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/Recruit/2014/358/ Last Date of Submission: 30.06.2014
Post applied for .
vkosfnr in ----------------------------------
Field of Specialization of above post (if any).............
mi;qZDr in ds fokskKrk dk {ks= ;fn dksbZ gks
Affix Recent
Passport Size
Photograph
Applied Under category Gen / SC / ST /OBC ...
Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk-@vuq-t-tk@v-fi-o- --------------------------------------------------------------------------------------Particulars of fee Remitted :
Bank Draft No.
Amount
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jkfk #-
Date
cSad MkV la[;k
Issuing Bank
fnukad
tkjhdrkZ cSd
1. Full Name (in Block Letters) ___________________________________________________________________
iwjk uke fgUnh esa lkQ v{kjksa esas _________________________________________________________________
2. Fathers/Husbands Name
___________________________________________________________________
___________________________________________________________________
firk@ifr dk uke
3. (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: ________________________________
4. Date of Birth & Place
5. (a)
tUe frfFk ,oa tUe LFkku
(b)
___________________________________
___________________________________
(c)
Age as on 1.07.2014
1.07.2014 dks vk;q
Years okZ
6.
Months ekg
Marital Status : Married / Unmarried
oSokfgd fLFkfr % fookfgr @ vfookfgr
Days fnu
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 nkk esa
VH oh-,pHH ,p-,p-
Please tick in the appropriate box
7.
OH vks-,p-
(a)
mi;qZDr ckDl esa lgh dk fukku yxkosaA
Nationality jkVh;rk __________________
(b)
Religion /keZ
_______________________
8. Academic Qualification (Commencing with the High School or an equivalent examination)
kS{kf.kd ;ksX;rk gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa
Examination
Degree
ijh{kk@ mikf/k
Subject /
Specialization
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Yea
r
okZ
Divisio
n
Js.kh
% of Marks /
Grade
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University / College /
Board foofo|ky;@
Distinctions /
Scholarship
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Nk=o`fk
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Matriculation /
10th / Secondary
Intermediate /
+2 / HS
Graduation/ + 3
Post Graduation
Any other
Qualification
9. Employment (Give particulars in descending order starting with the present post) fu;kstu orZeku in ls izkjEHk djds
vojksgh e esa fooj.k nsaA
Name & Address of
Employer fu;ksDrk dk
Post Held
in
uke vkSj irk
**Present
Pay Scale
osrueku
Basic Pay as
on date
ewy osru
Total
Gross
Pay
ewy osru
Period of
Employment
fu;kstu dh vof/k
From
ls
To
Nature of
Duties/Work
dk;ksZa ds Lo:i
rd
* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;kkklh@futh
** Mention whether revised or unrevised, if relevant. d`i;k lakksf/kr vFkok vlakksf/kr osrueku dk mYys[k djsaA
G.
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
10.
Training courses and conference/seminar/workshop papers (Please give the details in Annexure E)
izfk{k.k dk;Ze vkSj lEesyu ,oa ifjlaokn xksBh @ dk;Zkkyk esa i= d`i;k layXud E esa fooj.k nsaA
11.
(a) Membership/Fellowship of professional societies:
v O;olkf;d lkslkbVh dh lnL;rk@v/;s;rk o`fr
(b) Other activities/Responsibilities:
c vU; xfrfof/k;k @ mkjnkf;Ro
(c) if appointed, what period would you require before joining the post ?
l 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:
n vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks ij u nh x;h gks %
12.
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.
rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs Qksu] QSDl ua- ;fn gS 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
(i)
(ii)
(iii)
Name & Address:
Ph.No.
Name & Address:
Mobile No.
E-mail :
Ph.No.
Mobile No.
E-mail :
Mobile No.
E-mail :
Name & Address:
Ph.No.
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 ?kksfkr i=
eSa ----------------------------------------------------------------------------------------------- ;g ?kksfkr djrk@djrh gw fd bl vkosnu esa nh x;h lHkh
lwpuk;sa esjh iw.kZ tkudkjh ,oa fookl 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
Dated:
Name in BLOCK LETTERS
LFkku
fnukad
vH;FkhZ ds gLrk{kj
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 vkk; ds lkFk vxzsfkr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk
dks dksbZ vkifk ugha gSA
Place:
LFkku
Signature
Dated:
fnukad
Telephone
(Head of the Institution/Organisation
Fax
Designation with SEAL
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QSDl
bZ&esy
laLFkku@laxBu izeq[k
in
Address :
irk
Remarks:
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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
