Application Form

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Indian Institute of Technology Mandi

Mandi Himachal Pradesh -175001


Application for Project Associate
(1)

Post applied for

:________________________________

(2)

Name

:________________________________

(Affix Self

(3)

Father's Name

:________________________________

Attested recent

(4)

Address

:________________________________

passport size

________________________________

photograph)

City

:________________________________

State

:________________________________

Email

:________________________________

Mob./Phone No.

:________________________________

(5)

Sex

:________________________________

(6)

Date of Birth

:________________________________

(7)

Category: /SC/ST/OBC/General /PH

:________________________________

(8)

Educational Qualification

Sl.No.

Examination Passed

1.

High School (10th)

2.

Intermediate (10+2)

3.

Diploma

4.

B.Tech./B.E.

Branch

(9) Experience/Brief Record of Services:


Name & Address of
Designation
the Employer

Year of
Passing

School/Board/University

Duration
From

Salary drawn

% of Marks
& Division

Nature of Duties

To

I hereby certify that all the statements made by me in the application and supported by enclosures are
complete and correct to the best of my knowledge and belief. I understand that my candidature and appointment is
liable to be cancelled if any of them is found false.
Place:
Date:
Enclosures:

Signature of the Applicant

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