उड़ीसा के ीय िव िव ालय

Central University of Odisha

Application form for Group A /Group B /Group C Non–Teaching Positions
Advt. No:CUO/Admin.//Rect./NT/82 Dt.24.07.2020

Affix a Latest self

attested passport
Application Fee Details:
size photograph
SBI i-Collect Ref.No. and Date :

Amount of Fee :

1. Name of the Post applied for

2. Whether on Direct Recruitment or
on Deputation
3. Full name in Capital letters
4. Date of birth (DD/MM/YYYY)
Age as on ---------------
5. Father’s Name
6. Mother’s Name
7. Gender (Male / Female / TG)
8. Nationality
9. Category (UR/SC/ST/OBC/EWS)
10. Whether applicant is physically
disabled person. If so relevant
particulars may be furnished.
11. Address for communication with
Pin code

Phone No./ E-mail

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12. Educational Qualifications:

Name of Name of the Board / Month Class / CGPA, if Subjects

Examination University & Year Division applicable
passed and % of
Marks

13. Administrative experience: (in reverse chronological order)

Designation Name of the From To Scale of Pay/ Nature of duties

Organisation/ (DD/MM/ (DD/MM/ Basic Pay/
University/ YYYY) YYYY) Total
Institute emoluments
Level of Pay
(7th CPC)

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14. Teaching / Research Experience
(Applicable for the Post of Controller of Examination / Librarian only)

1. Experience Details
(Supporting documents should be attached)
A. Teaching Experience
B. Research Experience
i. Student –Research – P.G
ii. Student – Research – Ph.D
iii. Sponsored Projects
iv. Consultancy Projects
C. Examination / Library Related
(as the case may be)

D. Publications:

a. International Journals
b. National Journals
(Peer reviewed)

c. Papers published in
International Conferences

d. Papers published in National

Conferences

e. Books / Chapter published

15. Awards:

16. Present Position:

(Latest pay slip may please be attached)

Designation
Name of the Employer
Date of Appointment
Present Level of Pay /
Scale of Pay

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Present Basic Pay &
Total emoluments
Date of next
Increment

17. If selected, how much time you need to join the University:

18. Any other relevant information, you wish to furnish:

(Please attach separate sheet, if needed.)

19. Name and address of two References with complete address and contact no./e-mail

1. 2.

Declaration

I declare that the information furnished in this application is true to the best of my knowledge and
belief. I have not suppressed / concealed any information which may disqualify for the post for
which I am applying. If anything is found false at any stage, my candidature may be cancelled
without assigning any reason thereof.

Signature of the Applicant with date

Endorsement of the Forwarding Officer / Authority

Mr. /Mrs. / Ms. -------------------------------------------------------- Designation -----------------------------

----------- is working in ---------------------------------------------- on permanent / temporary basis.
His /her basic pay is ----------------- and gross emoluments are ---------------------. His/ her
application is forwarded and he/she will be relieved from this organisation within ------------- days
after receiving the appointment order. 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 Central University of Odisha.

Date : Signature
Place :

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