Application No.

 (To be filled by the office):_______ 
INDIAN INSTITUTE OF TECHNOLOGY GANDHINAGAR
At – Vishwakarma Govt. Engineering College Campus
Chandkheda, Ahmedabad-382424, Gujarat

APPLICATION FORM FOR JUNIOR STAFF

Demand Draft 
Advertisement No.  Name of issuing bank and date  Amount 
No. 
     
AO/Rect./02/2011-12 

Post Applied for________________________________________

(Please submit separate application if you want to apply for more than one post)
 

1. Name in full (BLOCK LETTERS)__________________________________

_________________________________ Paste a
Passport Size
2. Date of Birth _____/_____/_____ Recent Photo
(As in School Leaving/SSC Certificate)
3. Father’s/ Husband’s Name ________________________________________
4. Mailing Adress ___________________________________________________________
____________________________________________________________
___________________________Pin Code_________________________
Tel. No. (______)__________________Mobile No. _________________
STD Code Number Email ______________________
5. Permanent Address _______________________________________________________
________________________________________________________
___________________________Pin Code_____________________
6. Marital Status _________________ 7. Nationality __________________

8. Category: GEN/SC/ST/OBC (non-creamy layer)/ Physically Handicapped (PH) _______

(For other than GEN, attach copy of certificate)
9. Educational/ Technical Qualification (SSC onwards):
(use extra sheet if necessary)
Percentage of Marks/ Year of
Examination College/ University/ Board
Final Class Passing

SSC
10. Details of Employment (in chronological order, beginning with the first one):
(use extra sheet if necessary)
Name of Institution, Designation/how Period Nature of Total
Address many months in this From To Duties Monthly
capacity Salary last
drawn

I hereby declare that the information given by me in the performa above is correct to the best of
my knowledge and belief.

Date:
Place:
__________________________
(Signature of Applicant)

List of attachments: (please tick mark against attached documents)

self attested photo copies of certificates/testimonials in proof of

(i) Date of Birth Y N

(ii) Non-GEN Category Y N
(iii) Qualification (all mentioned under Sr. 9) Y N
(iv) Experience (all mentioned under Sr. 10) Y N
(v) Demand Draft (original) Y N

Note: Incomplete and/or erroneous applications are likely to be summarily rejected. If any query is
not applicable to you, write NA against it.

The application with all enclosures must reach the following address on or before May 31, 2011.

Assistant Registrar (Admin),

Indian Institute of Technology Gandhinagar,
VGEC Campus,
Chandkheda, Ahmedabad-382424, Gujarat