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IITB

The document appears to be an application form for a position at the Indian Institute of Technology Bombay, as it requests information such as the applicant's personal details, education history, employment history, languages known, and references within the Institute. The form collects standard applicant information over 20 items to evaluate candidates for the open position in a laboratory or department. It requests details such as name, date of birth, addresses, category, qualifications, experience, languages, relatives employed at IIT Bombay, and a declaration of truth of the information provided.

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Imran Mohammadsabir Mansuri
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69 views2 pages

IITB

The document appears to be an application form for a position at the Indian Institute of Technology Bombay, as it requests information such as the applicant's personal details, education history, employment history, languages known, and references within the Institute. The form collects standard applicant information over 20 items to evaluate candidates for the open position in a laboratory or department. It requests details such as name, date of birth, addresses, category, qualifications, experience, languages, relatives employed at IIT Bombay, and a declaration of truth of the information provided.

Uploaded by

Imran Mohammadsabir Mansuri
Copyright
© Attribution Non-Commercial (BY-NC)
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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INDIAN INSTITUTE OF TECHNOLOGY BOMBAY POWAI, MUMBAI 400 076

Please Affix a recent photo here with signature

Advertisement No._____________ dated ____________ 1. Post applied for: ___________________________ in the Lab_______________, Department of _________________ 2. Name in full (Capital letters): _________________ ___________________ _________________ (Surname) (First Name) (Middle Name) 3. Date of Birth ______/_____/________ 4. Fathers name/Husbands name____________________________________________________ 5. Address for correspondence: ______________________________________________________ ______________________________________________________Pin code __________________ Tel. No.__________ ____________________ (STD CODE) ( NUMBER) Mobile No._________________________ Email ID: _______________________________

6. Permanent address: _____________________________________________________________ ______________________________________________________Pin Code__________________ 7.Marital status: _________________ 8. Nationality: ______________ 9.Gender (Please tick appropriately ) M F

10 .Category GEN/ SC/ ST/ OBC(noncreamy layer)/ Physically Handicapped___________________ (Please attach attested copy of certificate) 11. Religion : __________________________ 12. Educational Qualifications (SSC onwards Please attach xerox copies) : Examination/ degree Branch % of Marks/ class Name of College/ University/Board Year of passing

Contd....2

13. Other / Technical Qualifications: (Please attach xerox copies) Course name % of marks/ Name of Institution class

Year of Passing

Duration of course

14. Details of Employment: (starting with the most recent) (Please attach xerox copies of certificates) (Particulars of all previous and present employment are to be furnished including training/ apprenticeship undergone, if any) Name of Designation Period Nature of duties Reasons for leaving Organization From To

15. Are you under any Contractual obligation to serve the Central/ State Govt./ any other Public Sector Undertakings. If so please furnish full details. 16. Are you in receipt of any Pension, Gratuity or Employer's share of contribution of Provident Fund from Central/ State Govt. or any Public Sector Undertaking? If so please give particulars there of : 17. Languages known to speak, read & write (Please tick in the applicable boxes) Language Speak

Read

Write

18. Details of relatives already employed in Indian Institute of Technology Bombay : Name of Relationship Department in which relative employed

Department in which employed

19. Any other information : (Attach separate sheet, if needed) 20. I hereby declare that all information given by me in this proforma is complete & correct to the best of my knowledge and belief. I understand that in the event of any information being found untrue or incorrect at any stage, my candidature is liable to be cancelled. I also declare that I have gone through the instructions and I understand the same. Signature of the Applicant Name :

Date: Place:

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