Society for Applied Microwave

Electronics Engineering & Research

APPLICATION FORM
(TO BE FILLED IN BLOCK LETTERS ONLY)

Affix Recent
Subject : ________ Post Applied :__________________ Sr.No.______ Passport
Advt. No.:______ Size Photograph

1. Name in full(Shri/Smt/Km) :_________________________________________________

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2. a) Father’s name: __________________________ b) Mother’s name: _________________________________

3. a) Date of Birth: ___________________19 _______

(in Christian era in figures) Date Month Year

b) Age as on closing date mentioned in Advt.: _________Years _________Months _________ Days

4. a) Sex (Male/Female) : _________________ b) Marital Status : ________________________________

5. Nationality: _____________________________

6. Reservation Category (SC/ ST): _____________________6 (a) Religion :_______________________________

(attach certificates if applicable)

7. Type of Present Employment, if employed (Central / State Govt / PSU’s/Others): _________________________

8. Address for correspondence(with Pin Code) _____________________________________________________

(Tele No., Mob. No., Fax & e-mail, if any) _____________________________________________________

9.Permanent Address (with Pin Code) _____________________________________________________

(Tele No., Mob. No., Fax & e-mail, if any) _____________________________________________________

10.Nearest Railway Station _____________________________________________________

11.Educational Qualifications #:
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*Exam University/ Date of Date of Subject Specialisation **Percentage Division Rank/Position
passed Institution/ Joining Passing in which as reqd. in of Marks in the Univ.
Board degree is advt. (if any)
awarded
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* In chronological order from X Standard (SSLC/HS/HSC) onwards, ** In case of CGPA/CPI, please give marks in
percentage also along with the conversion formula, # Specify the gap with reasons in Education career, if any.
12. Whether receiving Scholarship / Fellowship from any agency? If yes, indicate:-
i) Name of Agency, ii) Amount of Fellowship/ Scholarship, iii) Duration (since when)

13. Have you qualified GATE/NET(JRF)/NET : Yes / No/N.A

(a) If yes, give name of Test & year (with percentile for GATE):
(b) If registered for a higher degree, please indicate Title of Degree, University, date of registration and likely date
of completion

14. Professional Training:

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Period
Organisation From To Details of Training
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15.(a) Title of Project / Desertation / Thesis,(b) No.of Papers Published(Separate sheet may be used)

16. Areas of Specialisation/ Research :

17. Employment Record* (Attach separate sheet in following format, if necessary):-

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Name & Period of Designation Scale of Detailed Reason for leaving
address of service of the post pay of description
employer/ From To held each post of work
Orgn/Institution
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* Specify the gap, if any

18. Present Basic pay: Total Emoluments :

19. Are you under any contractual obligations to serve Central/State Govt/Any other Public Sector Undertaking
or Autonomous body and if so, give details :
(attach NOC if applicable)
20. Have you been interviewed for any recruitment/selection by SAMEER during the past one year?
If yes, give particulars:
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Sr Particulars Name of Posts & Date of Result
No. (eg. Date of Advt, Advt. No.) Discipline Interview
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21. Details of relatives already employed in SAMEER:
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Name of the Relative Relationship Lab/Estt in which employed Post Held
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22. Give two referees name & address and attach certificate from them: ________________________________
(Not related to the candidates) (Gazetted Officers/Professors of
reputed academic Institutions/Public Sector Executives etc) ________________________________

________________________________

________________________________

________________________________

23. Any other information you may wish to add, including extra curricular activities (use separate sheet if necessary).

24. Declaration

I declare that the foregoing information is correct and complete to the best of my knowledge and belief and
nothing has been concealed/distorted. If at any time, I am found to have concealed/distorted any material
information, my appointment shall be liable to summary termination without notice. If offered appointment, I will join
on specified date and subsequently, take up duty in the discharge of SAMEER assignments anywhere in India as
and when required.

Place: --------------------------------
Date:
Signature of Candidate
(important : use only a4 size paper for application and other testimonials)
 SUMMARY
(Use Separate Sheet)

Advt. No. : Subject: Post :

Sr. No.

Name : DOB: Nationality:

Month Year
Category: SC
Gen ST Age as on Closing Date:

Central/State Govt./Armed Forces/ PSU’s/Others:

Exam University Subject Month Year %age Div/Gde University Rank

Essential Qualification (EQ)

Highest Qualification (HQ)

Qualified : GATE NET(JRF) NET Year: Score:

Postal Address:

City: PIN:

Tele. No. Mobile: FAX:

(with STD code)

E.Mail :