GAURBI COLLEGE OF EDUCATION, ROHTAK (Govt.-Aided and affiliated to M.D. University, Rohtak) Sr. no. 22, Application Form e Paste here For office use only port "| DiaryNo, copy of zs your recent nacernrt Post applied for : ‘Name of the Newspaper. Dated Details of fee: Demand Draft Nos. (In favour of Principal, payable at Rohtak) Date ‘Amount (Rs.) ‘Name of applicant: (in block letters) Father's Name: (In block letters). Mother's Name ((In Block Letters). Date of Birth: Day, Month. Year (As recorded in the matriculation certificate) Age Years. months (as on the last date fixed for the receipt of application) Sex: (Male/Female) Marital Status: Nationality: Religion: ADHAR No. of Candidate: ‘Address for Correspondence (in Capital Letters): Pin Code, Mobile No, E-mail: Permanent Address (in Capital Letters): ee as Pin Code, Mobile No. 2 a ee E-mails- aA A LTT 3 tucational Qualifications :(Please attach one set of self attested copies along with original application). - ‘Sr. Exam Passed Year of Subjects Division with | Name of the No passing rade/CGPA | Board/University 1 Matriculation zz 12"/ Equivalent 3 BA/B.SC/.Com. 4 MA/M.Sc./M.Com. 4 B.Ed. 5 M.Ed. 6 M.Phil. I UGC (NET)/JRF 8 Ph.D. 9 Any Other 14. Research and Publications: ‘Sr. Name of the journal Year/ | impact | Title of the paper Referred | UGC Listed or No. ISSN Factor or Not Not No. = 15. Books Published: Sr.No. | Title of the Book 1SBN | Publisher's Name ‘Author/ Co- Year ] No. author16. Seminars and Conferences: No. Sr. | Name of institute Pate/ Year Co- presenter Presenter] | Title of the paper Seminar/ ‘Sponsored Workshop/ | by Conference 17. Chronological list of Teaching Experience: (Includi Current Position/ Employment) Sr. No. Name of the Institution Designation UG/PG | PayScale with GP Period From To Field of Specialization Ifeurrently employed, submit the NOC issued by the Employer. 18, Extra Co-curricular activities L19. List of documents attached withthe Application, Form. 1 a a 4 5 6 7 8 9 10 Note:~ The Candidate may use extra sheet of paper, if required, for furnishing any other relevant details. ‘A copy of the Application Form also be sent to The Dean, Colleges Development Council, M.D. University, Rohtak Place: Date: ‘Signature of the Applicant For Office Use Discrepancy (ies) if any: Eligible/ Ineligible: Signature of the Screening Committee