UNIVERSITY GRANTS COMMISSION

FORM OF APPLICATION
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POST: …………………………………………………………
(Indicate the name of the post as given in the advertisement)
__ ______ ________________________________________________________________________

01. (a) Name with initials :

(b) Names denoted by Initials :

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02. Whether Rev./Mr./Mrs./Miss :
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03. (a) Postal Address :

(Any change should be

communicated immediately)

(b) Contact Telephone No. :

(c) E-mail Address :

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04. National Identity Card No. :

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05. (a) Date of Birth : Year Month Date

(b) Age as at the closing date Years Months Days

of applications :
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06. Civil Status :
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07. Whether Citizen of Sri Lanka :
(State whether by decent or by
registration) if by registration,
give reference number & date
of certificate of citizenship
Contd…/2
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08. Race :
(State whether Sinhala, Tamil, person of Indian Origin or Muslim)
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09. Education :
From To
Schools Attended
Year Month Date Year Month Date
1.
2.
3.
4.
5.
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10. Qualifications- (All qualifications to be considered should be indicated in the application)

(a) University Education:

(Attach copies of certificates & transcripts)
Date of Effective
Class Duration
Degrees/Diplomas University Commencement Date
Year Month Date Year Month Date
1.

2.

3.

4.

(b) Professional Qualifications:

(Attach copies of certificates)
Date of Effective
Institution Qualifications Obtained Commencement Date Duration
Year Month Date Year Month Date
1.

2.

3.

4.

5.

Contd…/3
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(C) Postgraduate Qualifications.

(Attach copies of certificates)
Date of Effective Duration
Postgraduate Commencement Date (Prescribed
University By Course or
Degree/Diploma period of
By Research
Year Month Date Year Month Date Registration

1.

2.

3.

4.

5.

(d) Training/Workshops attended:

(Attach copies of certificates)
Name of the Training From To
Institution Programme/Workshop Duration
Year Month Date Year Month Date

1.

2.

3.

4.

5.

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11. Any other academic distinctions scholarships, medals, prizes etc.:
(indicate the Institution from which such awards have been obtained)
(Attach copies of certificates)
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Contd…/4
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12. (a) Research & Publications if any :
(If space is insufficient, please use separate sheet of same size)

(b) IT Projects
(If space is insufficient, please use separate sheet of same size)

Project Period Technology

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13. Highest examination passed in :
Sinhala/Tamil
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14. (a) Present Occupation :

1. Post :

2. Date of appointment to such post :

3. Whether confirmed in the present post :

4. Place of work with the Address :

5. Salary Scale of the post :

6. Present Salary a. Basic Salary :

b. Allowances :

Contd…/5
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(b) Previous appointments if any, with dates:

(Attach copies of service certificates)

Period of Service Salary Reason for

Department/
From To Cessation of
Post Institution Scale Employment
Year Month Date Year Month Date

15. (a) Period of experience gained as at the closing date of Applications

relevant to the post applied :

Years Months Days

(b) If you have obtained no-pay leave during this period, state reasons and
the period of such leave :

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16. Extra Curricular activities :
(If space is insufficient, please use separate sheet of same size)
Event
Achievements Level

Sports
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Subject Level

Other Certificates

Positions Professional Body/Society//Organization

Positions held in
Professional
Body/Societies/
Organizations/etc.

Achievements

_________________________________________________________________________________
17. (Names of two non related referees with addresses and Contact Nos. )
Name Designation Address Contact No:
Email Address
1.

2.
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I do hereby certify that particulars submitted by me in this application are true and accurate.
I am aware that if any of these particulars are found to be false or inaccurate, I am liable to be
disqualified before selection and to be dismissed without any compensation if the inaccuracy is
detected after appointment .

Date: ………………….. ………………………………..

Signature of Applicant

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For Internal Applicants Only.

Secretary,
University Grants Commission.

Application is recommended and forwarded. I certify that the particulars given in numbers
01 to 14 of this application are correct according to the applicant’s personnel file and if he / she is
selected for the said post he / she can be / cannot be released.

Remarks if any :

Vice-Chancellor/Secretary/Registrar
Rector/Director/SAS/Personnel/UGC

Institute:……………………………………………………….

Date: ………………………
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For public Service/ Corporation/ Statutory Board Candidates only

Secretary,
University Grants Commission.

Application is recommended and forwarded. I certify that the particulars given in numbers
01 to 14 of this application are correct according to the applicant’s personnel file and if he / she is
selected for the said post he / she can be / cannot be released.

Remarks if any :

………………………………..
Signature of the Head of the
Governing Body & Official Stamp

Name :……………………………………..……………

Designation :……………………………………..……………

Date :……………………………