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CENTRAL UNIVERSITY OF HARYANA

gfj;k.kk dsUæh; fo'ofo|ky;
FOR OFFICE USE ONLY
¼dk;kZy; ç;ksx gsrq½
SERIAL NO.
¼Øe la[;k½
APPLICATION FORM FOR TEACHING POSTS (Part – A)
¼'kSf{kd inksa ds fy, vkosnu&i=½ (Hkkx & v)
Name of the post applied for……..………………………………….
¼vkosfnr in dk uke½
School/ Department …….…………………………………………...
¼Ldwy@foHkkx½ PASTE HERE A
Advt. No (foKkiu la0)….…………Date ¼fnukad½ ………………. SIGNED COPY OF
YOUR RECENT
DEMAND DRAFT PARTICULARS (fMekaM Mªk¶V dk C;kSjk) PASS-PORT SIZE
Name of the Bank D.D. Number Date Amount PHOTOGRAPH
¼cSad dk uke½ ¼Mh-Mh- uEcj½ ¼fnukad½ ¼jkf'k½

1. Name in Full ¼iwjk uke½ ..…..……………………………………………………………..…………………….

(IN BLOCK LETTERS)

2. Father’s Name ¼firk dk uke½ ………………………………………………………………………………….

3. Mother’s Name ¼ekrk dk uke½ …………………………………………………………………………………
4. Husband’s Name (in case of married Women) ¼ifr dk uke (fookfgr fL=;ksa ds fy,½) ………………………..
…………………………………………………………..
5. Date of Birth: Day ¼tUe frfFk: fnu½ …………….…..Month ¼ekg½ ………………Year ¼o"kZ½ ……………..
(As recorded in the Matriculation or equivalent certificate (eSfVªd ;k led{k çek.k&i= ds vuqlkj ))
6. Age mez (as on the last date fixed for the receipt of application
(vkosnu i= çkfIr ds fy, fu/kkZfjr vafre frfFk ij ) ……………..years¼o"kZ½ …………months ¼ekg½

7. Nationality ¼jk"Vªh;rk½ ……………………………………….….

8. Religion ¼/keZ½ ……………………………………………..

9. Marital Status: ¼oSokfgd fLFkfr½: Married ¼fookfgr½ Unmarried ¼vfookfgr½

10. Sex: ¼fyax½: Male ¼iq:"k½ Female ¼efgyk½
11. Do you belong to any reserved category? ¼D;k vki fdlh vkjf{kr oxZ ls vkrs gS ½?: Yes gk¡ No ugh
If yes, specify the category (SC/ST/OBC/PWD) ¼;fn gk¡ rks Js.kh fufnZ"V djsa (vuq0 tkfr/vuq0 tutkfr/vU;
fiNM+k oxZ/'kkjhfjd v{ke)
12. If physically disabled, indicate the relevant particulars ¼;fn gk¡ rks C;kSjk ns ½%&
Nature of Disability If applicable, Percentage of
Write ‘yes’ disability
¼v{kerk dh çd`fr½ ¼;fn ykxw gks rks ^gk¡^ fy[ks½a ¼v{kerk dk çfr'kr½
a. Blindness or low vision :
v- ¼va/krk ;k de n`f"V½
b. Hearing impairment
vk- ¼Jo.k ckf/kr½
c. Locomotor disability or cerebral palsy (includes all cases of
Orthopaedically handicapped)
b- ¼efLr"d dk jDrJko i{kk?kkr (vfLFk fodykax ds lHkh ekeys
'kkfey)
13. Permanent Address ¼LFkk;h irk½ ………………………………………………………………………………..
………………………………………………………………………………………………………………………
PIN CODE ¼fiu dksM½ …………….…..Phone No ¼Qksu ua0½……………………Cell ¼eks0½ ………………….…

Address for correspondence ¼i=kpkj dk irk½ ……………………………………………………………………..

