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T D Appli PDF

This document is an application form for the post of ______________ at ICMR-Vector Control Research Centre in Puducherry, India. The 3-page form requests information including the applicant's name, address, date of birth, nationality, gender, marital status, community, educational qualifications, languages known, previous work experience, notice required before joining, and declaration of truth of information provided. The checklist reminds applicants to attach self-attested copies of required documents.

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aruna
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104 views3 pages

T D Appli PDF

This document is an application form for the post of ______________ at ICMR-Vector Control Research Centre in Puducherry, India. The 3-page form requests information including the applicant's name, address, date of birth, nationality, gender, marital status, community, educational qualifications, languages known, previous work experience, notice required before joining, and declaration of truth of information provided. The checklist reminds applicants to attach self-attested copies of required documents.

Uploaded by

aruna
Copyright
© © All Rights Reserved
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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VCRC

VECTOR CONTROL RESEARCH CENTRE

ICMR-VECTOR CONTROL RESEARCH CENTRE


MEDICAL COMPLEX, INDIRA NAGAR
PUDUCHERRY – 605 006
Phone No.0413-2272396, 2272397, Fax No.2272041, Email: [email protected]
Website: (www.vcrc.res.in)

Note: This application form should be filled in by candidate's own handwriting. Affix a recent
All informations must be given in words and not by dashes and dots. passport size
Please strike out whichever is not applicable. Incomplete application will be photograph
rejected.
(3.5cm x 4.5cm)

Application for the post of _________________________________

Demand Draft No: _________________________ Date: ________________________

Name of Bank: _______________________________________ Amount (`): __________

01. Name in Full: Shri./Smt./Kum. : __________________________________________________


(IN CAPITAL LETTERS)

02. Present / Communication Address : __________________________________________________

: __________________________________________________

: __________________________________________________

: ___________________________________________________

(B) Permanent address : ___________________________________________________

: ___________________________________________________

: ___________________________________________________

(C) Telephone /Mobile No : __________________________________________________

(D) E-mail : __________________________________________________

03. Date of Birth* (DD/MM/YYYY)_________________________ 04. Nationality _______________________

05. Gender: Male Female (Please  the appropriate box)

06. Marital status: Unmarried Married (Please  the appropriate box)

07. Community/Category* : SC ST OBC EWS UR PwD XSM


(Please  the appropriate box)
(*Self attested copies of certificates must be attached)

......2
-:2:-
08. Educational Qualification: (Attach Self attested copies of all certificates)

Class/
Sl. Examination Year of Name of the Board/ Percentage
Subjects taken
No passed passing University of marks
obtained

1. SSLC/Matric

2. HSC / 12th

3. Degree

Post Graduation
4.
(PG Degree)

Diploma / PG
5.
Diploma

Other
6. qualifications,
if any

09. Languages known:

Read Only Speak Only Read and Speak Examination Passed

10. Previous Service Details: (Chronologically starting from the present employer)
Date of Name of the post
Number of Scale of Pay
Name of the with status Nature of
years of & Gross Pay
Employer Joining Leaving (whether Regular work
experience drawn
/ Contractual)

.....3
-:3:-

11. If selected, what notice period would you require :


before joining

12. Any other information, you wish to add :

DECLARATION

I, ______________________________ hereby declare that the information furnished above is true to the
best of my knowledge and belief and no related information has been concealed. I am aware that if any of
the above statements are found to be incorrect or false or any material information or particulars have been
misstated, suppressed or omitted, I am liable to be disqualified for appointment and if appointed, my
appointment will liable to be terminated without any notice.

Signature of the candidate

Date:

Place:

CHECK LIST

Tick () whether the self-attested copies of the certificate and other documents in support of the
application are enclosed, as given under;

1. Certificate for proof of age :

2. Community certificate, if claim is under OBC/SC/ST :

3. Income & Asset certificate, if claim is under EWS :

4. Disability certificate, if claim is under PwD :

5. Discharge certificate, if claim is under XSM :

6. Certificates in support of Educational Qualifications :

7. Certificate for proof of Experience, if any :

8. Demand Draft (if applicable) :

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