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