राष्ट्रीय प्रौद्योगिकी संस्थान पुदुच्चेरी

थिरुवेत्ताकु ड़ी,कारैक्काल– 609 609

NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY
Thiruvettakudy, Karaikal – 609 609

Application Form for Non - Teaching Posts

For office use
APPL. No:

Please read the information carefully on website prior to filling up this application form. You may use
separate sheets wherever required. Documentary evidence(s) is/are to be attached for the data provided in
this application failing which due weightage will not be given during scrutiny. Application should be
neatly typed and submitted in both hard copy as well as soft copy as per the instructions.

Advertisement No. & Date:

SBI Collect Reference No: .

*(Attach Self Attested Copy)

Post Applied for:

Department (for the post of Technical Assistant):

----------------------------------------------------------------------------------------------------------------------------------

1. (i) Full Name (in BLOCK letters):

(ii) Father’s/Husband’s Name:

(iii) Whether belonging to GEN/OBC/EWS/SC/ST/PH

(Attach Certificate)

2. (a) Date of Birth: 2. (b) Age as on the last date of

application:
Years Months

3. (a) Nationality: (b) Gender: Male / Female:

(c) State/UT to which you belong:

1
 (d) Marital Status: Married / Unmarried /Divorced:

(e) Ground for claiming age relaxation (if any):

(Attach relevant document)

4. Postal Address for correspondence. 5. Permanent Address (with Phone no. & Mobile)

Pin Code: Pin Code:

Phone No.: Phone No.:

Res.: Res.:

(With STD Code) (With STD Code)

Mobile No. Email Id:

6. Educational Qualifications (Start with Highest Qualification and enclose all individual marklists):

Division
Sl. Examination Name of the Year of Year of Subject/ % of Marks/ No. of
/
No. Passed University/Board admission Passing Specializ Grade arrears*
Class
ation (CGPA) (if any)

*No. of subjects not cleared in first attempt

7. (a) Post held at present: (if any)

2
 Nature of the Post Name & Responsibilities
Date of
(Temporary/Probation/ Address of in the present
Post held Appointment
Permanent) Employer * job

* Copy of appointment order to be attached

(b) Present Pay Scale: GP/Pay level: Any other Pay:

Basic Pay: Dearness Allowance:

Gross Pay: Total Emolument:

(c) Type of organization (Government/Semi-Government/Govt. Aided/Autonomous Body/ Private etc.)

8. Professional Experience (In the reverse chronological order): (Attach extra sheet if required)

Sl. Name of the Post Period of Employment Pay Scale and Total Reasons for
No Employer held/nature Basic Pay Emolument Leaving
of duties drawn
From To

9. List of expertise you have related with post applied for:

3
 Sl. No. Organization
Name of work Your role Duration Status of Work Remarks
Detail

10. Prizes, Awards, Rank received etc. (if any, attach certificate):

S. No. Details of Prizes, Awards, Rank received etc

1.

2.

3.

4.

11. Training Programmes (Workshop / Seminar) organized / attended: (Attach extra sheet if required)

Sl. Title Venue Duration Sponsoring Authority

No.

12. Languages Known:

4
 Sl. No. Read Write Speak

13. Extra-Curricular Activities:

S. No. Details of Activities

14. Please give details of two referees (Not related to the candidate), At least one should be the current /
previous employer:

(i) Name: (ii) Name:

Designation: Designation:

Full Address: Full Address:

Contact No. Contact No.:

E-mail: E-mail:

15. Any other relevant information :

5
S. No. Details of other relevant Information

6
 DECLARATION

I declare that the statements made in this application are true to the best of my knowledge and belief. I
understand that misleading or wrong information supplied may lead to summarily rejection of
application /appointment (if found subsequently).

Date:
Place: (Signature of Applicant)

7
 Forwarded through Head of the Institute/Organization

Forwarded to NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY, KARAIKAL,

PIN: 609609

The applicant Mr./Ms./Dr. …………………………………………………………, who has submitted

this application for the post of ………………………………………………. in the National Institute of

Technology Puducherry has been working in this organization

namely……………………………………………………………………………………….as…………

…..………………………………………(name of the post), in a temporary/ contract/ permanent

capacity with effect from ………………… in the Scale of Pay/ Pay Band of

Rs………………………./-. He/She is drawing a basic pay of Rs. …………….. /-.

His/her next increment is due on ………………………………….

Also, on his/her selection, he/she will be relieved from the present position of ………………………….

………………………… . Further, it is certified that no disciplinary/vigilance case has ever been held

or contemplated or is pending against the said applicant.

There is No Objection for his/ her application being considered by the National Institute of Technology

Puducherry, Karaikal.

Date:
Place:

Name: Signature of the forwarding Authority

Designation: (with seal)

8
 Summary Sheet for Non - Teaching Posts
National Institute of Technology Puducherry, Karaikal – 609 609
(All data to be filled by the candidate with documentary evidence for scrutiny)

Name of the Candidate:

Post applied for: Department:

Sl. No. Degree Name of Institute/ Subjects Studied Year of % of Marks / For Office
/ Specialization Passing
University Grade (CGPA) Use
1. SSLC
(10th)
Higher Secondary
(10+2)
ITI
Certificate
Diploma
Certificate
UG

PG

Ph.D. / Any other

Qualification
Type Writing
Certificate
Shorthand
Certificate (if any)
2. Post held Organization Years/Months Salary Drawn

Total Experience

3. Technical/Computer Skills e.g.MS

Office/Excel/Any writing skill
certificate in (English/Hindi)

4. Any other relevant Qualifications

deemed fit as per applied post

5. Answer
Providing this information is Mandatory. If space is left blank answer will be Yes /
considered as NO.
No

9
 (i) Have you worked on any post in IIT / NIT/ IISc /Govt. Organization?

(ii) Have you been awarded at State / National level in Academics / Sports?

(iii) Have you been a rank holder during Academic Career? Specify level &
rank.

(iv) Are you holding an analogous post?

6. Any other skilled education:

10
List of enclosures: (*Self attested)
(Please tick in the relevant box)

 S. S. L. C Certificate
 H.S.C. Certificate
 U.G Certificate
 P.G Certificate
 Individual (semester/year wise) mark lists
 Ph. D (if any)
 Skill Certificate (Typewriting 35WPM)
 Shorthand Certificate (80 WPM)
 Experience Certificate
 Reservation Certificate

Any other (Please Specify)




Date: Signature of the candidate

11