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Application Form

This document is an application form for the positions of Technical Assistant or Administrative Assistant. It requests personal details such as name, gender, date of birth, contact information, and community. It also requests academic and professional qualifications, achievements, work experience, knowledge of characterization equipment, and references. The applicant is required to sign declaring that all information provided is true and accurate.

Uploaded by

Amrit Mohanty
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
21 views

Application Form

This document is an application form for the positions of Technical Assistant or Administrative Assistant. It requests personal details such as name, gender, date of birth, contact information, and community. It also requests academic and professional qualifications, achievements, work experience, knowledge of characterization equipment, and references. The applicant is required to sign declaring that all information provided is true and accurate.

Uploaded by

Amrit Mohanty
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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APPLICATION FORM

Post applied for Technical Assistant

Administrative Assistant

Personal Details

Full Name (including surname; in block letters)


Paste your
Photograph

Sex: Male Female Others

Marital Status : Single Married Others

Whether Physically Challenged: Yes / No.

If Yes, whether OH/HH/VH (Orthopedically/Hearing/Visually)

Date of Birth

Nationality Community: SC/ ST/ OBC/GEN

Permanent Home Address Correspondence Address (if different)

Telephone (Res) Telephone (Res)

Telephone (Mob) Telephone (Mob)

E-mail E-mail
1. Academic Qualifications

Examinations Passed/ appeared in chronological order. Documentary evidence of known results should be sent
with this form; only attested photocopies are acceptable

Year of % of marks/
Qualification Specialization University/ College
Passing Division

SSLC

HSC

DIPLOMA

UG

PG

Others

2. Achievements: (Attach separate sheet if required)


3. Relevant Work Experience (if any) :
(Attach separate sheet if required)

Job Title; Name of Full time From To


Responsibilities; Organization or Part-
Nature of time Month Year Month Year
work/training
Current post :

Other posts:

4. Knowledge on high end Characterization equipments related plastics/polymer Technology.


5. Name and address of Referee (s)

Referee 1 Referee 2

Telephone Telephone

E-mail E-mail

6. Declaration

I declare that the entries made in the columns of this proforma are correct and true to the best of my
knowledge and nothing has been either concealed or misrepresented by me. I understand that
CIPET:SARP reserves the right to withdraw any offer or cancel a registration made on the basis of
information which proves to be false or misleading.

Applicant’s Full Signature Date

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