application Form through proper
channel.
3. Reservation of posts of SC/BC/PH/ESM/Sports will be for Haryana residents only and as per
other conditions of reservation policy of State Govt./University.
4. Candidates applying for the posts under ESM category should submit a certificate duly
issued by the Zila Sainik Board to the effect that his/her father has not availed the benefit of
re-employment in any Government service, Public Sector Undertakings including ParaMilitary Forces, in view of State Government instructions.

5. The complete application forms should reach the office of Registrar, Deenbandhu Chhotu
Ram University of Science & Technology, Murthal (Sonepat) - 131039 by 26th November,
2012.
6. The application forms received after due date shall be rejected. The incomplete application
forms shall also be rejected.
7. The applicants must specifically mention the Category of the post in which he/she is
applying for and must enclose the attested copies of the documents.