NATIONAL ASSESSMENT AND ACCREDITATION COUNCIL
(An Autonomous Institution of University Grants Commission)
Application Form
Please strike out whichever is not applicable.
Please fill the form with your own handwriting in CAPITAL LETTERS
Name of the post applied for ICT Consultant /Sr. ICT Consultant (on contract basis)
Post applied: __________________________________
Part 1
(General)
Affix your
Name in Full as per SSC Records : ___________________________________________ recent passport
size photograph
Name in Full : First Name __________________________________
Middle Name __________________________________
Last Name __________________________________
Place of birth (City, District and State):__________________, __________________, ___________________
Date of Birth : DD________MM_________YY__________________ Gender :______________
Nationality :_______________________Religion :_______________________
PWD : VH_____________HH___________________OH________
Marital status :___________________________________________________
Father’s Name/Husband Name:____________________________________________________
Mother’s Name :___________________________________________________
Permanent Address :___________________________________________________
:___________________________________________________
:______________________PIN Code______________________
Address for communication :____________________________________________________
:____________________________________________________
:_________________________PIN Code___________________
Contact No. :_______________________Email id:_____________________
PAN Card No. :___________________________________________________
Blood Group :____________________________________________________________________
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NATIONAL ASSESSMENT AND ACCREDITATION COUNCIL
(An Autonomous Institution of University Grants Commission)
Part-2
(Qualification and Experience)
Educational/Professional Qualifications in reverse chronological order (Attach attested copies of
Certificates and Mark Sheets)
Examination Passed Board/ Duration of Degree Year of % of Div.
University Passing Marks
Technical qualifications, if any
Examination Passed Board/ Duration of Degree Year of
University Passing
Details of employment, if any in reverse chronological order (Attach separate sheets, if necessary).
Period of
Nature of work Employment
Name of the Post Regular/ Total
Temporary Emoluments
Organization held
From To
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NATIONAL ASSESSMENT AND ACCREDITATION COUNCIL
(An Autonomous Institution of University Grants Commission)
Please provide relevant Organizational experience, particularly in the area of the field of System
Administration, setting up New Systems, Managing and Maintaining websites of the organizations and
understanding and application of Open Source(Attach Photocopies of Relevant Certificates) :
# Section/ Office From To Position Responsibility Responsibilities
Held Type
(Please attach detailed summary of experience, organisation, period etc.)
Any other Relevant Information (if any):
If appointed, how much time would you require to report for the duty?
Referees (Two), with name designation and address :
(These should be persons resident in India and holders of responsible position, and should be intimately
acquainted with applicant’s character and work, but shall not be related to the applicant. Where the
candidate has been in employment She/ he should either give her/his present or the most recent employer
or immediate superior as a referee or produce a testimonial from him in regard to his/her fitness for the
post for which she/he is an applicant. The referee’s names should include complete postal address including
phone/mobile numbers and e-mail address)
First Referee:
Name : Position :
Address : Email ID :
Phone No.: Mobile No. :
Second Referee:
Name : Position :
Address : Email ID :
Phone No.: Mobile No. :
Did you previously apply for any post in this institute? If yes, provide particulars including outcome of
application:
Have you ever been discharged/ suspended from any position?:(Yes/ No)If yes, provide particulars:
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NATIONAL ASSESSMENT AND ACCREDITATION COUNCIL
(An Autonomous Institution of University Grants Commission)
Have you ever been convicted by any court of Law? : (Yes/ No)
Have you any relation among the employee of NAAC?: (Yes/ No)
If yes, provide details:
Details of enclosures: (attach separate sheets, if necessary). Candidates need to provide only the attested
photocopies of certificates/marks card/Experience Certificates/ Salary certificates Address proof/Aadhar
card/PAN card)
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
11. 12.
DECLARATION
I hereby declare that, I have carefully gone through the advertisement and recruitment rules and have understood
it. I also hereby declare that I have carefully read and understood the instructions/notes contained in the above and
that all the entries in this form are true to the best of my knowledge and belief. I also declare that I have not
concealed any material information which may debar my candidature for the post applied for. In the event of
suppression or distortion of any fact, like educational qualification or experience, made in this application form, I
understand that I will be denied any employment in the Institute.
Place………………………
Date………………………. Signature of the Applicant
(Please sign on all pages)
Note: For applying more than one post, please submit separate applications for each post.
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