Egkrek Xka/Kh Varjjk"V H Fganh Fo'Ofo - Ky : Mahatma Gandhi Antarrashtriya Hindi Vishwavidalaya
Egkrek Xka/Kh Varjjk"V H Fganh Fo'Ofo - Ky : Mahatma Gandhi Antarrashtriya Hindi Vishwavidalaya
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_____________________________________________________
Post Applied For (with the Name of School) ______________________Post Code no___________
Demand Draft ParticularsName of the Bank
DD No
Date
Value
.
1. Full Name (In Block Letters): _____________________________________________________
2. Father's /Husband's Name:
_____________________________________________________
3. Date of Birth:
_____________________________________
4. Place of Birth:
_____________________________________
___________________Religion________________________
7. Sex: Male/Female
_____________________________________
Affix recent
Passport Size
Photograph with
Signature
1) Yes__________
2) NO ______________
1) Yes_________
2) NO ______________
(if Yes, certificate from an officer not below the rank of Civil Surgeon should be enclosed)
_____________________________________________________
Year of
Passing
Board/
University
% of
Marks
Division/
Grade
Subject
Specialization/
Distinction
High School
Intermediate/PUC/
Hr. Sec.
Bachelors Degree
Masters Degree
Other
Technical Qualification (If any)
Name of
employer
Date of
Joining
Total Period
Leaving
Reason for
Leaving
Name
Reading
Writing
Speaking
17.
Pay scale
: _________________________________
Basic pay
: Rs ______________________________
: Rs ______________________________
Non-compoundable Increment
: Rs ______________________________
Dearness Allowance
: Rs ______________________________
HRA
: Rs ______________________________
Transportation Allowance
: Rs ______________________________
: Rs ______________________________
Total emoluments
: Rs ______________________________
: _________________________________
: _________________________________
(a) Whether the candidate in receiving any pension benefit. If so, the amount of pension and
pension equivalent of gratuity must be indicated.
_______________________________________________________________________
(b) Whether the candidate would be entitled to any pension benefits on his premature retirement
from his present post. If so, the amount of pension and the pension benefits any be
indicated, if selected for appointment in the university.
______________________________________________________________________
18.
(a) Have you been debarred or punished for adopting unfair means in any Examination by the
Institution/Board or University? If so, please specify.
______________________________________________________________________
(b) Have you at any time been convicted by a court for any criminal offence? If so, give name of
the court case number and offence.
______________________________________________________________________
(c) Is any criminal case pending against you in any court of law for any criminal offence.
_____________________________________________________________________
(d) Has any disciplinary action been taken against you by any University/Institution whether you
have served
_____________________________________________________________________
(e) Is any disciplinary inquiry/action pending against you in any University / Institution /
Organisation where you have served
_____________________________________________________________________
__________________________________
_______________________________
__________________________________
_______________________________
__________________________________
Date:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Important:
1. Photocopies of Certificates, Mark sheets, Testimonials etc should be attached with the application
(attested by the applicant himself) and the originals must be produced at the time of Interview and
at the time of joining, if selected.
2. Applicants who are in employment should send their application through proper channel.
3. The selected candidates shall produce, in original the matriculation or equivalent certificates as
proof of the date of birth. No other evidence will be accepted.
Endorsement by Employer
Also Certified that, the information furnished by the applicant is verified and correct as per our
office records.
.
Signature___________________________
Designation ________________________
(Headof theUniversity/Institution/Organisation with Seal)
Address ___________________________
___________________________________
Pin _______________________________
Tel No. ____________________________
Date _________________