Sl. No. …… Form No. …….
TEZPUR UNIVERSITY
(A Central University established by an Act of Parliament)
NAPAAM :: TEZPUR – 784 028 :: ASSAM Applicants must
APPLICATION PRO-FORMA FOR NON-TEACHING POSTS Paste
here a
(Ref.: Advertisement No. ________________) recent passport
size photograph
(Please read carefully the general conditions / instructions given below before filling in the
form)
To be returned to: Details of application fee (Pl. see instructions below):
The Registrar 1. Name of the bank: ……………………………………..
Tezpur University 2. Demand Draft/Bankers’ Cheque No. ………………...
Napaam, Tezpur – 784 028 Date …………………..
Assam (India) 3. Amount: Rs. …………..
GENERAL CONDITIONS / INSTRUCTIONS
1. Indian nationals only need to apply.
2. Please send crossed bank draft, drawn in any nationalised bank, of the amount as specified in the advertisement in favour of
Registrar, Tezpur University, payable at Tezpur. The bank draft should be drawn only on or after the date of publication of the
advertisement. Application fee sent in other forms will not be accepted. Applicants must write his / her name, address and the
post applied for on the overleaf the bank draft.
3. The application fee is not refundable.
4. For all the posts, where age limit is prescribed, the crucial (calculating) date for the same will be the last date of receipt of
the applications as declared in the advertisement.
5. For the post reserved for PWD, the minimum degree of disability is 40%.
6. Besides normal age relaxation for the reserved categories, Ex-serviceman and In-service personnel as per Govt. of India rules,
further age relaxation to an otherwise qualified candidate shall also be considered depending upon experience and other added/
higher qualification(s).
7. Candidates belonging to OBC (including MOBC) category must submit valid “Non Creamy Layer” certificate from the
appropriate authority, failing which such candidates will not be considered as reserved category (OBC) candidates.
8. The University reserves the right to fill in or otherwise, any or all the advertised posts.
9. Mere fulfillment of minimum qualification and experience do not entitle a candidate to be called for the interview.
10. Minimum requirement of qualification and / or experience may be relaxed in respect of exceptionally outstanding candidates.
Candidate(s) with higher qualification will be preferred.
11. No correspondence whatsoever will be entertained from candidates regarding postal delay, conduct and result of interview and
reasons for not being called for the interview.
12. Persons in employment should submit their applications through proper channel or enclose a “No Objection Certificate” from
their employer. However, a photocopy of the duly filled in application form along with the Bank Draft in original may be sent as
“Advance Copy” in order to avoid delay in receipt.
13. Applicants must fill-in both the parts (Part-A & Part-B) of the application form. Incomplete application and application not
in the prescribed form and application without photocopies of certificates / mark sheets, proof of date of birth, caste certificate,
etc. will be rejected. A list of enclosures must be furnished as provided in the application form.
14. Canvassing in any form will be a disqualification.
15. Any change of address for correspondence should be communicated to the Registrar, Tezpur University, giving reference of the
Advertisement and post(s) applied for.
16. The filled-in application form should be addressed to the “Registrar, Tezpur University, Napaam, - 784 028, Assam
(India) in an envelope superscribing “APPLICATION FOR THE POST OF ….”.
17. The University reserves the right to consider for appointment of persons who have not applied against the advertisement, if
otherwise qualified.
18. Applicants are advised to give phone numbers and e-mail address in their own interest to facilitate prompt
communication. If short-listed, all communications regarding interview, etc. will be made preferably through e-mail.
19. Applicants may attach additional sheet(s) wherever necessary quoting the serial number.
20. Applicants willing to apply for more than one post, must send separate application form for each post(s) along with
separate application fee.
21. Application(s) received after the last date as mentioned in the advertisement shall be summarily rejected.
Name in full (in CAPITAL letters): ……………………………………………………………………………
Post applied for: ………………………………… Department/Centre/Office……………………………….
