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JSS MAHAVIDYAPEETHA

JSS ACADEMY OF TECHNICAL EDUCATION


C-20/1, Sector-62, Noida-201301 (U.P.) Ph: 0120-2400115, 2400104, Fax:0120-2400097

Serial No.:___________
Application for the post of_____________________________________________
1. (a) Name in full___________________________________________________
(In block letters)
(b) Name of Father________________________________________________

2. (a) Permanent Address___________________________________________________________


______________________________________________________________________________
(b) Present Address_____________________________________________________________

Tel No.________________________________e-mail__________________________________

3. Date of Birth ____________________________Age___________________________________


Place of Birth___________________________

4. (a) Nationality________________

(b) Region & Caste___________________

(c) Sex______________________

(d) Marital Status ____________________

(e) Languages Known:


Speak

Read

Write

5. Academic Qualification commencing from Matriculation or Equivalent Examination:


Courses

Name of the institution in


which studied

Univ/Board
institution

Candidates with M.Tech, please indicate if it is Full time

Year of
passing

Class/Grade
if any with
% of Markes

Part time

Specification
if any

Distance learning

6. Have you published any papers? If so, give full particulars in a separate sheet of paper.
______________________________________________________________________________
7. Membership of Professional bodies.
______________________________________________________________________________
8. List of the Sports, Games and other Extra curricular activities in which you have participated.
______________________________________________________________________________
9. Give a list of honors/distinction/Prizes in studies or sports, if any
______________________________________________________________________________
10. Details of Past Employment(Experience)
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

11. (a) Are you in service presently:


If the answer to (a) above is yes, give

Yes/No

Name of the Employer________________________________________________________


Designation_________________________________________________________________
Basic Pay & Gross Salary Drawn ________________________________________________
Scale of pay________________________________________________________________
Total service in the present Cadre_______________________________________________
12. Joining time required if selected __________________________________________________
13. Additional information the applicant wishes to furnish, if any
14. List of enclosures:

1.
2.
3.
4.
5.

I hereby declare that the statements made in this application are true and correct to the best of my
knowledge and belief.
Date
Signature of the Candidate
Place....

NOTE: submit the application along with


(a) Copies of degree certificate and marks-cards for all Semesters/years of the qualifying
examination, Experience certificate, and age proof certificate etc,.
(b) Candidate already employed should enclose a certificate of last salary drawn.

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