banaras hindu university - BHU

Advertisement No./foKkiu la0% ____________________ Post Code/in dwV% ______________
Name of the post applied for / vkosfnr in dk uke% ______________________________________________
Tel. No. 0542-6703565, 6703236, 2368781 (Off.) Fax No.+91-542-2369951 Website: www.bhu.ac.in
BANARAS HINDU UNIVERSITY
dk’kh fgUnw fo’ofo|ky;
Varanasi-221 005 (India)
Okkjk.klh&221 005 ¼Hkkjr½
APPLICATION FORM FOR REGISTRAR/ FINANCE OFFICER/INTERNAL AUDIT OFFICER
dqylfpo@foRrkf/kdkjh@vkarfjd vads{k.k vf/kdkjh ds fy;s vkosnu çi=
Particulars of fee Remitted:
Amount_____________Bank Draft No.______________Date____________ Issuing Bank_______________
’kqYd dk fooj.k
jkf'k ¼#-½______________ cSad MªkV la[;k______________ fnuakd_____________ tkjhdrkZ cSad________________
1 Full Name (in Block Letters)
iwjk uke fgUnh es
¼lkQ v{kjksa esa½
2 Fathers’s/Husband’s
Name firk@ifr dk uke
3 (a) Address for Correspondence i=kpkj ds fy;s irk
_________________________________________
_________________________________________
_________________________________________
Tel./Mob. No______________Fax .______________
e-mail:_______________________________________
4 Date of Birth & Place tUe frfFk ,oa tUe LFkku
________________________________________
________________________________________
Age on the last date given in this advertisement
bl foKkiu esa nh xbZ vfUre frfFk dks vk;q
Years o"kZ_________________________________
Months ekg ______________________________
Days fnu ________________________________
6 Marital Status : Married/Unmarried
oSokfgd fLFkfr % fookfgr@vfookfgr _______________
MKS
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
(b) Permanent Address LFkk;h irk
Affix Passport
size Photograph
ikliksVZ vkdkj
dk QksVks
fpidk;sa
_________________________________________
_________________________________________
_________________________________________
Tel/Mob. No______________Fax _____________
e-mail:___________________________________
5 (a) Sex: Male/Female fyax % iq#"k@L=h
(b) Category oxZ
SC v-tk- ST v-t-tk-
OBC v-fi-oxZ General lkekU;
(c) if person with disabilities fodykax gksus dh n’kk esa
VH oh-,p- HH ,p-,p- OH vks-,p-
Please tick in the appropriate box mi;ZqDr ckDl esa lgh
dk fu’kku yxkb;sA
7 (a)Nationality jk"Vªh;rk _____________
(b)Religion /keZ _____________
_______________________________________
1

8. Academic Qualification (Commencing with the High School or an equivalent examination).
’kS{kf.kd ;ksX;rk ¼gkbZLdwy vFkok led{k ijh{kk ls çkjEHk djsa½s
MKS
Examination/
Degree
ijh{kk@mikf/k
Subject/
Specialization
fo"k;@ fo’ks"kKrk
Research Degree(s) ’kks/k mikf/k;ka :
Degree mikf/k University
fo'ofo|ky;
M.Phil. ,e fQy
Ph.D./D.Phil/D.Mus.
ih ,p Mh/Mh fQy/Mh E;wt
D.Sc./D.Litt.
Mh ,l&lh/Mh fyV~
Year
o"kZ
Division
Js.kh
Specific date of submission
of Ph.D. thesis
’kks/k&izcU/k tek djus dh frfFk
2
% of
Marks/
Grade
vad %@
xzsM
No. of
Attempts
Subject-
wise.
fo"k;kuqlkj
ç;kl la[;k
Specific date of
award mikf/k dh frfFk
University/
College/
Board
fo'ofo|ky;@
dkyst@cksMZ
Title of the thesis
’kks/k& izcU/k dk ’kh"kZd
(i) Whether Ph.D. awarded as per UGC Regulation 2009 (If yes, Please give documentary proof) YES / NO
D;k ’kks/k mikf/k ;w0th0lh0 jsxwys’ku 2009 ds vuq#i gSA ;fn gka] lk{; dh Nk;kizfr¡ layXu djsaA gka @ ugha
(ii)Whether qualified NET/SLET etc. (Conducted by UGC/CSIR/ICAR/State) (Indicate the date
and attach documentary proof) YES / NO
D;k ;w0th0lh0@lh0,l0vkbZ0vkj0@vkbZ0lh0,0vkj0@jkT; vkfn }kjk lapkfyr jk"Vªh;@ gka @ ugha
jkT; ik=rk ijh{kk mRrh.kZ gS: ¼frfFk nsa ,oa izek.k layXu djsa)
Distinctions/
Scholarship
fof'k"Vrk@
Nk=o`fÙk