Category opted (Please tick UR SC ST OBC PWD Ex-Serviceman
): OH VH HH
Signature of the applicant
Page 1 of 4
(To be returned with the filled in application form)
PART-A (BRIEF PARTICULARS OF APPLICANT)
1. (a) Advertisement No. and Date:
(b) Post applied for:
(c) Post Sl. No. as per the Advertisement:
2. Name in full (in CAPITAL letters):
(Please underline the surname)
3. Father’s/Mother’s/Spouse’s Name:
4. (a) Marital Status: (b) Gender: (c) Blood Group
5. (a) Correspondence address (in CAPITAL letters): (b) Permanent address (in CAPITAL letters):
(c) Phone No. Land line (d) e-mail:
(with STD)
Mobile
6. Date of Birth (as per Christian era):
Day Month Year
7. Age on the last date of receipt of application as
stated in the advertisement:
Years Month(s) Day(s)
8. Are you a citizen of India? Write YES or NO
9. (a) Do you belong to Scheduled Caste / SC ST OBC PWD Ex-Serviceman
Scheduled Tribe / Other Backward Classes /
Persons with Disability / Ex-Serviceman?
Write SC/ST/OBC/PWD/Ex-serviceman as the case may be:
(b) If none, write NONE in the box:
(c) If you belong to PWD (Persons with Disability), then state the OH VH HH
nature of disability as OH (Orthopaedically Handicapped), VH
(Visually Handicapped) or HH (Hearing handicapped):
10. Religion:
11. If appointed, what notice / how much time
would you require for joining the post?
I hereby declare that I have carefully read and understood the instructions and particulars supplied to me and that all the
statements made in this application are true and complete to the best of my knowledge and belief. I understand that the
competent authority can take appropriate action against me in case any of the information is found to be incorrect at any
stage.
Date: Signature of the applicant
Place: Name in full: …………………………………………………………...
(Applicants must also fill in the PART-B of the Application Form)
Page 2 of 4
PART-B
1. Educational Qualification:
Class / % of
Sl. Year of the Subject(s) (mention field of Name of the Board /
Examinations Passed Division / Marks
No. examination specialisation / major, if any) University / Institution
Distinction obtained
1. 10th Standard / H.S.L.C. / Matriculation
2. 10+2 Standard (PU / PD / Intermediate)
3. Bachelors’ Degree (Specify BA / [Link]. / B. Com.)
4. Master’s Degree (Specify MA / M. Sc. / M. Com.)
5.
2. Professional / Technical / Other qualifications, if any:
Sl. No. Degree / Diploma Year of the Division / Class % of marks Name of the Board / University / Institution
examination
1.
2.
3.
3. Details of past employment, if any:
Sl. Nature of duties / Date of Date of Length of Additional remarks about
Organisation / Institution Position held Pay scale
No. work joining leaving service experience, if any
1.
2.
3.
4.
5.
Page 3 of 4
4. Present Occupation (if any):
(i) Designation :
(ii) Date of joining :
(iii) Name of the :
Office/Institution /Organisation
with full address
(iv) Scale of pay :
(v) Present basic pay :
(vi) Total emoluments drawn :
(vii) Nature of duties :
5. Training programme(s) attended (if any):
Sl. Name of the programme Organized by Duration Period
No. From To
6. References: Please name two referees who are not related to you. If you are employed, one referee must be
your employer.
(i) Name :
Designation :
Address :
e-mail :
Mobile/Phone No. with STD code :
(ii) Name :
Designation :
Address :
e-mail :
Mobile/Phone No. with STD code :
7. Details of enclosures sent with this application form:
i) ii)
iii) iv)
v) vi)
vii) viii)
ix) x)
8. Declaration:
I hereby declare that I have carefully read and understood the advertisement, instructions and
particulars supplied to me and that all the statements made in this application are true and complete to
the best of my knowledge and belief. I understand that the competent authority can take appropriate
action against me in case any of the information is found to be incorrect at any stage.
Date: Full signature of the applicant
Place: Name in full: ……………………………………
Page 4 of 4