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S.
No Particulars Submission of the applicant
1 Name of the applicant 2 Designation 3 Date of Joining on regular basis after latest recruitment through HPSC/ by order of GOVT. 4 If similar permission was taken in the past? If yes, (i) Name of the course (ii) Institute (iii) Result be given 5 Details of Higher Qualification (Which the applicant intends to pursue) along with name(s) if proposed Technical Institute/University/Deemed University etc. With complete address. 6 Mode of Study: Indicate from the following options i) Regular (Full Time) ii) Regular (Part time)-Holidays-weekend, evening classes iii) Regular( Modular Programme of NITTTR) iv) Correspondence Note: Responsibility of proving the mode of study shall vest with the applicant and hence clarification to this effect must be obtained from the concerned University 7 Duration of course(Year(s) & Months) 8 Tentative date of start of course 9 If higher qualification is in regular mode, whether applicant intends to avail study leave as per Rule-8.126 of CSR Vol.I Part-I(Yes/No) 10 Whether candidate intents to avail leave for Course Work(other than study leave) for Ph.D. 11 Leave(more than 30 days) availed in the past, reason thereof and duration of leave. 12 Undertaking from the applicant that: i) No inquiry/explanation/charge sheet is pending against me, ii) The expenditure involved, if any, will be borne by the employee concerned. iii) For Correspondence /Part time courses leave if required shall be availed during the examinations days of said course only. iv) In case of correspondence course, applicant shall not claim benefit of two advance increments for higher qualification as per Finance Department Notification No.1/76/2011-1PR(FD) dt: 18.10.2011. The applicant understands and agrees that responsibility and the resultant consequences, if any, shall vest with himself/herself if the qualification/Institution of study is fake, unrecognized, unapproved by the competent authority/agency or violative of applicable laws in force. APPLICATION FOR POST FACTO PERMISSION TO STUDY PG DIPLOMA COURSE i.e “INDUSTRIAL RELATIONS AND PERSONNEL MANAGEMENT” THROUGH DISTANCE EDUCATION FROM SV UNIVERSITY/TIRUPATHI.
Signature of the applicant
FOR OFFICE USE ONLY In view of the above facts, it is recommended to allow the applicant for acquiring higher education.