Last Date of submission: 01/03/2016

JADAVPUR UNIVERSITY যা দ ব পু র িব শ িব দযা ল য়

PASSPORT SIZE PHOTO PHOTO

Kolkata- 700032

APPLICATION FORM (For Non-Teaching Post) Post applied for : ........................................................................................................ (Advt. Ref. No. & date) .............................................................................................. SBCollect Refarence No.(attach a copy) DU............................................................. 1. Name of the candidate in full: (use block letters) 2. Address in full: a) Permanent ........................................................................................................... ............................................................................................................ ............................................................................................................ Pin .....................................

Phone ...............................

b) Present (for correspondence) ........................................................................................................... [if other than (a)]

............................................................................................................ Pin .....................................

Phone ...............................

3. a) Date of Birth : D

b) Place of birth:

D

M

M

Y

Y

Y

Y

Village/Town/City.................................................Dist............................ State........................................................................................................

4.

Nationality:

By birth........................................................At present...........................

5. a) Religion:

................................................................................................................

b) Caste (SC/ST/OBC-A/OBC-B/UR): .................................................................................................... c) Differently abled:

...............................................................................................................

(evidence to be produced) ............................................................................................................... (Please Specify)

6.

Gender:

7.

Father's name, present or former....................................................................................................

8.

Male/Female/Third Gender and Others

Marital Status:

Married/Unmarried

occupation or profession

....................................................................................................

and address:

....................................................................................................

Mother's name, present or former.................................................................................................... occupation or profession

....................................................................................................

and address:

....................................................................................................

9. Parent's Nationality:

Father.........................................Mother.......................................

10. Husband's/Wife's name, present...................................................................................................... or former, occupation or profession............................................................................................... and address (if applicable):

................................................................................................

11. *Give particulars of all examinations passed and diplomas or degrees obtained at the University or other places of higher or technical education commencing form Matriculation or equivalent examination (attached certified copy of the University or Institution record): University/ Board

Examination passed

Year of passing

Class or Division

% of marks

Subjects taken

Remarks

12. Have you been employed? If so, give the following details, otherwise indicate what you have been doing since your last examination mentioned in item 11 unless the period is covered: Nature of Post

Date of joining

Date of leaving

Salary / Reasons for leaving (Basic & the post allowances)

Name & address of the Employer

Remarks, if any

13. a) Candidate's mother-tongue: b) Other Languages: (if any) he/she can speek, read and write fluently

................................................................................................ ...............................................................................................

14. Any position of authority held or ............................................................................................... distinction gained at school or ............................................................................................... colleges including games, sports and other social activities: ................................................................................................ 15. If higher initial salary is expected please .................................................................................... mention grounds for asking such salary: ..................................................................................... 16. Have you any contract obligations with ....................................................................................... your employer? If so, furnish details: 17. Will you relieved by your employer,

........................................................................................ ..........................................................................................

if selected? 18. Give names of two referees, with address other than your relatives, who are in a position to give information about you and your work: Name

Address & Phone No.

Position

Period for which candidate is known to referee

1. 2.

19. Next of kin to be notified in case of .............................................................................................. emergency (give name, address with)............................................................................................ relationship)

............................................................................................. Pin..........................................Phone....................................

20. Additional Remarks: Applicants may mention here any special qualifications or experience which have not been given under the above items. If necessary, a seperate sheet of paper may be used which should be attached to this application.

21. List of attached testimonials form school/college authorities or present or former employers, sent with the application (originals to be produced when required):

a) b) c) d) e) f)

22. Whether any relative is an employee of Jadavpur University : Yes / No if yes, give details Name................................................................................ Relationship......................................... Designation....................................................................... Department......................................... Section............................................................................... Unit etc...............................................

D E C LA R AT I O N I declare that the entries in this form and the additional particulars (if any) furnished in reply to the questions above are true to the best of my knowledge and belief. Date........................................... Place..........................................

....................................................... Signature of the Candidate (in full)

N.B.

i) Papers and documents submitted with the application will not be returned. ii) Separate sheet(s) may be attached wherever necessary. iii) All enclosures including attested copies of testimonials are to be submitted in single copy. iv) Without attested copies of evidences, the application will be considered incomplete.