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Project Assistant Application Form

This 3-page document is an application form for the position of "Project Assistant" at Dr. D. Y. Patil Institute of Engineering, Management and Research in Pune. The form requests information such as the applicant's name, date of birth, contact details, educational qualifications, experience, publications, personal details, and a declaration signed and dated by the applicant. It instructs applicants to email the completed form in PDF format by September 12, 2018 and mentions the application is subject to being incomplete will not be considered.

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nemaderakesh
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24 views3 pages

Project Assistant Application Form

This 3-page document is an application form for the position of "Project Assistant" at Dr. D. Y. Patil Institute of Engineering, Management and Research in Pune. The form requests information such as the applicant's name, date of birth, contact details, educational qualifications, experience, publications, personal details, and a declaration signed and dated by the applicant. It instructs applicants to email the completed form in PDF format by September 12, 2018 and mentions the application is subject to being incomplete will not be considered.

Uploaded by

nemaderakesh
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Dr. D. Y.

Patil Institute of Engineering, Management and Research,


Pune
Advt. No. 01/2018
Application form for the post of “Project Assistant”
Project code : 178

Affix passport
1. Name(in block letters):_____________________________________________________________________________________
size photograph
here at time of
2. Date of Birth (DD/MM/YY):____________________________________________________________________________ interview

3. Address for Communication: Permanent Address:

__________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________

__________________________________________________________________
__________________________________________________________________
City:____________________________Pin :____________________________ City:____________________________Pin :____________________________

Phone No.:______________________________________________________ Phone No.:______________________________________________________

*Email:_________________________________________________________

*Please make sure that the e-mail ID is correct and legible.

[Link] of University/ Institution Studied (10th onwards):


Degree / Subjects/Area of Year of Average
Institution Class
Examination Passed specilaization Passing Marks/CGPA

[Link] Qualifying Examination(s) Passed (if any):

(a) CSIR/UGC- NET-JRF (b) JEST/GATE

Registration/Roll No.:_________________________________________ Registration/Roll No.:_____________________________________

Date of exam:___________________________________________________ Score (percentile and Rank):_____________________________

Valid till:________________________________________________________ Valid till:___________________________________________________

Page 1 of 3
[Link] (Teaching/Research/Industrial etc) if any:
Period
Name of the Organization Designation Nature of Work
From To

7. Research Publications (if any, submitted/accepted/published):

8. Personal Information:
a Nationality
b Gender
c Marital status
d Father’s/Spouse’s Name
e Whether person with disability : Yes/No
(if yes, furnish necessary document)
f Whether belongs to: UR / SC/ST/OBC / PH Category?
(Please write as applicable)

Send the completed application by email (convert into PDF Format) addressed to
vpdive@[Link] on or before September 12, 2018.

Please mention “Project Assistant” in the subject line of the email.

(Note: Incomplete applications will not be considered)

Page 2 of 3
DECLARATION
I hereby declare that I have carefully read the instructions and particulars supplied to
me and that the entries made in this application form are correct to the best of my knowledge
and belief.

Place: Signature of the Applicant


Date: (To be signed at the time of interview)

(The print out of this application form signed and dated by the applicant along with recent passport size
photograph and photocopies of relevant certificates and other testimonials in support of age, qualification,
caste, experience etc. will be collected at the time of interview. Applicant has to bring all the original
certificates at the time of interview for the purpose of verification, along with one set of self attested
photocopies)

Page 3 of 3

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