FOR PURELY TEMPORARY NON-TEACHING POST

For Office Use Only

Inward No. Est. No. Sr. No.
Date ___/___/2020 Date ___/___/2020
Section Establishment

Bhakta Kavi Narsinh Mehta University

Govt. Polytechnic Campus, Bhakta Kavi Narsinh Mehta University Road
Khadiya, Junagadh, Gujarat (India) - 362 263
Ph. 0285-2681400 / Fax: 0285-2681503
Website : http://www.bknmu/edu.in Email : [email protected]

Application form for the Non-Teaching Post

Advertisement No. No.Bknmu/Esta./200/2020 , Dated : 29/08/2020 Affix the
Date:___/____/2020 Rs. /- 3.5 c.m X 3.5 c.m.
Demand Draft No.
Self-Attested latest
Name of Bank Branch Photograph only

Payable at Branch City

IMPORTANT: Before filling in the form please read the form, Instructions and Qualification criteria carefully.

1. (In Block letters) Name in full:

Mr./Mrs./Ms./Dr.
Father’s Name
Mother’s Name

2.(i) Please Tick mark (√) appropriate column. Please enclose Caste Certificate of appropriate authority, if
applicable.
S.C. S.T. SEBC PH EWS General Other

(Attach a certificate from the competent authority with Caste validity certificate for S.C./S.T./ Socially and
Educationally Backward Class (SEBC) /PH/ EWS Certificate.) (SEBC candidate must be attached Non-Creamy layer
certificate)
(i) Caste Certificate No. Issue Date

(ii) Name of Issuing Authority

Age
3. Date Month Year
(Years)

(A true copy of the Higher Secondary School Leaving Certificate in which the Birth Date is registered should be
enclosed.)
Page 1 of 7
 A Birth Place Tal. Dist. State

B Native Place Tal. Dist. State

C Race & Religion Nationality Mother tongue

D Blood Group Height (cms) Weight (Kgs.)

E Personal Marks of Identification

F Aadhaar Card No.

G Pan Card No.

H City/District where
Election Card No.
Registered

Married Unmarried
4. Please Tick mark (√) appropriate column

5. Full Name & Address for correspondence (In Block Letters)

Present: Permanent:

City City

Pin code Pin code

Tal. Tal.

Dist. Dist.

State State

Phone No Phone No

Mobile No. Mobile No.

E-Mail E-Mail

Page 2 of 7
6. Educational Qualifications : Examinations passed (Attested copies of all testimonials/ Certificates including
Marks, Grade, Certificate should be attached) :

Year & Month of

studies were carriedLanguage in which

each of the No. of attempts for
Subsidiary Subject

Encl. at Page No.

Passing the
Total Marks

passing
Name of the
Sr. Examination with Class,
Principal Subject University or
No. Passed Grade, Exact
Examination Body
percentage (%)

Examination

examinations
1 2 3 4 5 6 7 8 9 10

1 S.S.C

2 H.S.C.

I Sem
Bachelor’(Specify Degree)

II Sem

III Sem

IV Sem

3
V Sem

VI Sem

If semester
system is not
followed please
give details of
last year
consolidated
marks

I Sem
Post Graduation

II Sem

4 III
Sem

IV
Sem

5 Other

6 Computer Knowledge YES/NO Duration of Course and Date

CCC
7 TALLY Accounting Course YES/NO Duration of Course and Date

Page 3 of 7
(8) Details of Experience : (Post held in Private or Public employment giving details of Work) (Teaching, Laboratory,
Industry etc.)

Encl at page No.

Month
Full

Year
Grant-in Basic Pay Reason for
Full Name & Address of time/
Designation Date of Date of Aid/ Self & Pay leaving
the Employer where Part
(Type of work) joining Leaving Finance/ Scale or Previous
Employed Total time/
Private Fixed pay Employment
Experienc Adhoc
e
1 2 3 4 5 6 7 8 9 10 9

(09) Present Position :

No.Encl at page
Grant-in Basic Pay or
Full Name & Address Full time/
Work Aid/ Self Pay Band & Date of
of the Employer where Designation Part time/
Done Finance/ A.G.P. OR appointment
Employed Ad hoc Fixed Pay
Private

Area of Specialization

(10) Any other relevant information (Special experience/merits) not included above (Participation in curricular and co-
curricular activities, NCC / NSS / Sports / Cultural Activities etc. enclose all Certificates)

Sr. No. of Encl. at

Activities Institution From To page No.
No. Days
1 N.C.C.
2 N.S.S.
3 Sports
4 Cultural activities

(11) Languages Known Tick mark (√) appropriately :

Sr.
Language Read Write Speak
No.
1 English

Page 4 of 7
 2 Gujarati
3 Hindi
4

(12) Name, address and Phone No. of not more than two persons to whom reference can be made:
Period for which
Phone No./
No. Name Full Address he/she has known to
Mobile No.
the candidate

DECLARATION
I hereby solemnly affirm that the information given in this application form is true and correct to the
best of my knowledge and belief. I also affirm that I have never been convicted by any court of law or
suspended / dismissed by any employer/organization from job. I understand that if any of the information
given by me in this form is found incorrect, my candidature is liable to be cancelled at any stage without
assigning any reason. I confirm that I shall abide by the decision/s of the University with regard to my
application.
______________________
Name and Signature of the Candidate
Date:
Place:

Forwarded through:
(For employed candidates only)

I herewith forward the application of _____________ for the post of ___________ at the Department of
_________________, Bhakta Kavi Narsinh Mehta University, Junagadh. He/She is working as an
_______________ in our organization on a ______________basis. We have "No Objection" to his
application being considered and, if selected, for his/her appointment as to the concerned post in your
University.

_____________________
Name and signature of the competent
authority with seal

Note : (i) All Copies of Marksheet / Certificates should be Self Attested.

(ii) List of enclosures attached by the applicant should be arranged strictly in the
following order which enclose : Please tick (√)

Sr. Details Enclosed with Application Form (√) Encl. at

No. Page No.

Page 5 of 7
 Educational Qualifications Certificates
1. Application Form with Photograph & Separate Sheet.
2. Caste Certificate (If necessary)
3. Higher Secondary School Leaving Certificate.
4. Aadhaar Card / Election Card Copy
5. S.S.C. / H.S.C. all Marksheet.
6. F.Y.,S.Y. & T.Y. all Marksheet & Degree Certificate.
7. Postgraduate’s Degree -Previous & Final Year all Marksheet & Degree Certificate.
8. Experience Certificates
9. CCC Certificate
10. TALLY Accounting course Certificate
11. Other Qualifications Certificates

Page 6 of 7
 Bhakta Kavi Narsinh Mehta University Sr. No. :
(To be Submitted with application form) EST. No.:
Advertisement No. 06/2020 No.Bknmu/Esta./200/2020 , Dated : 29/08/2020
# For the Post Applied for : (Temporary Basis) Category
Bhakta Kavi Narsinh Mehta University,
# Name of Department :
Junagadh

# Name of the Candidate : Dr./Mr./Ms./Mrs./

# Date of Birth : ____/____/_____ _____ years
# Forwarded through / NOC :
# Remarks :
Educational Qualifications
Percentage(%) Passing Year
Degree Class Subject University
/ Grade
1 2 3 4 5 6

Year Month From To Experience

1 2 3 4 5
Worked as ___________________ in ______________ at
__/___/20__ __/___/20__
_________________________________________
Worked as ___________________ in ______________ at
__/___/20__ __/___/20__
_________________________________________
Worked as ___________________ in ______________ at
__/___/20__ __/___/20__
_________________________________________
Worked as ___________________ in ______________ at
__/___/20__ __/___/20__
_________________________________________
Working as ________________________ in _______
_____________________________ at _____________ with Basic
__/___/20__ __/___/20__
Pay / Fixed Pay of Rs.________/- in the Pay Band of
Rs.____________/- with A.G.P.______
Total Experience

Page 7 of 7