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2014 Adv 1 ApplForm DirectRec

This document is an application form for direct recruitment to the National Institute of Pharmaceutical Education & Research. The form requests information such as the applicant's personal details, educational qualifications, employment history, research experience, publications, references, and a statement of objectives. The applicant is asked to provide details of their current and previous positions, pay scales, areas of specialization, membership in professional bodies, awards received, and research interests if selected. The form must be filled in block letters with no blank fields and signed with a declaration that the information provided is true.

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Rajesh Kumar
Copyright
© Attribution Non-Commercial (BY-NC)
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61 views

2014 Adv 1 ApplForm DirectRec

This document is an application form for direct recruitment to the National Institute of Pharmaceutical Education & Research. The form requests information such as the applicant's personal details, educational qualifications, employment history, research experience, publications, references, and a statement of objectives. The applicant is asked to provide details of their current and previous positions, pay scales, areas of specialization, membership in professional bodies, awards received, and research interests if selected. The form must be filled in block letters with no blank fields and signed with a declaration that the information provided is true.

Uploaded by

Rajesh Kumar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application No.

(For office use only)

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NATIONAL INSTITUTE OF PHARMACEUTICAL EDUCATION & RESEARCH

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APPLICATION FORM FOR DIRECT RECRUITMENT


(TO BE FILLED BY THE APPLICANT IN BLOCK LETTERS, NO PART OF THE FORM SHOULD BE LEFT BLANK)

Advertisement No. Post Applied for 1. Fee Paid: Rs. DD No. : Date :
Please affix a recent passport size photograph

2.

Name of the applicant

Married

Single
/ Husbands Name

Male
(please tick)

Female

3.

Fathers Name

4.

Address: Present (for communication)

PIN 5. Address: Permanent

PIN Fax: E-Mail: Telephone: 6. 8. 9. Date of Birth Nationality: Present Employment: Designation: Organisation: Date of Joining: Pay Scale / Pay Band (PB) Pay in PB + Grade Pay (GP) / AGP Total Emoluments (Per month)(Rs.):

Office:
Day Month Year

Residence: 7. Age as on closing: Years/months/days date of applications

-210. 11. Pay expected (Rs.):____________________________________________________________ Tick-Mark the appropriate Box (Please attach a copy of the documentary proof) GEN 12. 13. SC ST OBC PH XSM

Total years of the experience after attaining essential qualification: Areas of specialization

14.

Current areas of Research


(Only for academic positions)

15.

Academic Record starting with secondary education Examination Branch/ Specialization

(Please attach photo copies of certificates/Mark Sheets etc.)

Board/College/ Univ./ Institution.

Year of passing & degree awarded

%age of marks

Division

16.

Employment [Please attach photo copies of experience certificates] Position held (Regular / Contractual)
(Exact dates to be given)

Duration

Employer

From

To

Total period
(yy/mm/dd)

Basic pay with scale of pay

Detailed description about nature of duties performed & performing* (Mandatory)

/ / / /
*

/ / / /

/ / / /

/ / / /

Please attach separate sheet (s) with complete description of the duties performed & being performed, failing which, application may not be considered.

17.

Have you ever been discharged/suspended from any position? If yes, state reasons. __________________________________________________________________________________________ __________________________________________________________________________________________

-318. Special Awards/Honours received, if any: Year Name of award/honour Name of organization

19.

Membership of professional bodies: Name of the Body Status of Membership: Life/Annual

20.

Please mention below best five research publications and attach separate list of all publications (To be filled only by the applicant) Sr. No.
i ii iii iv v

Year

Title of Publication

Name of Journal

21.

Name & Address of three Referees (should be your reporting officer(s) and/or employer(s) in the previous and present
(Mandatory) employment(s))

S. No. 1.

Name

Occupation/Position

Official Address

Contact Information Phone: Fax: Email: Phone:

2.

Fax: Email: Phone:

3.

Fax: Email:

-422. Statement of objectives


a) b) c)
(To be filled up in Candidates own hand writing)

Please indicate as to why you wish to join NIPER, Mohali How in your opinion do you meet the job requirement as advertised? A short paragraph about the research/teaching/development projects you would like to undertake and the courses that you would like to handle.

DECLARATION I, hereby, declare that all entries in this form as well as attached sheets are true to the best of my knowledge and belief and nothing has been concealed. There are __________ attached sheets along with this form. Date: Place:

(Signature of the applicant)

(Note: Use separate sheet if necessary for any of the above items.)

-5-

Endorsement by the Head of the Department or Office


Candidate already in employment should get the following endorsement signed by his/her present employer No.____________________ Date______________

Forwarded application of Dr./ Shri / Ms._________________________________ (Name & Designation). It is certified that: 1. 2. 3. The information furnished by Dr./ Shri / Ms. _________________________________________ has been verified from official records and found to be correct. It is also certified that no disciplinary/ departmental enquiry is either pending or contemplated against ____________________________________ and that he/she is not undergoing any penalty. His/ Her integrity is certified. Signature.. Designation. Stamp:

SYNOPSIS
(to be filled and submitted alongwith the completed application form) 1. 2. 3. 4. 5. 6. 7. 8. Post applied for (Advt. No.) Name Address for communication Contact No. Email Id Date of Birth Category (UR/SC/ST/OBC) / Sub Category (PH/XSM) YY MM DD

Age as on 18-02-2014 (last date of receipt of applications) (Copy of matriculation certificate is attached)

(Details should be exactly as per certificate(s) attached) [Exact dates to be given] Designation Pay band (PB) & Grade Pay and Gross salary Complete Office address with contact numbers and email id of the Employer & Reporting Officer FROM Years Months Days Years TO Months Days EXACT DURATION Years Months Days

EXPERIENCE

(Signature of the candidate)

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