9. Administrative/Teaching/Professional/Research Employment (Give particulars in descending order starting with the present post)
iz'kklfud@'kSf{kd@O;olkf;d@vuqla/kku fu;kstu ¼orZeku in ls çkjEHk djds vojksgh Øe esa fooj.k nsa½
MKS
Employer
fu;ksDrk
Status of
Institute/
University
laLFkk dh fLFkfr
Post Held
in
Pay Band
osrueku
3
AGP/GP
,-th-ih-@th-ih-
10. Do you belong to organized services of Govt. of India? If yes, give details
D;k vki Hkkjr ljdkj dh laxfBr lsokvksa ls lacfU/kr gSa- ;fn gk¡] rks foLr`r fooj.k nsaA
11. Summary of experience/performance
dk;Z vuqHko@fu"iknu dk laf{kIr fooj.k
A
v
B
c
Administrative Experience (in years)
iz'kklfud vuqHko ¼o"kksZa esa½
Teaching Experience
v/;kiu dk vuqHko
i Under Graduate/Lukrd
ii Post Graduate/ LukrdksRrj
iii Total Teaching Experience/ dqy v/;kiu vuqHko
C
l
i
ii
Publications
çdk'ku
Research and academic contributions
leh{kkRed if=dkvksa esa ’kks/k i=
Books/Chapters in books
iqLrdsa@iqLrdksa esa v/;k;
From
ls
Period of Employment
fu;kstu dh vof/k
From/ ls To/rd
To
rd
Nature of
Duties/Work
dk;ksZ ds Lo#i
Total years & Months
dqy o"kZ vkSj eghus
Note:- List of publications with details, reprints of papers and acceptance letters (in case of accepted papers) must be
enclosed izdkf'kr 'kks/k&i=ks dh lwph] mudh iqueqZfnzr izfr;k¡ ,oa Lohd`r ’kks/k&i=ks ds Lohd`r i= dh Nk;kizfr;k¡ layXu djsaA

D
n
E
bZ
MKS
Research Projects
vuqla/kku ifj;kstuk;sa
Number of Thesis Supervised
i;Zosf{kr ’kks/k dh la[;k
i Ph.D./ih,p-Mh-
ii M.Phil/ ,e-fQy
F
j
G
y
Prizes /Medals/Awards/Honors
iqjLdkj@ind@vokMZ@lEeku
Awarded
çnÙk
4
Submitted
iw.kZ gqbZ
In progress
çxfr ij
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 çfr;ksfxrk vkSj lekt lsok vkfn
• As a student fo|kFkhZ thou esa
• After entering into service / ukSdjh esa vkus ds ckn
12 Training courses and conference/seminar/workshop papers
izf'k{k.k dk;Zdze vkSj lEesyu ,oa ifjlaokn xks"Bh@ dk;Z'kkyk esa i=
13 (a) Membership/Fellowship of professional societies:
¼v½ O;olkf;d lkslkbVh dh lnL;rk@v/;s;rk o`fr
(b) Other activities/Responsibilities:
¼c½ vU; xfrfof/k;ka@mÙkjnkf;Ro
(c) Are you willing to accept the initial salary of the grade? (If no, state what is the minimum salary acceptable with
justification thereof).
¼l½ D;k vkidks vkosfnr osrueku dk U;wure Lohdk;Z gS\ ¼;fn ugh] dkj.k lfgr Li"V djsa fd fdruk U;wure~ ewy osru
Lohdk;Z gS½A
(d) if appointed, what period would you require before joining the post?
¼n½ fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko’;drk gS\
(e) Any other relevant information, if not given above:
¼;½ vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks mÿij u nh x;h gks%
14 (a) Has there been any break in your academic career? If so, give details.
¼v½ D;k dHkh vkidh fo|ksiktZu dk Øe Hkax gqvk\ ;fn gk¡ rks dkj.k lfgr fooj.k nsaA
(b) Have you been punished during your studies at college/University? If so, give details.
¼c½ D;k dHkh vkidks fo|ksiktZu ds nkSjku fo’ofo|ky;@dkyst }kjk n.M fn;k x;k\ ;fn gk¡ rks fooj.k nsaA

