TAMIL NADU DR.J.
JAYALALITHAA FISHERIES UNIVERSITY
APPLICATION FORM
(For Technical Posts Only)
Photo
Application Number
(For Office use Only)
Advertisement Number :
Date :
Application Fee Details :
DD No. :
Date :
Bank :
Amount (Rs.) :
Application for the Post of
.
In the discipline of
.
1 Name of the
Applicant
(In BLOCK LETTERS)
2 Father’s Name
Mother’s Name
Spouse Name
3
Date of Birth
Age (as on cutoff
date) Enclose Years Months days
Attested Proof
4 Place of Birth and Nativity (District and State):
Enclose Attested Proof
Gender (√ mark) Male Female Transgender
5
1
6 Nationality
7 Community (√ mark) OC BC BCM MBC DNC SC SCA
ST
Caste (Enclose proof)
8 Marital Status (√ mark) Married Single
9 Permanent Address
(Door No., Street Name,
Village/Town, District,
State, Pin code)
10 Address for
Correspondence
(Door No., Street Name,
Village/Town, District,
State, Pin code)
E-mail Address
Mobile Number
Aadhar Number
11 Mother Tongue
12 Vernacular Language in
School / College
13 Other Languages known
To Read
To Write
To Speak
14 Name of the Qualification / Examination
Period of
study
From To
X or SSLC
XII or HSC
UG Degree
PG Degree
Ph.D.
Degree
Note: Attach attested copies of certificates in support of each degree or diploma
received
2
e List of Books / Book chapters/Manuals published
Title Year Author Co-Author Publisher
Note: Furnish only the number published for a to d, Enclose the list of publications with
Author(s)/ Year/ Title / Journal/ Separately and copy of the first page of the publications use
a separate sheet if required.
19 Workshop / Seminar / Symposia / Summer Institute/ Refresh course Attended and
conducted
Attended Conducted
Title
From To From To
National
International
Note: Use a separate sheet if required; Enclose proof
20 Training Attended and Conducted
Attended Conducted
Title
From To From To
National
International
Note: Use a separate sheet if required; Enclose proof
21 Guidance of research scholars as Chairman of the Advisory Committee (Enclose Certificate
page of Thesis)
Degree Awarded Submitted In-Progress
Ph.D.
[Link].,
Others
22 Medals/Awards won
Name of the award Award given by Award given for
Year
(Indicate) (Organization) (Purpose of award)
International
National
State
University
Society
Others
Note: Use a separate sheet if required; Enclose proof
4
23 Funds mobilized
Name of the
Position Research Funding agency Duration Amount
Scheme
Pl
Co-Pl
Others
24 Patent / Innovation / Technology Transferred (Enclose proof)
Name of the patent/
Year Beneficiary Utility
Innovation / Technology
25 Extracurricular Achievements (NCC/NSS/Sports and Games etc.,)
Period
Activity Level
From To
Note: Use a separate sheet if required; Enclose proof
26 Scale of Pay in the Present Post and Basic pay drawn, if already employed
27 Is there any commitment to serve any organization? Yes / No
If yes, furnish details.
28 Countries visited, if any and the duration and purpose of visit
Country visited Duration Purpose of visit
Note: Use a separate sheet if required; Enclose proof
29 List three referees known to you who can certify your professional competency
Name Address with Phone number
Note: Testimonial from referees to be produced at the time of interview
5
30 Any Other Information regarding experience, etc., in support of satisfying the
eligibility conditions prescribed for the post now applied for.
Note: Use a separate sheet if required.
31 List of Professional Societies in which you are member and position, if any
Professional Society Position
Note: Evidence to be produced at the time of interview
32. DECLARATION
I solemnly and sincerely affirm that all information furnished in the application are
true and correct to be best of my knowledge and belief.
Should there be any incorrect or false information having been furnished that may
come to light in due course, I find myself for such action as the University may
decide.
I understand that I am liable for criminal prosecution and the University has the right
to cancel my candidature / selection as the case may be and I would forego my
selection and the application fee.
I further undertake to submit all the required originals at the time of interview
process, as per the Tamil Nadu Fisheries University rules, failing which I would forego
my interview.
Place:
Date: Signature of the Candidate