Bidhan Chandra Krishi Viswavidyalaya P.O.- KRISHI VISWA VIDYALAYA, MOHANPUR- 741 252 DIST- NADIA, WEST BENGAL

APPLICATION FORM FOR CANDIDATES

(Space for Office use only)

Received SBI Draft No………………………… Rs. ….………… dated .......................... ..... as application fee Signature of the receiving assistant

(TO BE FILLED IN BY THE CANDIDATE IN HIS/HER OWN HAND WRITING)

To The Registrar Bidhan Chandra Krishi Viswavidyalaya P.O. Krishi Viswavidyalaya Dist. Nadia. Pin : 741 252 West Bengal

Space for candidate’s photograph (Passport size)

Sir, In response to your advertisement No. ……………………………… I wish to apply for the post of ………………………………………………….. My particulars are given below.

Signature of Candidate in full 1. Name in full (in Block letter)

Surname

2. i) Candidate’s address in full where correspondence is to be made with contact number & email id (if any)

(i)

ii) Candidate’s permanent address

3. i) Date of birth (ii) Place of birth

Name

(ii)

(i)

(ii)

iii) Dist. and State to which you belong iv) Whether an Indian citizen. 4. Father’s name, address and occupation (if dead, state his last address & occupation before death

(iii)

(iv)

2 5. i) Marital status

i)

ii) Husband’s name, occupation & address for

ii)

Married/Unmarried/Widow/Divorced

married woman candidate only) 6. Candidate’s mother tongue 7. Give particulars of all examinations passed and degree and technical qualifications obtained at the University or other places of higher technical education or instruction (commencing with the Matriculation/Secondary or equivalent examination. Examination School/College Year of Class or Subject Academic or Degree or or University Division & % Distinctions, if Admission Passing of Diploma any marks out obtained

8. Reasons of gap, if any: 9. Scholarship and fellowships enjoyed:

10. In which language (including Indian languages) you can read, write or speak. Give particulars and examination(s) passed in each. Read only Speak only Read & speak Read, write and speak Examinations passed

11.

a) Are you free from debt ? b) If you are under liability to repay money advanced by any institution or party for education or for any other purpose: State the particulars. Answer ‘Yes’ or ‘No’ to question (a). If the answer is ‘No,’ answer question (b) clearly.

12. Whether belong to Scheduled Caste/Tribe/OBC. If yes, give details with attested copy. 13. Present and previous employment: - Give Particulars Name of Designation Pay scale and Date of Permanent or employer of post salary (Basic + temporary Joining Leaving other allowances

Reason leaving

of

3 14.

Teaching Experience: (May be given in Annexure)

15. Research Experience/Extension Experience: (May be given in Annexure)

16.

Co- curricular activities: (May be given in Annexure)

17. Are you prepared to accept the minimum initial pay offered ? If not, state what is the lowest initial pay that you would accept in the prescribed scale : 18. Particulars of place (with periods and residence) where you have resided for more than one year at a time during the preceding five years. From To Residential address in full Name of the District Headquarters of the place mentioned in the preceding column

19. a) Have you ever been arrested, prosecuted, kept under detention of bound down/fined, convicted by the Court of Law for any offence or debarred disqualifying by any selection/examination or rusticated by any university or any other educational authority/institution. b) Is any case pending against you in any Court of Law, university or any other educational authority/institution at the time of filling up this form? If the answer to (a) or (b) is yes, give full particulars 20.

If selected, what notice would you require before joining?

21. Research Publication – Give details paper here and attach reprints with the application (use extra sheet if required)

22.

Special qualifications or experience, if any –

4 23.

Name and designation and address of two referees must not be related with the candidate

24.

List of documents attached to the application –

Declaration I hereby declare that the statements in this application form are true to the best of my knowledge.

Date:

Candidate’s full signature

CANDIDATE ALREADY EMPLOYED SHOULD GET THE FOLLOWING ENDORSEMENT SIGNED BY HIS/HER PRESENT EMPLOYER No. ………………..

Date …………………………..

i)

The entries relating to the details of service mentioned by …………………………………. are correct.

ii)

There are no circumstances rendering him/her unsuitable for appointment to the post applied for ……………………………………………………………………

iii)

His/Her confidential dossiers/Service Book is/are attached

(Office Seal) Date: ………………………

Signature Designation Department/Office