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Indira Gandhi National Tribal University: Amarkantak (M.P.)

This document is an application form for non-teaching posts at the Indira Gandhi National Tribal University. It requests information such as personal details, educational qualifications, work experience, references and a declaration signed by the applicant. It also includes instructions that currently employed candidates should apply through their employer and that the institution has no objection to the applicant being considered for the position.

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Jana Vinaya
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© © All Rights Reserved
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47 views4 pages

Indira Gandhi National Tribal University: Amarkantak (M.P.)

This document is an application form for non-teaching posts at the Indira Gandhi National Tribal University. It requests information such as personal details, educational qualifications, work experience, references and a declaration signed by the applicant. It also includes instructions that currently employed candidates should apply through their employer and that the institution has no objection to the applicant being considered for the position.

Uploaded by

Jana Vinaya
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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Indira Gandhi National Tribal University

Amarkantak (M.P.)
(A Central University established by an Act of Parliament)
Mekal Sadan, Kapildhara Road, Amarkantak (M.P.) 484 886
website: www.igntu.nic.in , www.igntu.ac.in
APPLICATION FORM FOR THE NON-TEACHING POSTS
Ref. No. IGNTU/Rec.Cell/2015/032/ Dt. 20/
20/01/2015
01/2015
Post applied for .

Last date of Submission: 28.02.2015

vkosfnr in ------------------------------------------------------Affix Recent


Passport Size
Photograph

Field of Specialization of above post (if any).............

mi;qZDr in ds fo'ks"kKrk dk {ks= ;fn dksbZ gks


Applied Under category Gen / SC / ST /OBC / PH .....

Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk-@vuq-t-tk@v-fi-o-@fodykax ---------------------------------------------------------------Particulars of fee Remitted :
Bank Draft No.
Amount

'kqYd dk fooj.k%
jkf'k #-

1.
2.
3.

cSad MkV la[;k

Date

Issuing Bank

fnukad

tkjhdrkZ cSd

Full Name (in Block Letters)

_____________________________________________________________

iwjk uke fgUnh esa lkQ v{kjksa esas

_____________________________________________________________

Fathers/Husbands Name

_____________________________________________________________

firk@ifr dk uke

_____________________________________________________________

Mothers Name

_____________________________________________________________

ekrk dh uke

_____________________________________________________________

4. (a) Address for Correspondence


(b) Permanent Address
i=kpkj dk irk
LFkk;h irk
______________________________________
__________________________________
______________________________________
__________________________________
______________________________________
__________________________________
Tel. No. ____________________________
Tel. No. ________________________________
Fax No. ____________________________
Fax No. ________________________________
e-mail: ____________________________
e-mail: ________________________________
5. Date of Birth & Place
6. (a)
tUe frfFk ,oa tUe LFkku
(b)
___________________________________
___________________________________
(c)

Age as on 28.02.2015
28.02.2015 dks vk;q
Years okZ

Months ekg

7. Marital Status : Married / Unmarried


oSokfgd fLFkfr % fookfgr @ vfookfgr

Sex: Male/Female fyax

% iq#k @L=h
Category : SC v-tk- / ST v-t-tk- /
OBC v-fi-oxZ / General lkekU;
If person with disabilities

fodykax gksus dh nkk esa


VH oh-,pHH ,p-,p-

Days fnu

OH vks-,p-

Please tick in the appropriate box

8. (a)
(b)

mi;qZDr ckDl esa lgh dk fukku yxkosaA


Nationality jkVh;rk __________________
Religion /keZ

_______________________

9.

Academic Qualification (Commencing with the High School or an equivalent examination)

kS{kf.kd ;ksX;rk gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa

Examination
Degree

Subject /
Specialization

Yea
r

ijh{kk@ mikf/k

fok;@
fokskKrk

okZ

Divisio
n
Js.kh

% of Marks /
Grade

University / College /
Board foofo|ky;@

vad % @xzsM

dkyst@cksMZ

Distinctions /
Scholarship

fofkVrk@
Nk=o`fk

Matriculation /
10th / Secondary
Intermediate /
+2 / HS
Graduation/ + 3

Post Graduation

Any other
Qualification

10. Employment (Give particulars in descending order starting with the present post) fu;kstu orZeku in ls izkjEHk
djds vojksgh e esa fooj.k nsaA
Name & Address of
Employer fu;ksDrk dk

