Sl. No.

…………………

(To be filled by Office)

(Application Form)
For office use only: Date of receipt of application:
(i) POST APPLIED FOR Affix your
recent
Specialization, if any Passport size
photograph
(ii) ADVERTISEMENT No. here.

(iii) DETAILS OF FEE PAID: - Rs. 500/-

Demand Draft: In favour of Finance Officer, KMCLU INCOME ACCOUNT, Payable at Lucknow

(Name of the Issuing Bank) (Demand Draft No.) (Date) (Amount)

IMPORTANT: USE ONLY BLOCK LETTERS TO FILL THIS PAGE

1. FULL NAME :
(As recorded in the (First Name) (Middle Name) (Surname)
Matriculation
or equivalent certificate)

2. PRESENT POSTAL ADDRESS: ……………………………………………………………………

WITH TELEPHONE/MOBILE No. /E-mail: …………………………………………….……….…
…………………………………………………………………………….……………………………

3. PERMANENT POSTAL ADDRESS: ………………………………………………………………

WITH TELEPHONE/MOBILE No. /E-mail: …………………………………………….……….…
…………………………………………………………………………….……………………………

4. FATHER'S NAME : ……………………………………………………………...........

(As recorded in the Matriculation or equivalent certificate)

5. MOTHER'S NAME : ……………………………………………………………...........

6. GENDER : MALE/FEMALE (Strike-off whichever is not applicable)

7. MARITAL STATUS : MARRIED/SINGLE (Strike off whichever is not applicable)

8. DATE OF BIRTH :
(As recorded in the Matriculation (Date) (Month) (Year)
or equivalent certificate)
9. PLACE OF BIRTH :
(District) (State) (Country)
 10. ORIGINALLY RESIDENT OF : …………………………………………………………………….

11. NATIONALITY : …………………………………………………………………….

12. WHETHER BELONGS TO : YES/NO (Strike off whichever is not applicable)

SCHEDULED CASTE/TRIBE/
OTHER BACKWARD CLASS: Category: Gen / SC / ST / OBC (Attach relevant document)

13. DISABILITY : YES/NO (Strike off whichever is not applicable)

(PHYSICALLY HANDICAPPED)
IF YES, NATURE OF DISABILITY: 1. __2. 3. ___

14. CANDIDATE'S MOTHER TONGUE: ………………………………………………………………

15. WHAT OTHER LANGUAGES (S) (if any) THE CANDIDATE CAN SPEAK, READ AND
WRITE FLUENTLY: Language Speak Read Write

16. EDUCATIONAL/PROFESSIONAL QUALIFICATION:

Name of the Marks Distinct
Sl. Year of Name of
Examination univ./ Division Subjects obtained. ion
No. passing The institution &% (if any)
Board
Matriculation
/High School
/Senior
Cambridge /
I.C.S.E./C.B.
1. S.E. or
equivalent
examination
Intermediate/I
.S.C. or
2. equivalent
examination
B.A./B.Sc./
B.Com./
B.Tech or
3. equivalent
examination
M.A./M.Sc./
M.Com./ M.
Tech or
4. equivalent
examination
5. M.Phil.

6. Ph.D./D.Phil.

Any Other
7. Qualification
Note: Strike off alternatives, which do not apply in your case.
* In the case of Grading (CGPA) System, calculate equivalent percent and fill in the relevant
column. Also, enclose conversion formula certified by the concerned academic institution.
17. WHETHER THE CANDIDATE HAS CLEARED ANY ONE OF THE FOLLOWING TEST:
U.G.C. – J.R.F. Examination YES / NO
C.S.I.R. – J.R.F. Examination YES / NO
NET UGC / CSIR YES / NO
GATE YES / NO
(Strike off which is not applicable and attach self-attested copy of the award letter)

18. ANY OTHER SCHOLARSHIP/ : ……………………………………………………………….

FELLOWSHIP AWARDED
(Attach self-attested proof thereof) …………………………………………………………….

