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Application Form

This document is an application form for recruitment to a post at the National Institute of Technology, Raipur. It requires applicants to fill in personal details, educational qualifications, employment history, and references, along with necessary declarations and enclosures. The form must be completed in capital letters or typewritten on A-4 size paper.

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KING Official
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29 views4 pages

Application Form

This document is an application form for recruitment to a post at the National Institute of Technology, Raipur. It requires applicants to fill in personal details, educational qualifications, employment history, and references, along with necessary declarations and enclosures. The form must be completed in capital letters or typewritten on A-4 size paper.

Uploaded by

KING Official
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
NATIONAL INSTITUTE OF TECHNOLOGY, RAIPUR APPLICATION FORM FOR RECRUITMENT TO THE POST OF. {All the columns are to be compulsorily filled in neatly in capital letters or should be type-written using only A-4 size paper in the prescribed format) ‘Affix 4. Advertisement No. si attested passport 2. Code No. ae size photograph 3. Name of the post applied for 4. Name of the Applicant a. Postal address for communication b Permanent Address 5. a. Telephone No. x as b. E-mail 6. Father's /Husband Name 7 Date of Birth a i erage (as per SSC/SSLC/HSLC) 8 Gender Male (Female 9. Nationality 10. Religion 11. Category & Caste ‘Scheduled Caste (SC) / ‘Scheduled Tribe (ST) / Other Backward Community (OBC) | General (UR) Physically Handicapped (PH) / Ex-Servicemen (Ex-Ser) (Should enclose valid certificate (Non Creamy Layer ' Validity) as applicable issued by the competent authority in the form prescribed by Govt. of India) Cont... sl 12. Have you ever been convicted by a court of law or is there any criminal case disciplinary action / vigilance enquiry pending against you? WAY SRO: oo eee event Ny eee ee 13. Education / Professional/Technical Qualifications (Use Annexure-1. Attach attested copies of certificates / mark sheets. etc.) FullName | Board’ | Duration of | Year of] Division | Subject(s) | Specialization ofthe | Institute’ | DegreeDip.' | Passing] with % | studied Examination | University | Training of Passed Marks 14 Details of employment in reverse chronological order. In case of re- appointment/promotion in different scale, please mention on the subsequent row with all details. (Use Annexure - I) Fullname | Post] Regular! Period of Period of Pay Gross of the Org.! | held | Temporary’ | employment each Scale | Emoluments Dept./ Permanent/| From | To | employment Institute Contract | (ou | om | in Years my) | wiyy) | __Months 15. Ifappointed, how much time will you require for joining the post 7 16. Please name three references who are not your relatives : Sr | Name Occupation [ Address Tel. No: Email 17. Any other relevant information : 18. Details of Enclosures hereby declare that | have carefully read and fully understood all the instructions and details pertaining to the post being applied by me and all statements made and information furnished in this application are true and complete to the best of my knowledge and belief | also declare that | 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 category or educational qualification, etc. made in my application form, | understand that | will be denied any employment in the Institute and if already employed on any of the posts in the Institute. my services will be terminated forthwith. Place Date (Signature of applicant ) ANNEXURE -1 Education/Professional/Technical Qualifications(Attach attested copies of certificatesimark sheets, etc.) Board / Institute / Full Name of the Duration of | Year of Examination Passed University Degree/Dip.! | Passing Training (Signature) of employment in reverse chronological order. on the subsequent row with all details. (Attach atteste ANNEXURE -II In case of re-appointment) d copies of certificates) promotion in different scale, please mention Full Name of the Org.’ Dept. Post held Regular Period of employment | Period of each Pay Scale Gross Institute Temporary From To employment in Monthly Permanent’ | (oommrvy) | (oonamy) | Years ! Months Emoluments Contract (Signature)

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