……………………………………….PIN CDE ¼fiu dksM½ …………..……….…..………………………………
Email ID ¼bZ&esy½.……………………………………………………………..……………………….……

14. Educational qualifications (Attach additional pages, if required)

¼'kS{kf.kd ;ksX;rk (vko';drkuqlkj vfrfjDr i`"B yxk;sa )

Month CGPA
Name of the Board % of
Name of & Year passed Division (if grading is Subjects studied
the
/ University ¼mÙkh.kZrk dk ekg ¼Js.kh½ Marks applicable) ¼fo"k;½
¼cksMZ@fo'ofo|ky; dk ¼vad dk
course vkSj o"kZ½ çfr'kr½ ¼lhth,ih
uke½ (xzsfMax ç.kkyh
¼ikB~;Øe dk
uke½ esa)
(a) (b (c) (d) (e) (f) (g)
10th Class /
equivalent
10+2
/equivalent
Bachelor’s
degree
Master’s
degree
M.Phil. /
equivalent
Ph.D.

Indicate specifically whether Ph.D. degree has been

awarded Yes ¼gk¡½ / No ¼ugha½
¼D;k ih,p-Mh- dh mikf/k çkIr gks xbZ gS ½
Whether Ph.D. degree was with course work or not Yes ¼gk¡½ / No ¼ugha½
¼D;k ih,p-Mh- mikf/k ds lkFk dkslZ odZ 'kkfey Fkk½
NET/SLIET for
lectureship, if any Subject Roll No Year Position
¼usV/LysV ¼fo"k;½ ¼vuqØekad½ ¼o"kZ½ ¼fLFkfr½
O;k[;krk ds fy,½

Any other
exams passed
¼;fn vU; dksbZ
ijh{kk mÙkh.kZ dh gks½
 15. Chronological list of experience (including current position/ employment)
¼vuqHko] c<+rs Øe esa (orZeku fLFkfr/ jkstxkj lfgr)
Period of Experience
¼vuqHko dh vof/k½ Nature of Scale of Pay
To date No. of years/ Appointment ¼osrueku½
Designation & Name & address of From ¼dc rd½ months / work /
scale of pay employers date (As on date of Duties
¼inuke o ¼fu;ksDrk dk uke Advertisement) ¼fu;qfDr dh
osrueku½ ¼dc ls½ ¼o"kZ ,oa ekg dh çd`fr/dk;Z / PB AGP
,oa irk½ la[;k ¼ihch½ ¼,thih½
çd`fr½
¼foKkiu dh frfFk
dks½
(a) (b) (c) (d) (e) (f)

16. Nature of experience ¼vuqHko dh çd`fr½

a) Teaching ¼f'k{k.k½ No. of years No. of months
¼Lkky½ ¼Ekghus½
i) Under-graduate level ¼Lukrd Lrj½

ii) Post-graduate level ¼LukrdksÙkj Lrj½

b) Post-doctoral experience
¼iksLV&MkWDVjy vuqHko½
c) Other experience, if any
¼vU; vuqHko] ;fn gks½
Total experience ¼dqy vuqHko½

17. Details of Post doctoral experience ¼ih,p-Mh- mikf/k ds ckn ¼iksLV MkWDVjy½ vuqHko dk C;kSjk½
Agency Host Institute From date To date Duration
¼,tsalh½ ¼estcku laLFkku½ ¼dc ls½ ¼dc rd½ ¼vof/k½

18. Academic distinctions ¼fo'ks"k ;ksX;rk½

Name of the Academic
Academic distinction obtained
Course / Body
¼vdknfed ikB~;Øe dk ¼çkIr vdknfed oSf'k"V~;½
uke@ckWMh½
19. Publications, if any (Mention here only numbers. The details and copies of the reprints be enclosed)
¼çdk'ku, vxj gks rks (;gk¡ dsoy la[;k dk mYys[k djsa. foLrkj ds fy, iqueZqfær çfr;ka layXu djsa )
Published [Indexed / Communicated
Publications ISBN / ISSN numbered] Accepted / In [other than b & c]
¼çdk'ku½ (No.) Print (No.) (No.)
¼Lohd`r@eqæ.k esa½ ¼ [k vkSj x ds
¼çdkf'kr½ (la[;ka)
[baMSDl]vkb,lch,uWvkbZ,l,l,u vfrfjDr çsf"kr½
¼la[;ka½] (la[;k)
(a) (b) (c) (d)
Books
¼iqLrdsa½
Research
Publications
¼'kks/k&çdk'ku½
Other publication
¼vU; çdk'ku½
20. Seminars ¼fopkj&laxks"Bh½

