APPLICATION FOR THE POSITION OF ------------------------------------------------------------------------------------------------------------(Name of the position to be indicated) CODE No.
For Office use only Space for affixing Passport size Photo
Application No.
Date of Receipt
1. Advertisement No. 2.
Date and Name of News Paper in which advertisement appeared
3.
Name in full (In BLOCK LETTERS)
NARL/RMT/03/2016 dated 28.11.2016
4. Nationality 5.
Place of birth (Village/Town, District, State)
6. Date of birth (dd/mm/yy) 7. Name of parent / Spouse
8.
Address for correspondence (in BLOCK LETTERS with PIN Code and contact Phone No.)
9. E-mail id:
Phone No.
10. Nearest Railway Station
11. Permanent Address (in BLOCK LETTERS with PIN Code)
Category ( √ mark) 12. (Must be supported by Documentary evidence)
UR
SC
ST
OBC
PWD
Contd…..…2
:2: 13. Educational /Professional qualification (indicating clearly the examinations passed, University/Board, year of passing and percentage of marks, subjects taken starting from SSC/SSLC onwards to final degree etc. (Enclose copies of certificates & Mark lists)) Name of the Exam
Name of University/ Board
Year of passing
Main Subjects / Specialization
Class & % of Marks*
th
10 or equivalent th
12 or equivalent Degree st
M.Sc 1 year nd
M.Sc 2 year Details of NET/ GATE / JEST/ JAM
*CGPA candidates should specify the equivalent % 14. Details of previous/present employment held, if any, including bond obligations, in chronological order starting from present position to backwards Name and address of State whether Scale of pay/ Period of service the employer/ Govt.quasiPost held Nature of duties Salary drawn From To Organisation Govt./Private
15.
If your replies to (13)&(14) above do not cover all the periods from school leaving till date briefly state how you spent the uncovered period
16. If selected the minimum time required to join the position 17. Any other relevant information you wish to add
DECLARATION I affirm that the information given in this application is true and correct. I also fully understand that if at any stage it is discovered that any attempt has been made by me to willfully conceal or misrepresent the facts, my candidature may be summarily rejected and my fellowship/employment may be terminated.
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