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Dr. Babasaheb Ambedkar Technological University, Lonere
Advertisement No.: DBATU/REG/ADVT/ Date:
08/02/2024
Online payment details:-
Reserved Category Rs. 500/ and Other Rs. 1000/
Affix passport
UTR No.:___________________ size photo
Amount Paid:_______________
To,
The Registrar,
Dr. Babasaheb Ambedkar Technological University,
Lonere, Mangaon,
Raigad 402103
Sub: Application for the post of Registrar
Please [√ ] wherever applicable
1.
Surnam
e
Name in full First
Shri/Smt./Kum name
. (in BLOCK Middle
letters) name
[Link] Address
Current postal address
(in BLOCK letters)
Email ID
Mobile No.
Tel. No.
3. Personal Information
D D M M Y Y Y Y
Date of Birth
Years Month Days
Age (as on date)
s
Birth Place
Nationality
Male/ Female
Married/ Unmarried
4. Category
Caste S.C. S.T. D.T. N.T. S.B. O.B.C OPEN
category (A) C. .
B C D
5. Educational Experience
Educational Qualification
Examinatio University/ Month and Subject Percentag Class/
n Board Year of e of Marks Division
Passing obtained
S.S.C.
H.S.C.
Graduate
Post-
Graduate
Doctor’s
Degree
Any other
qualificatio
n
6(a). Teaching Experience
Institution/ Position Nature of Period of Total Exp.
Organization Held Appointment appointment
From To
(Date) (Date)
Asst.
Professo
r
Asst.
Professo
r Senior
Scale
Asst.
Professo
r
Selectio
n Grade
Asso.
Professo
r
Professo
r
6(b). Administrative Experience
Institution/ Position Nature of Period of Total Exp.
Organization Held Appointmen appointment
t From To
(Date) (Date)
Head
Dean
Registrar
Any Other
6(c). Professional Experience/ Research
Institution/ Position Nature of Period of Total Exp.
Organization Held Appointme appointment
nt From To
(Date) (Date)
7. Other Qualifications and experience, if any.
8. Implementation of Innovative Administrative Practice (If any, describe
in 100 words).
____________________________________________________________
____________________________________________________________
9. Knowledge of ICT (Mention specific skills):-
10. Give your vision note on ‘Unversity Governance in the light of NEP
implementation’. (Please give details on separate sheet)
11. (a) Present position:
(b) Name of Institution/ Organization where employed:
(c)
Salary:
Pay Level:
D.A. Rs.
H.R.A. Rs.
C.L.A. Rs.
Others Rs.
Allowances, if
any
Total Rs.
(d) Date of appointment:
(e) Date of next increment:
(f) Attach Last Pay Certificate, if any
12. Names of persons who have given reference letters.
Sr.
No Name & Designation Email ID Mobile No.
.
13. Names and addresses of not more than three persons to whom
references may be made
1) ____________________
2) ____________________
3) ____________________
I hereby declare that all statements made by me in this application are
true, complete and correct to the best of my knowledge and belief. I
understand that in the event of any information being found false,
incomplete or incorrect, my candidature/ appointment is liable to be
cancelled/ terminated. I further understand that no notice shall be taken
of any request for withdrawal of my application.
Place:
Date:
(Signature of candidate)