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Non Teaching Application Form

The document is an application form for a non-teaching position at the National Institute of Technology Goa. It requests information such as the applicant's name, address, date of birth, nationality, employment history, academic qualifications, references, and a declaration that the information provided is true. Supporting documents such as mark sheets must be attached.

Uploaded by

Athiesh Kumar
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108 views3 pages

Non Teaching Application Form

The document is an application form for a non-teaching position at the National Institute of Technology Goa. It requests information such as the applicant's name, address, date of birth, nationality, employment history, academic qualifications, references, and a declaration that the information provided is true. Supporting documents such as mark sheets must be attached.

Uploaded by

Athiesh Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NATIONAL INSTITUTE OF TECHNOLOGY GOA

(Ministry of Human Resource Development,Government of India)


Farmaguid, Ponda-403 401,GOA.

APPLICATION FOR A NON-TEACHING POSITION

(Please Fill in BLOCK LETTERS)

Advertisement No.

Post Applied for

Department

1. Name in Full (First Surname)





(Please tick)

2. Address: Present



Permanent :



FAX
E-mail
Telephone Office: Residence: Cell:

3. Date of Birth: 4. Nationality:


Day

Month

Year
5. Present Employment:
Designation
Organization
Date of joining
Scale of Pay (Rs).
Basic Pay (Rs.)
Total Emoluments
(per month)(Rs.)



6. Basic Pay expected (Rs.) : ________________


Affix here recent
passport size
photograph



Married


Single
Male Female


4

7.(a) Tick-mark the appropriate box if you belongs to the particular category

GEN SC ST OBC


(b) Occupation of father and Mother: _____________________

(c) Yearly income of parents (Rs.) ______________


8. Total years of the experience after attaining essential qualification


9. Areas of Specialization



10. Academic Record starting with secondary education ( Please attach Xerox copies of all Certificate & mark sheet)

Examination Branch/
Specialisation
College/University
/Institute
Year Percentage of
mark

Class/
Division/Grade
















11. Employment: [particular of your past position (s)]

Name of the
Employer
Post held Period of Employment Basic Pay with
Scale of pay
Nature of Duty
From To






12. Have you ever been discharged/suspended from any position? :
If yes , state reasons:

13. Special Achievements or Awards/Honours received, if any:
Year Name of Award/Honour/Achievement











14. Names and addresses of three Referees (at least one of them should be familiar with your recent works)
(1) (2) (3)

Name

Occupation
or position

Address



Fax


E-mail

Phone No.



15. Any other point that the Board should consider for selection:






16. I hereby declare that I have carefully read and understood the instructions and particulars
supplied to me, and that all entries in this form as well as attached sheets are true to the best of
my knowledge and belief.

There are ____________________ attached sheets along with this form.


Date:
Place:
(Signature of Applicant)


Note: Use separate sheet if necessary for any of the above items.

List of Attachments:

1.
2.
3.
4.
5.
6.
7.

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