ANNEXURE–

ANNEXURE–1
PRESCRIBED APPLICATION FORMAT–
FORMAT–NON-TEACHING POSITIONS
Advt.No.: IIITP/NT/ADV/R/2024/4404 Date:08/02/2024

Application for the Post of Assistant Registrar

Affix Coloured
Passport Size
Department
Photograph
Signed across
Group/Level A/10

Instructions:
Attach all Annexures as suggested. All Annexures (inA4 size) should be attached in spiral bound form
including this application (No Staples).

Category (A):UR SC ST OBC EWS (tick one, as applicable)

(B) : PWD (tick, if applicable)

Fee Remittance:

Bank/ Place DD/UTR No Date Amount(Rs.500/-orRs.250/-)

Panjab National Bank 601944 07/03/2024 Rs. 590/-

1) Name(in Capital Letters) :VYANKATRAO SAHEBRAO KHAIRNAR

Date of Birth: Sex: M F

DD MM Y Y Y Y

2) Address for Correspondence :

Administration & Purchase Department,

National Forensic Science University, Opposite Goa Milk Dairy,

Curti, Ponda, Goa - 403 401

Contact/ Mobile No.: 9730428084 Email ID : vskhairnar@rediffmail.com

Additional Mobile No.: 9112061974

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Signature of the Applicant

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1. Name of the
Applicant VYANKATRAO SAHEBRAO KHAIRNAR
(In Block Letters)

2. Father’s /
Husband’s Name SAHEBRAO KERU KHAIRNAR
3. Date of Birth Gender Age in Years as on Marital Status
Nationality
(dd/mm/yyyy) Male/Female 18/03/2024 Married/Unmarried
25/04/1974 Male 49 year 10 Months Married Indian
4.
Name of the Institute and Year of %of Marks/ Class/
Qualification Discipline
University Passing CGPA Division

10th -- MSSHSE, Board Pune 1989 54.83% B

Humanities &
12thorDiploma MSSHSE, Board Pune 2000 42.46% Pass
Social Science
Y.C.M. Open University,
Art 1997 52.10% B
Graduation Nashik
Dr. Babasaheb Ambedkar
Marathwada University,
Art 2016 58.50% B+
Post Graduation Aurangabad (Ch. Sambhaji
Nagar)
MS-Board of Technical
Others, if any M.S.-CIT 2002 57% B
Education, Pune

5.
Work Experience Details Total Work Experience (in years): 18.8 years
(Please attach Supporting Documents; Use additional sheets, if required)

Total Salary (Per

Institute/ Designation/
From To Nature of Work month) In Rs.
Organization Post Held
National Forensic
i) Science University, Assistant Administrative -on Rs. 1,00,348/-
20/03/2023 Till Date
Goa Campus Registrar regular post (as per 7th CPC)

Dr. BabasaheB
Ambedkar Marathwada Section Officer Administrative -on Rs. 60,071/- (as per
ii) University, Aurangabad 28/02/2014 20/03/2023
(Superintendent) regular post 6th CPC)
(Ch. Sambhaji Nagar)
Maharashtra University Clear-cum- Administrative- on Rs. 19,000/-
26/03/2007 28/02/2014
iii) of Health Science, Nashik typist/D.E.O. regular post (as per 6th CPC)
The Institutions of Administrative -on Rs. 9,927/-
Office Secretary 19/05/2005 25/03/2007
iv) Engineers (India), Nashik contractual basis (consolidated)

Signature of the Applicant

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6. Description of Work Experience
(Give chronological detailed description of the work performed by you in relation to the previous experience and
related knowledge)
1. Look after day to day administration, maintenance of campus building hostels, under the
supervision & control of Campus Director / Dy. Registrar.
2. Procurement of stationary and other items for Office administration, Lab equipments,
maintain stores and inventory, etc. for these preparing notes, letters, agendas, minutes,
sanction order, Bill, Vouchers, etc.
3. GeM and non GeM items procurement. & working on Member for LDPC, LPC for
procurement procedure
4. Recruitment of contractual faculties, appointment and their records, etc.
5. Timely Payment of electricity bills, water Bills, Telephone bills, etc
6. Liaising with other Govt. entities i.e. CPWD, PWD, Electricity Board, Housing Board, etc.
7. Maintain attendance record all outsourcing staff, Housekeeping and security staff, etc
8. Keeps an inventory of office equipment and furniture, identifies them with unique asset
Nos., co-ordinates annual verification of the assets.
9. Revised, update syllabus with the approval of competent authorities.
10. Examination works- getting exam form filling up with prescribed fees, declare Centers for
examination with the students strengths, preparing panel of Examiners, paper setters,,
etc. examination evaluation,
11. Issued Transcript, Migration, Passing Certificates to all passed out Students, etc.
12. Working in Ph.D. Section for all works related to registration & up to issuing notification of
Ph.D.
Any other Relevant Information such as 1. Working on Computer windows, vista, of day to
Computer Knowledge and Skills which have day office activities.
not been included under the heads given
above.
2. Having knowledge of email, ERP, Internet, MS-
World, excel, power point, etc.
3. Online file tracking system.
4. Working online Marks entry
5. Online exam forms processing of students.

DECLARATION

I hereby, solemnly declare that the information furnished in this application are true and correct to the best of my
knowledge and belief. If at any time I am found to have concealed/suppressed any material/information or have given
any false details, my candidature/appointment shall be liable to be summarily cancelled/ terminated without any
notice or compensation.

Place: Goa

Date: 07/03/2024 Signature of the Applicant

Name: Vyankatrao S. Khairnar

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 CHECKLISTFORDOCUMENTS

Sr. Whether Attached

No. Particulars
(Yes/No/Not Applicable
Yes
Hard copy of the Prescribed Application Form duly
1
signed on all the pages

Yes
th
2 10 StandardCertificate

Yes
th
3 12 StandardCertificate

Yes
Graduation Degree Certificate & Mark- Sheets
4 for all years.

Yes
Post Graduation Certificate &All Mark Sheets for all
5
years

NO
(will be submitted at the time of Interview)
6 NOC Certificate from the Current Employer

Service Certificate for all the previous Yes

employments issued by Cadre Controlling
Authority / Personnel Officer in the prescribed
7
proforma or consisting of all the designations, pay-
scales, type of employment, self-attested along
With offer and discharge letters
Yes
SC/ST/PwD Certificates (wherever applicable)in
8
prescribed pro-forma of Central Government Only

EWS & OBC-NCL Certificate (wherever applicable) NA

9 issued in the current Financial Year only as per
Central Government Format
Yes
Cast Validity Certificate for SC/ST/OBC-NCL
10
candidates belonging to Maharashtra State

Note: - Candidate has to fill the above Check List and attached all the applicable
documents.

Signature of the Applicant

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