Offline Application Form - Indira Gandhi National Tribal University

Indira Gandhi National Tribal University
Amarkantak (M.P.)
(A Central University established by an Act of Parliament)
Mekal Sadan, Kapildhara Road, Amarkantak (M.P.) – 484 886
website: www.igntu.nic.in , www.igntu.ac.in
APPLICATION FORM FOR THE NON-TEACHING POSTS
Ref. No. IGNTU/Rec.Cell/2015/032/ Dt. 20/
20/01/2015
01/2015
Post applied for ……………………………….
Last date of Submission: 28.02.2015
vkosfnr in ------------------------------------------------------Affix Recent
Passport Size
Photograph
Field of Specialization of above post (if any)…………………………………….............…
mi;qZDr in ds fo'ks"kKrk dk {ks= ¼;fn dksbZ gks½ ……………………………………………
Applied Under category Gen / SC / ST /OBC / PH ………………………..……..…….
Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk-@vuq-t-tk@v-fi-o-@fodykax ---------------------------------------------------------------Particulars of fee Remitted :
Bank Draft No.
Amount
'kqYd dk fooj.k%
jkf'k ¼#-½
1.
2.
3.
cSad Mªk¶V la[;k
Date
Issuing Bank
fnukad
tkjhdrkZ cSd
Full Name (in Block Letters)
_____________________________________________________________
iwjk uke fgUnh esa ¼lkQ v{kjksa esas½
_____________________________________________________________
Father’s/Husband’s Name
_____________________________________________________________
firk@ifr dk uke
_____________________________________________________________
Mother’s Name
_____________________________________________________________
ekrk dh uke
_____________________________________________________________
4. (a) Address for Correspondence
(b) Permanent Address
i=kpkj dk irk
LFkk;h irk
______________________________________
__________________________________
______________________________________
__________________________________
______________________________________
__________________________________
Tel. No. ____________________________
Tel. No. ________________________________
Fax No. ____________________________
Fax No. ________________________________
e-mail: ____________________________
e-mail: ________________________________
5. Date of Birth & Place
6. (a)
tUe frfFk ,oa tUe LFkku
(b)
___________________________________
___________________________________
(c)
Age as on 28.02.2015
28.02.2015 dks vk;q
Years o’kZ
Months ekg
7. Marital Status : Married / Unmarried
oSokfgd fLFkfr % fookfgr @ vfookfgr
Sex: Male/Female fyax
% iq#’k @L=h
Category : SC v-tk- / ST v-t-tk- /
OBC v-fi-oxZ / General lkekU;
If person with disabilities
fodykax gksus dh n”kk esa
VH oh-,pHH ,p-,p-
Days fnu
OH vks-,p-
Please tick in the appropriate box
8. (a)
(b)
mi;qZDr ckDl esa lgh dk fu”kku yxkosaA
Nationality jk’Vªh;rk __________________
Religion /keZ
_______________________
9.
Academic Qualification (Commencing with the High School or an equivalent examination)
“kS{kf.kd ;ksX;rk ¼gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa½
Examination
Degree
Subject /
Specialization
Yea
r
ijh{kk@ mikf/k
fo’k;@
fo”ks’kKrk
o’kZ
Divisio
n
Js.kh
% of Marks /
Grade
University / College /
Board fo”ofo|ky;@
vad % @xzsM
dkyst@cksMZ
Distinctions /
Scholarship
fof”k’Vrk@
Nk=o`fÙk
Matriculation /
10th / Secondary
Intermediate /
+2 / HS
Graduation/ + 3
Post Graduation
Any other
Qualification
10. Employment (Give particulars in descending order starting with the present post) fu;kstu ¼orZeku in ls izkjEHk
djds vojksgh Øe esa fooj.k nsaA
Name & Address of
Employer fu;ksDrk dk
Post Held
**Present
in
Pay Scale
uke vkSj irk
osrueku
Basic Pay as
on date
ewy osru
Total
Gross
Pay
ewy osru
Period of
Employment
Nature of
Duties/Work
fu;kstu dh vof/k
dk;ksZa ds Lo:i
From
To
ls
rd
* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;Ùk”kklh@futh
** Mention whether revised or unrevised, if relevant. d`i;k la”kksf/kr vFkok vla”kksf/kr osrueku dk mYys[k djsaA
11. Details of Training Programmes attended @Hkkx
Name of Programme
dk;ZØe dk uke
Year
o’kZ
fy;k x;k izf”k{k.k dk;ZØeksa dk fooj.k
Duration (in days)
vof/k
Organizing Instituion
vk;kstd laLFkku
12.
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 izfr;ksfxrk vkSj lekt lsok vkfn
As a student
fo|kFkhZ thou esa
After entering into service
ukSdjh esa vkus ds ckn
13.
(a) Any other Experience/Achievement /Qualificaiton considered to be relevant to the post applied for:
¼v½ vU; vuqHko@miyfC/k@;ksX;rk tks vkosfnr in ds fy, izklafxr gS
(b) Other activities/Responsibilities:
¼c½ vU; xfrfof/k;k¡ @ mÙkjnkf;Ro
(c) if appointed, what period would you require before joining the post ?
¼l½ fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko”;drk gS \
(d) Any other relevant information, if not given above:
¼n½ vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks Åij u nh x;h gks %
14.
15.
Have you ever been convicted or any case pending against you.
Yes/No
vki U;k;ky; ls dHkh nafMr gSa \ dksbZ eqdn~nek vkids fo:) py jgk gS \
gk¡@ugha
Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three reference not related to you.
Reference should be of persons with or under who have intimate knowledge of your work.
(i)
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
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
Name & Address:
Ph.No.
Name & Address:
Mobile No.
E-mail :
(ii)
Ph.No.
Name & Address:
Mobile No.
E-mail :
(iii)
Ph.No.
Mobile No.
E-mail :
List of Enclosures (Please tick in the box)
layXu vfHkys[kksa dh lwph
1
2
3
4
5
6
7
8
9
10
Declaration to be signed by the applicant
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 ?kksf’kr i=
eSa ----------------------------------------------------------------------------------------------- ;g ?kksf’kr 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 eSaus 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 eqvkots
ds c[kkZLr dj nh tk;sxhA
Place:
Signature of Applicant
LFkku
vH;FkhZ ds gLrk{kj
Dated:
Name in BLOCK LETTERS
fnukad
uke
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 vxzsf’kr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk
dks dksbZ vkifÙk ugha gSA
Place:
LFkku
Signature
Dated:
fnukad
Telephone
(Head of the Institution/Organisation
VsyhQksu
laLFkku@laxBu izeq[k
Fax
Designation with SEAL
QSDl
bZ&esy
in
Address :
irk
Remarks:
fVIi.kh%
1. Candidate already employed should submit application through his/her employer.
fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA