Payment details of Application Fee
Space for
Transaction No. &
dt._________________
affixing
passport size
Amount ________________________ NEHRU SCIENCE CENTRE photograph
(a unit of National Council of Science Museums)
Name of Bank __________________ Ministry of Culture, Govt. of India
Dr. E. Moses Road, Worli,
Branch ___ _____________________
Mumbai – 400 018 (Maharashtra)
Form of application for the post of___________________________________
Application for the post of _________________________________ (Trade/Discipline :_________________)
(Category :______________) at Nehru Science Centre, Mumbai against Advertisement No. NSCM/03/2025.
Closing Date 20.03.2025.
1 Name in full :
(in block letters) __________________________________________________
2 Address in full :
a) Permanent Address :
__________________________________________________
__________________________________________________
________________________________Pin Code___________
b) Present Address :
__________________________________________________
__________________________________________________
_______________________________Pin Code___________
Phone No._______________ Mobile No.__________________
Email ID : __________________________________________
3 a) Date of Birth :
b) Place of Birth :
c) Age as on 20.03.2025 : __________ Years __________ Months __________ Days
4 Father’s / Husband’s Name :
__________________________________________________
a) Address :
__________________________________________________
________________________________Pin Code___________
b) Occupation :
(if dead, give last address, in case of __________________________________________________
married woman give husband’s name,
address & occupation)
c) If retired from Govt. Service indicate :
whether he is a Pensioner or a _________________________________________________
Family Pensioner and if so, give
particulars
…2…
:2:
5 Mother’s Name :
__________________________________________________
a) Address :
__________________________________________________
________________________________Pin Code___________
b) Occupation :
(if dead, give last address) __________________________________________________
c) If retired from Govt. Service indicate :
whether she is a Pensioner or a __________________________________________________
Family Pensioner and if so, give
particulars
6 Are you* :
a) a Citizen of India by birth and or by __________________________________________________
domicile?
b) a person having migrated from :
Pakistan or other countries with the __________________________________________________
intention of permanently settling in
India? or subject to Nepal?
‘Yes’ / ‘No’ If ‘Yes’, give details.
* Answer ‘Yes’ or ‘No’ and cancel the
words, which are not applicable.
7 Do you belong to SC / ST / OBC? :
State ‘Yes’/ ‘No’ and if ‘Yes’, indicate Yes / No. (Category:_________)
Caste.
(Attach a certificate(s) from the District Caste:_____________________________________________
Magistrate in support of your claim)
8 Is (or was) your Father - :
(a) A citizen of India by birth and/or by :
domicile? __________________________________________________
(b) A person having migrated from :
Pakistan or Bangladesh or other __________________________________________________
countries with the intention of
permanently settling in India or a __________________________________________________
subject of Nepal?
* Answer ‘Yes’ or ‘No’ and cancel the
words, which are not applicable
9 State your -
a) Religion :
b) Do you belong to EWS category? :
Answer ‘Yes’ or ‘No’. If ‘Yes’,
(Attach an “Income & Asset __________________________________________________
Certificate” issued by a Competent
Authority in the format prescribed by __________________________________________________
Govt. of India for the F. Y. 2023-24
and valid for the year 2024-25)
c) Are you an Anglo-Indian? :
__________________________________________________
…3…
:3:
d) Are you Physically Handicapped? :
If ‘Yes’, give details __________________________________________________
e) Are you Ex-service personnel? :
Answer ‘Yes’ or ‘No’ if ‘Yes’ give __________________________________________________
particulars and attach relevant
discharge certificate
10 Particulars of all Examination passed and Degrees and Technical Qualifications obtained at the University
or other places of higher technical education (commencing with the Secondary or equivalent examination).
Attach self-attested testimonials.
Examination(s)/ Name of the Board / Percentage Class or Year of Major Subjects Taken
Degree University of Marks Division Passing
obtained obtained
1 2 3 4 5 6
11 Particulars of Professional / Technical Qualification :
Examination(s) Name of the Institute/ Percentag Class or Year of Major Subjects Taken
Passed Board / University e of Marks Division Passing
obtained obtained
1 2 3 4 5 6
12 Experience (give details of all employment)
Nature of Employment / Name of Employer/ Date of Date of Salary Drawn
Post held Organization/Company Joining Leaving
1 2 3 4 5
13 Are you a Govt. Servant at present? :
If so, please state whether your ________________________________________________
appointment is Temporary or
Permanent
14 Are you willing to accept the :
minimum initial pay offered? If not, ________________________________________________
state what is the lowest initial pay
that you would accept in the
prescribed scale.
…4…
:4:
15 Do you have any relative working in :
NCSM? If so, please give details. ________________________________________________
16 What language (including Indian languages) can you read, write or speak. Give particulars and state any
examination passed in each.
Read only Speak only Read and Speak Read, Write and Examination passed,
Speak if any
1 2 3 4 5
17 Are you willing to work anywhere in :
India? (Answer ‘Yes’ or ‘No’ ) ________________________________________________
18 List of Enclosures : :
1 6
2 7
3 8
4 9
5 10
Note:
1. Information in respect of columns - 3, 7, 9, 10, 11 & 12 should necessarily be supported by self-
attested copies of certificates & testimonials, otherwise the application will not be considered.
2. If you are in Government/Semi Government service/Public Undertaking/Autonomous organization,
application should be routed through proper channel.
3. Canvassing in any form and/or bringing in any influence, political or otherwise, will be treated as a
disqualification for the post.
I hereby declare that the information furnished in this application is true & correct to the best of my
knowledge and belief.
__________________________
Date: Signature of Candidate
______________________________________________________________________________________
Candidate already employed should get the following endorsement signed by his / her present
Employer.
ENDORSEMENT BY THE HEAD OF THE DEPARTMENT OR OFFICE
(if he/she is Government/Semi Government Servant)
File No.:____________________ Date :___________________________
Name :___________________________
Signature :___________________________
Designation:__________________________
Forwarded