19. RESEARCH PUBLICATIONS :………………………………………………………….

(Give the subject/topics of the paper
published together with the name of ....……………………………………………………….
journals. Reprints of all papers stated
here should be enclosed with the ……………………………………………………..........
Application) (Please attach separate sheet, if necessary)

20. BOOKS/MONOGRAPHS/ : ……………………………………………………….......

REVIEWS PUBLISHED
(Attach proof thereof) ……………………………………………………...…....

21. ANY POSITION OF AUTHORITY : …………………………………………………...………

HELD OR DISTINCTIONS
(other than scholarship) GAINED AT …………………………………………………….……….
SCHOOLS & COLLEGES INCLUDING
GAMES AND SPORTS AND OTHER
SOCIAL ACTIVITIES

22. APPOINTMENTS (if any) SO FAR HELD: ………………………………………………………

(Specify relevant post-qualification experience only)
Sl. Nature of Post Date of Date of Basic Salary Reasons for Name and Address of
No. Joining Leaving Last Drawn Leaving the Post Employer
23. ANY OTHER QUALIFICATION(S) : …………………………………………………………….
RELEVANT TO THE POST APPLIED FOR …………………………………………………...………….
…………………………………………………...………….
24. LIST OF SELF ATTESTED TESTIMONIALS ATTACHED HEREWITH
(Originals to be produced at the time of interview)
(i) ......................................................................................................................................................
(ii) ......................................................................................................................................................
(iii) .....................................................................................................................................................
(iv) .....................................................................................................................................................
(v) ......................................................................................................................................................
(vi) .....................................................................................................................................................
(vii) .....................................................................................................................................................
(viii) ...................................................................................................................................................
(ix) .....................................................................................................................................................
(x) ......................................................................................................................................................
(xi) .....................................................................................................................................................
(xii) ....................................................................................................................................................
(xiii) ....................................................................................................................................................
(xiv) ....................................................................................................................................................
(xv) ....................................................................................................................................................

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

Note : Applications without the above self-attested testimonials (applicable to the
candidate) will not be entertained.
DECLARATION
I,_________________________________ son/daughter of __________________________
hereby declare that all statements and entries made in this application are true, complete and
correct to the best of my knowledge and belief. In the event of any information being found
false or incorrect or ineligibility being detected before or after the Selection Committee and
Executive Council meetings, my candidature / appointment may be cancelled by the
University.
Dated:

Place:
……………………………………………..

Signature of the Candidate*

……………………………………………..
*Name as signed (in BLOCK LETTERS)
* Application not signed by the candidate is
liable to be rejected.
 Assessment methodology for calculation of API/Research
(As per UGC Regulation, 2018 Appendix II Table 3A)
S.N. Academic Record Score
1. Graduation 80% & 60% to less 55% to less 45% to less
Above = 15 than80% = than 60% = than55% =
13 10 05
2. Post-Graduation 80% & 60% to less 55% (50% in case of
Above = 25 than80% = SC/ST/OBC (non-
23 creamy layer)/PWD)to
less than 60% = 20
3. M.Phil. 60% & 55% to less than 60% = 05
above = 07
4. Ph.D.* 30
5. NET with JRF 07
NET 05
SLET/SET 03
6. Research Publications (2 marks 10
for each research publications
published in Peer-Reviewed or
UGC- listed Journals)
7. Teaching / Post Doctoral 10
Experience (2 marks for one
year each) #
8. Awards
International / National Level 03
(Awards given by International
Organisations/ Government of
India / Government of India
recognised National Level
Bodies)
State-Level (Awards given by 02
State Government)
#However, if the period of teaching/post-doctoral experience is less than oneyear then
the marks shall be reduced proportionately.
Note:
(A) (i) M.Phil + Ph.D Maximum - 30 Marks
(ii) JRF/NET/SET Maximum - 07 Marks
(iii) In awards category Maximum - 03 Marks
(B) Number of candidates to be called for interview shall be decided by the concerned
universities.
(C) Academic Score - 80
Research Publications - 10
Teaching Experience - 10
Total - 100
(D) Score shall be valid for appointment in respective State SLET/SET Universities/ Colleges/
Institutions only.