Seminars/ Conferences/ Workshops/ Training National International Total

programmes, attended. (No.) (No.) (No.)
¼laxks"Bh@lEesyu@dk;Z'kkyk@çf'k{k.k dk;ZØe ¼jk"Vªh;½ (la[;k) ¼vUrjkZ"Vªh;½ ¼dqy
esa Hkkx fy;k½ (la[;k) la[;k½

21. Seminars ¼fopkj&laxks"Bh½

Seminars/ Conferences/ Workshops/ Training National International Total
programmes, organized. (No.) (No.) (No.)
¼fopkj&laxks"Bh@lEesyu@dk;Z'kkyk@çf'k{k.k ¼jk"Vªh;½ ¼vUrjkZ"Vªh;½ ¼dqy
dk;ZØe vk;ksftr fd;k½ (la[;k) (la[;k) la[;k½
(la[;k)
22. Research projects (only externally funded)
¼'kks/k ifj;kstuk (dsoy ckg~; foÙk çk;ksftr )
As PI/CO-PI or Amount of grant
Title of projects completed Funding Agency
Investigator and duration
¼laikfnr ifj;kstuk dk uke½ ¼çk;ksftr ,tsalh½ ¼ihvkbZ@dks&ihvkbZ ;k ¼vuqnku dh jkf'k
buosfLVxsVj ds :i esa½ ,oa vof/k½

Title of ongoing projects ¼pkfyr 'kks/k&ifj;kstuk dk uke½

23. Research guidance ¼'kks/k funsZ'ku½

Research guidance (No. of students guided) M.Phil. / Equivalent (No.) Ph.D. (No.)
¼'kks/k funsZ'ku (fo|kfFkZ;ksa dh la[;k ) ¼,e-fQy-;k led{k½ ¼ih,p-Mh½-
(la[;k) (la[;k)

Completed ¼lEiUu½
Under supervision ¼pkfyr½

24. Present position ¼orZeku fLFkfr½

Name of the University Pay in Pay Gross Pay / Total Increment

GP/AGP
Designation / institution Band (Rs.) Salary p.m. (Rs.) date (Date/Month)
(Rs.)
¼Ikn½ ¼fo'ofo|ky;@laLFkku ¼is&bu is cSaM½
dk uke½ ¼:i;s½ ¼thih@,thih½ ¼dqy os¼:i;s
ru çfrekg½ ¼osru o`f) frfFk½
½
¼:i;s½ ¼fnu@ekg½
25. List of self attested testimonials attached (original to be produced at the time of
interview). Please tick the ones applicable.
¼layXu Lo vfHkçekf.k çek.k&i=ksa dh lwph ¼ewy lk{kkRdkj ds le; çLrqr djuk gksxk½ d`i;k ykxw
dks fpg~fur djsa½%&
i. Matriculation mark sheet and certificate
¼ek/;fed ¼eSfVªd½ dk vad&i= ,oa çek.k&i=½
ii. Intermediate marksheet and certificate
¼mPp ek/;fed ¼baVjfefM,V½ dk vad&i= ,oa çek.k&i=½
iii. Bachelor’s Programme (Final) mark sheet and degree
¼Lukrd ¼Qkbuy½ dk vad&i= ,oa çek.k&i=½
iv. Master’s Programme (Final) mark sheet and degree
¼LukrdksÙkj ¼Qkbuy½ dk vad&i= ,oa çek.k&i=½
v. M.Phil. degree
¼,e-fQy- mikf/k½
vi. Ph.D. /D.Phil degree
¼ih,p-Mh-@Mh-fQy- mikf/k½
vii. D.Litt, D.Sc., L.L.D degree
¼Mh-fyV-] Mh-,llh-@,y-,y-Mh- mikf/k½
viii. NET, UGC-JRF, CSIR-JRF Award Certificate
¼usV];wthlh&tsvkj,Q]lh,lvkbvkj&tsvkj,Q çek.k&i=½
ix. Caste Certificate issued by the Competent Authority (OBC/SC/ST/etc)
¼;ksX; vf/kdkjh }kjk çnÙk tkfr çek.k&i= (vuq0 tkfr/vuq0 tutkfr/vU; fiNM+k oxZ vkfn)
x. Experience certificates
¼vuqHko çek.k&i=½
xi. Recommendation letter(s)
¼vuq'kalk&i=½
xii. Award (s) /Fellowship (s)
¼vokMZ@QSyksf'ki½
xiii. Publication (s)
¼çdk'ku½
xiv. Disability Certificate
¼v{kerk çek.k&i=½
xv.

xvi.

xvii.

xviii.

