भारतीय सूचना प्रौद्योगिकी संस्थान सेनापति,
मणिपुर
Indian Institute of Information Technology Senapati, Manipur
(An Institute of National Importance under Ministry of Education, Govt. of India)
Mantripukhri, Imphal West, Manipur, India-795002, https://iiitmanipur.ac.in
Annexure I
Application Form for Placement Officer
Affix your recent
(Advt. No.: IIITM/2025/PLO/1 Dated: 18/08/2025) passport size
photograph
1. Name in Full: ____________________________________________________________
2. Date of Birth : DD________MM_________YY__________________
3. Gender: ___________________ Nationality: ___________________________
4. Marital status: ______________________
5. Father/Spouse’s name: _______________________________________________
6. Permanent Address: _______________________________________________________
_______________________________________________________
______________________PIN Code_________________________
7. Address for communication: _________________________________________________
_______________________________________________________
______________________PIN Code_________________________
8. Contact No.: _______________________Email id: _______________________________
9. Alternate Contact No. : _______________________Email id: _______________________
10. PAN Card No.:_____________________________
11. Aadhar card No.: ____________________________
12. Blood Group: ______________________________
13. LinkedIn profile link: ___________________________________________________
Part-2
(Qualification and Experience)
14. Educational/Professional Qualifications in reverse chronological order
(Attach attested copies of Certificates and Mark Sheets)
Examination Passed Board/ Duration of Degree Year of % of Div.
University Passing Marks
15. Details of employment, if any in reverse chronological order (Attach Photocopies of
Relevant Certificates):
# Organization name Designation From To Responsibilities
16. Any other Relevant Information (Details of Special achievements, Awards, Trainings etc.)
17. Recruitment process you are planning to adopt at IIIT Manipur in brief.
18. Best practices followed in the annual placement process
19. Type of training offered to students to facilitate placement
20. Remedial measures adopted to help poorly/not placed students in the (pre)final year
21. What should be the strategy of the placement officer to bring more companies to IIIT
Manipur?
22. Referees (Two), with name designation and address:
First Referee:
Name: ____________________________Designation:___________________________
Address: _______________________________________________________________
Email ID: _________________________ Mobile No.: __________________________
Second Referee:
Name: ____________________________Designation:___________________________
Address: _______________________________________________________________
Email ID: _________________________ Mobile No.: __________________________
23. Have you ever been discharged/ suspended from any position? (Yes/ No) If yes, provide
particulars:
24. Have you ever been convicted by any court of Law? (Yes/ No)
25. Have you any relation among the employee of IIIT Manipur (Yes/ No)
If yes, provide details:
26. If appointed, how much time would you require to report for the duty?
DECLARATION
I hereby declare that I have read and understood the recruitment rules and instructions and that all
information provided is true and correct to the best of my knowledge
Signature of the Applicant
Place………………………
Date……………………….
(Please compile the filled-in document along with all enclosures into one PDF and
send it to [email protected] )
