Indira Gandhi National Tribal University, Amarkantak (M.P.)
Indira Gandhi National Tribal University, Amarkantak (M.P.)
Indira Gandhi National Tribal University, Amarkantak (M.P.)
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<strong>Indira</strong> <strong>Gandhi</strong> <strong>National</strong> <strong>Tribal</strong> <strong>University</strong>,<br />
<strong>Amarkantak</strong> (M.P.)<br />
(A Central <strong>University</strong> established by an Act of Parliament)<br />
Mekal Sadan, Kapildhara Road, <strong>Amarkantak</strong> (M.P.) – 484 886<br />
website : www.igntu.nic.in<br />
APPLICATION FORM FOR THE NON-TEACHING POSTS<br />
Advt. No. IGNTU/Acad/01/2011 Last Date of Submission : 20.01.2012<br />
Post applied for ………………………. vkosfnr in ----------------------------------<br />
Field of Specialization of above post (if any)………………….............…<br />
mi;qZDr in ds fo”ks’kKrk dk {ks= ¼;fn dksbZ gks½ …………………………<br />
Affix Recent<br />
Passport Size<br />
Photograph<br />
Applied Under category Gen / SC / ST /OBC …………………..…….<br />
Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk-@vuq-t-tk@v-fi-o- ---------------------------------------------------------------------------------------<br />
Particulars of fee Remitted :<br />
Amount Bank Draft No. Date Issuing Bank<br />
“kqYd dk fooj.k% cSad MªkV la[;k fnukad tkjhdrkZ cSd<br />
jkf”k ¼#-½<br />
1. Full Name (in Block Letters) ___________________________________________________________________<br />
iwjk uke fgUnh esa ¼lkQ v{kjksa esas½ _________________________________________________________________<br />
2. Father’s/Husband’s Name ___________________________________________________________________<br />
firk@ifr dk uke<br />
3. (a) Address for Correspondence<br />
i=kpkj dk irk<br />
______________________________________<br />
______________________________________<br />
______________________________________<br />
Tel. No. ________________________________<br />
Fax No. ________________________________<br />
e-mail: ________________________________<br />
___________________________________________________________________<br />
(b)<br />
Permanent Address<br />
LFkk;h irk<br />
__________________________________<br />
__________________________________<br />
__________________________________<br />
Tel. No. ____________________________<br />
Fax No. ____________________________<br />
e-mail: ____________________________<br />
4. Date of Birth & Place<br />
5. (a) Sex: Male/Female fyax % iq#’k @L=h<br />
tUe frfFk ,oa tUe LFkku<br />
(b)<br />
___________________________________<br />
Category : SC v-tk- / ST v-t-tk- /<br />
___________________________________<br />
OBC v-fi-oxZ / General lkekU;<br />
Age as on 1.08.2011<br />
(c) If person with disabilities<br />
1.08.2011 dks vk;q<br />
fodykax gksus dh n”kk esa<br />
VH oh-,p- HH ,p-,p- OH vks-,p-<br />
Years o’kZ Months ekg Days fnu<br />
Please tick in the appropriate box<br />
mi;qZDr ckDl esa lgh dk fu”kku yxkosaA<br />
6. Marital Status : Married / Unmarried<br />
7. (a) <strong>National</strong>ity jk’Vªh;rk __________________<br />
oSokfgd fLFkfr % fookfgr @ vfookfgr<br />
(b) Religion /keZ _______________________
8. Academic Qualification (Commencing with the High School or an equivalent examination)<br />
“kS{kf.kd ;ksX;rk ¼gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa½<br />
Examination<br />
Degree<br />
ijh{kk@ mikf/k<br />
Matriculation /<br />
10 th / Secondary<br />
Subject /<br />
Specialization<br />
fo’k;@ fo”ks’kKrk<br />
Yea<br />
r<br />
o’kZ<br />
Divisio<br />
n<br />
Js.kh<br />
% of Marks /<br />
Grade<br />
vad % @xzsM<br />
<strong>University</strong> / College /<br />
Board fo”ofo|ky;@<br />
dkyst@cksMZ<br />
Distinctions /<br />
Scholarship<br />
fof”k’Vrk@<br />
Nk=o`fÙk<br />
Intermediate /<br />
+2 / HS<br />
Graduation/ + 3<br />
Post Graduation<br />
Any other<br />
Qualification<br />
9. Employment (Give particulars in descending order starting with the present post) fu;kstu ¼orZeku in ls izkjEHk djds<br />
vojksgh Øe esa fooj.k nsaA<br />