Post Held

**Present

in

Pay Scale

uke vkSj irk

osrueku

Basic Pay as
on date

ewy osru

Total
Gross
Pay

ewy osru

Period of
Employment

Nature of
Duties/Work

fu;kstu dh vof/k

dk;ksZa ds Lo:i

From

To

ls

rd

* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;kkklh@futh


** Mention whether revised or unrevised, if relevant. d`i;k lakksf/kr vFkok vlakksf/kr osrueku dk mYys[k djsaA
11. Details of Training Programmes attended @Hkkx
Name of Programme

dk;Ze dk uke

Year

okZ

fy;k x;k izfk{k.k dk;Zeksa dk fooj.k


Duration (in days)

vof/k

Organizing Instituion

vk;kstd laLFkku

12.

Extra curricular activities-give details, if any, of proficiency acquired in games, sports and of participation in
other extra curricular or social activities such as NCC, Public Lectures, Debates, Social Service etc.

vU; xfrfof/k;ksa dk fooj.k& ;fn dksbZ gS] [ksy dwn] ,u-lh-lh-] laokn izfr;ksfxrk vkSj lekt lsok vkfn
As a student

fo|kFkhZ thou esa

After entering into service

ukSdjh esa vkus ds ckn

13.

(a) Any other Experience/Achievement /Qualificaiton considered to be relevant to the post applied for:

v vU; vuqHko@miyfC/k@;ksX;rk tks vkosfnr in ds fy, izklafxr gS

(b) Other activities/Responsibilities:

c vU; xfrfof/k;k @ mkjnkf;Ro

(c) if appointed, what period would you require before joining the post ?

l fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko;drk gS \

(d) Any other relevant information, if not given above:

n vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks ij u nh x;h gks %

14.

15.

Have you ever been convicted or any case pending against you.

Yes/No

vki U;k;ky; ls dHkh nafMr gSa \ dksbZ eqdn~nek vkids fo:) py jgk gS \

gk@ugha

Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three reference not related to you.
Reference should be of persons with or under who have intimate knowledge of your work.

(i)

rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs Qksu] QSDl ua- ;fn gS ds lkFkA lUnHkZ O;fDr og gksuk pkfg;s ftlds
lkFk ;k ftlds v/khu vH;FkhZ us dk;Z fd;k gks ;k tks vH;FkhZ ds dke ls iw.kZr;k voxr gksA
Name & Address:
Ph.No.
Name & Address:

Mobile No.

E-mail :

(ii)

Ph.No.
Name & Address:

Mobile No.

E-mail :

(iii)

Ph.No.

Mobile No.

E-mail :

List of Enclosures (Please tick in the box)

layXu vfHkys[kksa dh lwph


1
2
3
4
5
6
7
8
9
10

Declaration to be signed by the applicant


I _______________________________________ hereby declare that the entries in this form
are correct and true to the best of my knowledge and belief. If at any time, I am found to have
concealed /suppressed any material/information or given any false details, my appointment shall be
liable to be summarily terminated without notice or compensation.

vH;FkhZ }kjk gLrk{kfjr ?kksfkr i=


eSa ----------------------------------------------------------------------------------------------- ;g ?kksfkr djrk@djrh gw fd bl vkosnu esa nh
x;h lHkh lwpuk;sa esjh iw.kZ tkudkjh ,oa fookl esa lR; gSA ;fn fdlh le; ;g ik;k x;k fd eSaus dksbZ lwpuk
fNik;h gS vFkok esjs }kjk nh x;h dksbZ lwpuk vlR; ik;h x;h rks esjh fu;qfDr fcuk fdlh uksfVl vFkok eqvkots
ds c[kkZLr dj nh tk;sxhA
Place:

Signature of Applicant

LFkku

vH;FkhZ ds gLrk{kj

Dated:

Name in BLOCK LETTERS

fnukad

uke

Forwarded with the remarks that the institution/organization has no objection to the
candidature of the applicant being considered for the post applied for, as above.
bl vkk; ds lkFk vxzsfkr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk
dks dksbZ vkifk ugha gSA
Place:

LFkku

Signature

Dated:

fnukad
Telephone

(Head of the Institution/Organisation

VsyhQksu

laLFkku@laxBu izeq[k

Fax

Designation with SEAL

QSDl
bZ&esy

in
Address :

irk

Remarks:
fVIi.kh%
1. Candidate already employed should submit application through his/her employer.
fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA

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