Affix recent
APPLICATION for the post of Passport size
Photograph
1. NAME (In Block Letters) :
2. Father’s Name :
3. Address :
Mobile No :
E-mail ID :
4. Date of Birth : Age : Sex :
5. Place of Birth : District: State :
6. Mother Tongue :
7. Nationality & Religion :
8. Community : GT / GT(W-DW) / BC / BC(W-DW) / MBC/DNC / MBC/DNC(W-DW) / SC / SC(A)(W-DW)
9. Caste :
10. Academic Qualifications :
Academic / Technical Board / Branch/ Year of Class
[Link] Name of the Institution % of Marks
Qualification University Discipline Passing Obtained
Specialisation : ___________________________________________________________________
11. Professional / Teaching / Research Experience (attach separate sheets if necessary)
Period of Employment Teaching /
Sl. Pay and Scale Industrial/
Name of the Post Employer
No of Pay From To Yrs Mon Research
12. Present Salary Drawn :
Scale of pay Pay Drawn
13. Membership of Professional Bodies :
14. Co-curricular activities :
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
d. __________________________________________________
15. Extra-curricular activities :
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
d. __________________________________________________
16. Any other relevant Information:
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
Place: Signature:
Date: Name : _________________