Total Number of above self attested testimonials attached (in words)

¼layXu Lo&vfHkçekf.kr çek.k&i=ksa dh dqy la[;k½ ¼'kCnksa esa½

N.B. Applications without the above self attested testimonials (applicable to the candidate)
will not be entertained
¼ fVIi.kh% Lo&vfHkçekf.kr çek.k&i=ksa ds fcuk ¼;ksX; mEehnokj½ vkosnu&i= Lohd`r ugha fd;k tk;sxkA½
State whether you have been at any time (a) dismissed, removed or debarred from Service or (b) convicted by a Criminal
¼crk,a fd ¼d½ vki dHkh ukSdjh ls c[kkZLr@gVk, x, gS ;k ¼[k½ vijkf/kd ekeyksa esa dHkh nks"kh@tsy ik, x, gS½

Court. Please tick YES ¼gk¡½ NO ¼ugh½

I hereby declare that all entries made by me in this application are true, complete and correct to the best of my
knowledge and belief. I understand that in the event of any information being found false, incomplete or
incorrect, my candidature/appointment is liable to be cancelled/terminated.
¼ eSa ?kks"k.kk djrk@djrh gw¡ fd mi;qZDr nh xbZ lHkh tkudkfj;k¡ esjh tkudkjh esa lR;] lgh vkSj iw.kZ gSaA mi;qZDr
dksbZ Hkh tkudkjh vlR;] xyr ;k viw.kZ fl) gks rks esjh fu;qfDr dks [kkfjt fd;k tk ldrk gSA ½

Signature of the Applicant

¼vkosnd ds gLrk{kj½

Place ¼LFkku½ …………………………

Date ¼fnukad½ ………………………….

(The endorsement below is to be signed and forwarded by the Head of the Department/Employer in the case of
the in-service candidates whether in permanent or temporary capacity failing which the application is liable to be
rejected).
¼LFkk;h@vLFkk;h lsokjr vH;kFkhZ fu;ksDrk@foHkkxk/;{k ls vuqeksnu rFkk vxzlkfjr djk;sa@,slk u djkus ij vkosnu vLohd`r fd;k tk
ldrk gSA½
ENDORSEMENT OF THE EMPLOYER
¼fu;ksDrk }kjk vuqeksnu½
Ref. No ¼lanHkZ la[;k½ …………… Date ¼fnukad½ …………………………..
FORWARDED

The applicant …………………………….… (name) is holding the post of ……………………………………… in this

College/University/Institution/Department in a temporary/substantive basis since……..…………(date). His/Her present
Pay is Rs…………………………in the Pay structure of Rs……………….………………. with AGP/GP of
Rs………………...and he/she is drawing salary of Rs. ………………….per month. His/Her next date of increment is
……………………We have no objection to his/her application being considered.

Signature of the Officer

(with office seal)

¼vxzlkfjr½
¼vkosnd ……………………………………………….…….… ¼uke½……………………………………………in ij
bl egkfo|ky;@fo'ofo|ky;@laLFkku@foHkkx esa vLFkk;h@lcLVsafVo :i esa ……..…………¼fnuksa½ ls dk;Zjr
gSaA budk orZeku osru :i;s …………………………….… gS rFkk budk osrueku :i;s …………………gS lkFk
esa ,thih@thih :i;s ……………….…………………………. gSA ;fn buds vkosnu dks Lohdkj fd;k tkrk gS rks
gesa dksbZ vkifÙk ugha gksxhA½

¼vf/kdkjh ds gLrk{kj½
¼eksgj lfgr½