Name & Address of Post Held **Present Basic Pay as<br />
Period of Nature of<br />
Employer fu;ksDrk dk in Pay Scale on date<br />
Employment Duties/Work<br />
uke vkSj irk<br />
osrueku ewy osru<br />
fu;kstu dh vof/k dk;ksZa ds Lo:i<br />
Total<br />
Gross<br />
Pay<br />
ewy osru<br />
From<br />
ls<br />
To<br />
rd<br />
* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;Ùk”kklh@futh<br />
** Mention whether revised or unrevised, if relevant. dì;k la”kksf/kr vFkok vla”kksf/kr osrueku dk mYys[k djsaA<br />
G.<br />
y<br />
Extra curricular activities-give details, if any, of proficiency acquired in games, sports and of participation in<br />
other extra curricular or social activities such as NCC, Public Lectures, Debates, Social Service etc.<br />
vU; xfrfof/k;ksa dk fooj.k& ;fn dksbZ gS] [ksy dwn] ,u-lh-lh-] laokn izfr;ksfxrk vkSj lekt lsok vkfn<br />
As a student<br />
fo|kFkhZ thou esa<br />
After entering into service<br />
ukSdjh esa vkus ds ckn
10. Training courses and conference/seminar/workshop papers (Please give the details in Annexure – E)<br />
izf”k{k.k dk;ZØe vkSj lEesyu ,oa ifjlaokn xks’Bh @ dk;Z”kkyk esa i= ¼dì;k layXud ¼E½ esa fooj.k nsaA<br />
11. (a) Membership/Fellowship of professional societies:<br />
¼v½ O;olkf;d lkslkbVh dh lnL;rk@v/;s;rk o`fr<br />
(b) Other activities/Responsibilities:<br />
¼c½ vU; xfrfof/k;k¡ @ mÙkjnkf;Ro<br />
(c) if appointed, what period would you require before joining the post <br />
¼l½ fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko”;drk gS \<br />
(d) Any other relevant information, if not given above:<br />
¼n½ vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks Åij u nh x;h gks %<br />
12. Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three reference not related to you.<br />
Reference should be of persons with or under who have intimate knowledge of your work.<br />
rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs ¼Qksu] QSDl ua- ;fn gS½ ds lkFkA lUnHkZ O;fDr og gksuk pkfg;s ftlds<br />
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<br />
(i)<br />
(ii)<br />
(iii)<br />
Name & Address:<br />
Ph.No. Mobile No. E-mail :<br />
Name & Address:<br />
Ph.No. Mobile No. E-mail :<br />
Name & Address:<br />
Ph.No. Mobile No. E-mail :<br />
List of Enclosures (Please tick in the box)<br />
layXu vfHkys[kksa dh lwph<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10
Declaration to be signed by the applicant<br />
I _______________________________________ hereby declare that the entries in this form are<br />
correct and true to the best of my knowledge and belief. If at any time, I am found to have concealed<br />
/suppressed any material/information or given any false details, my appointment shall be liable to be<br />
summarily terminated without notice or compensation.<br />
vH;FkhZ }kjk gLrk{kfjr kksf’kr i=<br />
eSa ----------------------------------------------------------------------------------------------- ;g kksf’kr djrk@djrh gw¡ fd bl vkosnu esa nh x;h lHkh<br />
lwpuk;sa esjh iw.kZ tkudkjh ,oa fo”okl esa lR; gSA ;fn fdlh le; ;g ik;k x;k fd eSaus dksbZ lwpuk fNik;h gS<br />
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<br />
dj nh tk;sxhA<br />
Place:<br />
Signature of Applicant<br />
LFkku<br />
vH;FkhZ ds gLrk{kj<br />
Dated:<br />
fnukad<br />
Name in BLOCK LETTERS<br />
uke<br />
Forwarded with the remarks that the institution/organization has no objection to the<br />
candidature of the applicant being considered for the post applied for, as above.<br />
bl vk”k; ds lkFk vxzsf’kr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk<br />
dks dksbZ vkifÙk ugha gSA<br />
Place:<br />
LFkku<br />
Signature<br />
Dated:<br />
fnukad<br />
Telephone<br />
VsyhQksu<br />
(Head of the Institution/Organisation<br />
laLFkku@laxBu izeq[k<br />
Fax<br />
Designation with SEAL<br />
QSDl<br />
in<br />
bZ&esy Address :<br />
irk<br />
Remarks:<br />
fVIi.kh%<br />
1. Candidate already employed should submit application through his/her employer.<br />
fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA