ANNEXURE-I

PROFORMA FOR APPLICATION

Space for
1.

Advertisement No:

2.

Post Applied for:

3.

Bank Draft No. of Rs. 1,000/- only

with date & amount:

4.

Name (in block letters):

photograph duly
signed by the
candidate

Last Name:
Middle Name:
First Name:
5.

Fathers /Husbands Name:

6.

Permanent Address :

7.

Address for correspondence :

Pin code :
Tel. No. & Fax No. with STD Code:
E- mail :
Mobile :

8.

Nearest Railway Station:

9.

Date of Birth (Date/Month/Year):

(please attach certificate)

10.

Age as on 31st January 2015 :

(in Years, Months and Days)

11.

Scale of Pay of present post & present Basic Pay and Total emoluments drawn:
(for employed candidates)

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12. Educational Qualifications starting with Higher Secondary (10+2):

Exams
passed :

13.

Name of
the Board/
University

Year of
passing

Subjects

Division

If Ph.D., mention the following:

(i)

Title of thesis:

(ii)

University:

(iii)

Name of Supervisor(s):

(iv)

Year of award of the degree:

(please attach copy of doctorate degree)

(v)

Summary (maximum 2 pages):

14.

Secondary and Tertiary skills, if any :

15.

Number and details of papers published :

(Attach list)

16.

Number of books published (Attach list) :

17.

Total experience as on 31.01.2015 in years and months

(a)

After M.A/M.Sc:

(b)

After Ph.D:

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Percentage
of marks
obtained

Annexure
Number

18.

Employment details (Chronologically from present position backwards):

Name of the
Employer/
Organization

Post held
Full Address of
Employer/Organization (with pay
scale)

Period
From* To*

Total
emoluments
drawn (Rs.)

Nature of
duties/
experience

* Specify Month and Year

19.

References: (Name and Designation along with contact address details including fax,
email and mobile)
(i)
(ii)

20.

Any other relevant information:

21.

List of Enclosures Attached:

DECLARATION
I affirm that information given in this application is true and correct. I also fully understand
that if at any stage it is found that any attempt has been made by me to wilfully conceal or
misrepresent the facts, my candidature may summarily be rejected and employment
terminated.
PLACE :
DATE :

(SIGNATURE OF THE APPLICANT)

......................................................................................................................................................

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CERTIFICATE TO BE FURNISHED BY THE EMPLOYER/FORWARDING

AUTHORITY
Certified that :
(i)

The particulars furnished by Dr./Shri./Smt/Kum.___________________are

correct.

(ii)

There is no vigilance/disciplinary case either pending or contemplated against

him/her.

(iii)

Integrity of the applicant is certified.

(iv)

The applicant would be relieved to join the Wildlife Institute of India in the
event of his/her selection within a 3 month period.

Date :
Name :
Department :
Office :

Signature of Head of Department/Forwarding Authority

Tel. No. :

Fax No. :

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Mobile:

E-mail :