VASANTA COLLEGE FOR WOMEN
(Admitted to the Privileges of Banaras Hindu University)
KFI, Rajghat Fort, Varanasi
APPLICATION FORM FOR TEACHING POST
Advertisetment No. _____________________________________________________ Date _________________
Post applied for ______________________________________________________________________________
Department _______________________Specialization (for Education Department Only)______________________
(For office use only)
Details of fee payment :
Registration Number ______________
DD No. __________________________ Paste your recent
No. of Enclosures Claimed ________ passport size
Dated ___________________________ photograph here
Attached________ and sign across the
Amount _________________________ photo so that part
of signature should
(Signature) Bank Name ______________________ be on form
Branch __________________________
1 Name
(In Capital Letters)
Day Month Year
2 Date of birth
3 Place of birth City/Village State Country
4 Father's Name
5 Mother's Name
6 Nationality
7 Gender Male/ Female/Transgender
Category SC/ST/OBC/Other categories give details ______________________
8 (Please strike out whichever options
are not applicable) S. No. of proof enclosed ______________
Marital status Married / Unmarried/ Divorcee
9 (Please strike out whichever options
are not applicable)
Name of spouse ____________________________________
10 If differently abled, indicate the relevant Yes/ No Percentage of S. No. of proof of
particulars disability enclosure
a. Blindness or low vision:
b. Hearing impairment
c. Locomotor disability or Cerebral Palsy (includes
all cases of Orthopedically handicapped)
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11. Address for correspondence
(a) Mailing address ________________________ (b) Permanent address _____________________________
______________________________________ ____________________________________________
______________________________________ ____________________________________________
______________________________________ ____________________________________________
(c) E-mail ___________________________________(d) Mobile No.___________________________________
(e) Alternate Mobile No. ______________________ (f) Landline No. ________________________________
12. Educational Qualifications (Attach additional pages, if required)
Name of Name of Year Di CGPA % of Marks Subjects S. No. of
course the Board/ passed visi (if grading is (pl. indicate studied proof of
University /Awarded on applicable) equivalent to enclosure
CGPA also)
(a) (b) (c) (d) (e) (f) (g) (h)
10th Class /
equivalent
10+2/Higher
Secondary
equivalent
Bachelor's
degree
Master's
degree
[Link]*
[Link]*
Title:
M. Phil.
Title:
Ph.
D./[Link].
NET/ SLET/SET for Subject Roll No. Year
Assistant Professor, if
any
Any other exams passed
13. Nature of experience S. No. of proof of
a) Teaching No. of years No. of months enclosure
i) Under-graduate level
ii) Post-graduate level
b) Post-doctoral experience
c) Other experience, if any
Total experience
* (Only for the post of Assistant Professor in Education.)
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14. Chronological list of teaching experience (starting from current position/ employment)
Designation Scale of pay Name & Period of Experience Nature of S. No. of
& present address of From date To date No. of work/ proof of
Basic & AGP employers years/ duties enclosure
months
(a) (b) (c) (d) (e) (f) (g) (h)
* (Add separate sheet if required, to be annexed at relevant S. No.)
15. Details of Post doctoral experience S. No. of proof of
Agency Host Institution From To Duration enclosure
Total experience years Months
* (Add separate sheet if required, to be annexed at relevant S. No.)
16. Academic distinctions and Awards S. No. of proof of
Name of the Academic Course/ Body Academic distinction obtained enclosure
* (Add separate sheet if required, to be annexed at relevant S. No.)
17. Names and complete postal addresses of 3 referees (The referee should be the last employers of the
candidate or any other person having know-how of candidate's experience/ knowledge and should not be related
to the applicant)
Referee-1 Referee-2 Referee-3
Names, Designations & complete
postal address
Email:
Phone (Landline) with STD code
Mobile No.:
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18. RESEARCH, PUBLICATIONS AND ACADEMIC CONTRIBUTIONS
(A) Published Papers in Journals (UGC Listed Journals/Peer Reviewed Journals)
S. Title Name ISSN Impact Whether No. of Whether you Score* S. No. of
No. with of No. factor Peer co- are the first or proof of
Page Journal reviewed. authors corresponding enclosure
nos. Impact author
factor, if
any
*Please refer to table 3B of UGC Regulation 2018
List of self attested testimonials attached (original to be produced at the time of interview)
S. No. of
S. No. Check List enclosure
No. of sheets
i. 10th Class / equivalent mark sheet/ certificate
ii. 10+2/Higher Secondary equivalent mark sheet / certificate
iii. Bachelor's degree mark sheet/ certificate
iv. Master's degree mark sheet/ certificate
v. [Link] (Final) mark sheet/ certificate
vi. [Link] mark sheet/ certificate
vii. M. Phil. degree certificate
viii. Ph.D./ D. Phil. degree certificate
ix. [Link]., [Link]., L.L.D. degree certificate
x. NET, UGC-JRF, CSIR-JRF Award Certificate
xi. Caste Certificate issued by the Competent Authority (OBC-
NCL/SC/ST)
xii. Experience certificates
xiii. No Objection Certificate if employed
xiv. Award (s)
xv. Fellowship(s)
xvi. Publication (s)
xvii. Disability Certificate issued by competent Authority
Total number of sheets enclosed_________ (please give sequential number to each sheet and signature with date).
19. Have you been reprimanded ever Yes/No
Give detail if yes __________________________________________
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20. Any other information/ qualification relevant to the post applied for:
21. Declaration
I, ________________________ son/ daughter of ________________________________ hereby declare that all
the statements and entries made in this application are true, complete and correct to the best of my knowledge
and belief. In the event of any information found false or incorrect or ineligibility being detected before or after
the Selection Committee and Management meetings, my candidature/ appointment may be cancelled by the
College.
I have never been convicted or contemplated for any unlawful activity.
Signature of the Applicant*
_________________________________
Date : ______________________ *Application not signed by the candidate is liable to be rejected
22. Endorsement by the EMPLOYER
a) In case of in-service candidates in Government/ Semi-Government organizations/ Public Sector Undertakings
/ Autonomous Organizations, the endorsement form must be signed by the employer.
b) In case of in-service candidates from Private Sector, acceptance of resignation and relieving letter from the
employer must be submitted at the time of joining.
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Forwarded to the Manager, Vasanta College for Women, Varanasi-221001
The applicant Dr./Mr./Mrs/Ms. _____________________________ who has submitted this application for the
post of _____________________________________in Vasanta College for Women, Varanasi, has been in
employment in a temporary/ contract/ permanent capacity on the post of ______________________with effect
from ________________ in the Scale of Pay of Rs. _______________________. He/She is drawing a basic
pay of Rs. ________________________________. His/ Her next increment is due on ___________
Further, it is certified that no disciplinary/ vigilance case has ever been held or contemplated or is pending
against the said applicant. There is no objection for his/her application being considered by the Vasanta College
for Women and in the event of selection, he/she will be relieved to join Vasanta College for Women,
Varanasi as per rules.
Signature of the forwarding officer with seal
Name :_________________________________
Designation:__________________________
Place:__________________________________
Date:__________________________________