Annexu

re-I
Application Form for Direct Recruitment of Teachers

Bank Draft
Details (Date
& amount &
Name of Bank): _________________________________________
If you have applied earlier, give details: -
Advt. Post Categor Fee Mode of Payment of application fee
No. applied y Submitted Cash Demand Draft (Number, Date & Name of
for (in Rs.)
Bank)

1. Full Name (In block letters) ___________________________________________

2. Post applied for Department______________________
Paste Attested
3. (a) Fathers/Husbands Name: ________________________________________ Passport Size
Photograph
(b) Mothers name: _________________________________________________
4. Address with phone/email (if available):
Address for Correspondence Permanent Address
Address: Address:

Phone: Phone:
Email:
5. (a) Date of Birth: (b) Place of Birth: (c) Nationality:
(d) Male or Female: (e) Marital status: (e) Category:
(f) Religion:
6. Educational Qualifications (Strike off which is not applicable):
Exam Passed University/ Year of Percentage of Division Main Award/Medal/
Board Passing Marks/Grade Subjects Merit, if any
Matric
Hr.Sec./Pre.Univ./ 10+2/
Inter/Equivalent
BTech/BBA/BSc/B.Com/
Any Other
MTech/MBA/MCom/MA/
MSc /MCA /Any other
NET/GATE
M.Phil
Ph.D Subject...............................................
Topic of Thesis..

Year of Award of Degree .

Name of the University/Institute that has awarded the Ph.D.

Any other Exam.

Area of Specialization

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7. Teaching/Professional/Research positions held (Give in chronological order starting with the present
post).
Employer Post held Pay Scale Basic Pay Period of employment Nature of duties/ work

8. (a) Has there been any break in your service career? ________________________________________
If so, give details thereof with reasons_________________________________________________
(b) Have you ever been punished during your service:________________________________________
or convicted by a Court of Law? If so, give details._______________________________________
(c) Have you ever been declared medically unfit? or asked to submit your resignation or discharged or
Dismissed from service? If yes, give details on a separate sheet._____________________________
9. (a) Total teaching experience(full-time) in Institute/College/University:_________________________
(b) Total Research experience: ______________________________________________________
(c) Any other experience: ______________________________________________________

10. Guidance/Supervision of Ph.D. Thesis:

(a) Number of Candidates registered for Research Supervision at present: ____________________
(b) Number of Candidates who have successfully Completed/Submitted Ph.D Thesis.
11. Have you studied Hindi up to Matric standard? Yes/No
12. Present Designation and Grade Pay (Rs)In the Pay Scale of (Rs).
Total Emoluments..
13. List of Publications:
Publications Published Accepted for Publication
With details of publication With details
Books
a) Independently
b) Jointly
Research Papers
a) Independently
b) Jointly
Patents
a) Independently
b) Jointly
Any Other Publication
a) Independently
b) Jointly

*Paper accepted for publication will carry weight equivalent to published paper

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14. Any other relevant information:

It is certified that the foregoing information given by me is correct and true to the best of my knowledge
and belief and no material information has been concealed. Further, I am aware of the fact that if the
information given above is found incorrect or false at any stage, I am liable to be punished.

Date. Signature of the Candidate

No Objection Certificate (For Employed candidates)

This is to certify that the institute/ college/ university has no objection if Mr./Mrs./Dr
S/o, D/o Mr. / Dr. .. is appointed by the
Deenbandhu Chhotu Ram University of Science & Technology, Murthal. His/ her work and conduct at
this place is . as per the records. He/ she bears a
.Character.

Head of Institute/ College /University

with Seal
..

For office use only

Recommendation of Screening Committee

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