(c) Have you been punished during your services or convicted by a court of law? If so, give details.
¼l½ D;k dHkh ukSdjh ds nkSjku vkidks nf.Mr fd;k x;k gS ;k fdlh U;k;ky; }kjk vkidks nks"kh çekf.kr fd;k x;k\ ;fn gk¡
rks fooj.k nsaA
(d) Were you at any time declared medically unfit or asked to submit your resignation or discharged or dismissed?
If yes, give details in a separate sheet.
¼n½ D;k dHkh vki LokLF; ijh{kk esa v;ksX; ?kksf"kr gq;s] vkils R;kxi= nsus ds fy;s dgk x;k vFkok vkidks fdlh ukSdjh ls
ineqDr ;k c[kZkLr fd;k x;k gS\ ;fn gk¡ rks i`Fkd i`"B ij fooj.k nsaA
(e) Do you have any case pending against you in any court of law? If yes, give details.
¼/k½ D;k vkids fo#} dksbZ U;kf;d ekeyk fopkjk/khu gS ;fn gk¡ rks fooj.k nsaA
15 Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three references not related to you.
References should be of persons with or under whom you have worked, or who have intimate knowledge of your work.
rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs ¼Qksu] QSDl u- ;fn gS½ 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 gkasA
i
ii
iii
16 List of Enclosures/ layXu çys[kksa dh lwph (Please tick in the box ckDl esa lgh dk fu’kku yxk;sa½
(a) Bank Draft & Photograph cSad MªkV ,ao Nk;kfp=
MKS
(b) Copies of Mark-sheets & Certificates of educational qualifications & certificate of clearing NET/SLET/JRF
etc vad&i=ksa] ’kS{kf.kd çek.k&i=ksa ,oa jk"Vªh;@jkT; ik=rk ijh{kk@dfu"d v/;srk ikl djus ds çek.k i=ksa dh
Nk;kçfr;k¡
(c) Copies of certificates of experience. vuqHko çek.k i=ksa dh Nk;kçfr;k¡
(d)List of publications with details, reprints of papers and acceptance letters (in case of accepted papers)
izdkf'kr 'kks/k&i=ks dh lwph] mudh iqueqZfnzr izfr;k¡ ,oa Lohd`r ’kks/k&i=ks ds Lohdkj i=ksa dh Nkk;kizfr;k¡A
(e) Copies of other relevant certificates & documents. vU; lEcfU/kr çek.k i=ksa dh Nk;kçfr;k¡
(f) Photocopies of ACRs for last 5 years attested on each page. fiNys ik¡p o"kZ ;k vf/kd ds okf"kZd xksiuh;
fjiksVZ dh lR;kfir Nk;kçfr;k¡
(g) Vigilance clearance certificate foftysal fDy;jsal izek.k i=
(h) Integrity Certificate lR;fu"Bk dk çek.k i=
(i) A certificate from the controlling officer to the effect that you can be spared immediately in the
event of appointment. fu;arkf/kdkjh }kjk bl vk’k; dk izek.k i= fd p;uksaijkUr dk;Z xzg.k gsrq vkidks
orZeku in ls eqDr dj fn;k tk;sxkA
5

16 Declaration to be signed by the candidate
Place:
LFkku
Dated
fnuakd
MKS
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 ?kks"k.kk i=
eSa ,rn~}kjk ;g ?kks"k.kk djrk@djrh gw¡ fd bl vkosnu esa nh x;h lHkh lwpuk;sa esjh iw.kZ tkudkjh ,oa fo’okl esa lR; gSA
;fn fdlh le; ;g ik;k x;k fd eSus 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 eqvkotss ds c[kZkLr dj nh tk;sxhA
6
Signature of Applicant/ vH;FkhZ ds gLrk{kj
Name@uke ---------------------------------------------
17 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 vk’k; ds lkFk vxszf"kr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa bl in ij p;u gsrq fopkj gksus ij laLFkk dks
dksbZ vkifÙk ugha gSA
Place: LFkku
Dated fnuakd
Telephone VsyhQksu
Fax QSDl
e-mail bZ&esy
Remarks/fVIi.kh%
1- Candidate already employed should submit application through his/her employer.
1- fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA
Signature /gLrk{kj
(Head of the Institution/Organisation laLFkku@laxBu izeq[k)
Designation in
Address irk