J. C. Bose University of Science and Technology, YMCA, Faridabad

(formerly YMCA University of Science and Technology) A State Govt. University established vide State Legislative Act. No. 21 of 2009 SECTOR-6, FARIDABAD, HARYANA-121006

Ph:012*-*******, 2242143 (Fax) web: www.ymcaust.ac.in Sr. No:

APPLICATION FOR EMPLOYMENT

D.D No dated Bank Rs. Advertisement No

Post Applied for

1. Name:

(as entered in the University / Board in Capital letters) 2. Father’s / Husband’s Name:

3. Present/ Postal Address:

Phone No.

Mobile No e-mail: 4. Permanent Address:

Phone /Mb:

5. Date of Birth: Age

6. Place of Birth:

District: State:

7. Nationality: Religion:

8. Marital Status: Aadhar Number:

9. Do you belong to any reserve category i.e.

(SC, BC-(A)/ (B), ESM others if so, please attach a proof of the same) Attach latest

photograph

duly signed

10. Educational Qualification (if space is insufficient attach separate sheet) Sr.No.

Name of Exam passed

Year of

Passing

Duration

of course

Board / University

Marks obtained/

Total marks

Exact %age of

Marks

Obtained

Division

1. 10th

2. 10+2/ ITI

3. CTI/ Diploma

4. B. Sc/ B.Com/ BA/ B.Lib

5.

BE/ B.Tech/ M.Sc/

M.Com/ MA/ M.Lib

6. ME/ M.Tech/ M.Phil

7.

Ph.D/ Fellowship of

IIMs, ICA or ICWA

8.

Any other relevant

qualification

11. Experience (if space is insufficient attach separate sheet): Starting from beginning Sr.

No.

Name of Post Name of Company/

Organization /Institute

Period Pay

Band

Basic Pay

+G.P

Total Emolument

drawn p.m.

Nature of

duties

Reason for

From To Total leaving

12. Any other training

13. No. of Research Papers / Books published (publications): i) International Journal

ii) National Journal

iii) International Conference

iv) National Conference

v) No. of Books Published

vi) No. of research scholars guided / guiding (only Ph.D) 14. Languages (Mother Tongue):

Other Languages: Language Speak Read Write

15. Proficiency in games and sports:

(Only if you have won any distinction)

16. Special & other activities:

17. Joining period required, if selected:

18. Minimum Pay acceptable Rs.

19. Details of Enclosures (Attested copies of certificates and Testimonials should be enclosed without which the application would not be considered)

20. References: Name and addresses of two persons, who will vouch for you

(These should be residents in India holding responsible position. They should be intimated/ acquainted with the applicant’s character and work, but must not be related by blood or marriage. When the candidate has been in employment, he should either give his present or immediate superior of recent employer as a reference or produce a testimonial from him in regard to the candidate fitness for the post for which he is an applicant). i) Name: Occupation/Position: Address ii) Name: Occupation/Position: Address I hereby affirm and declare that the statement made by me in the above application is correct to the best of my knowledge and nothing has been concealed therein. I shall be held responsible for any false/ incorrect statement and my candidature will stand cancelled at any stage.

Place:

Date:

(SIGNATURE OF APPLICANT)*

* Candidate is required to sign all documents & pages of application form. Use extra sheets if required UNDERTAKING

(To be submitted by the applicants for group C/D posts along with the application form) I hereby furnish the following information:

A. Whether any person from among the applicant’s father, mother, spouse, brothers, and sons is, was or has been a regular employee in any Department/ Board/ Corporation/ Company/ Statutory Body/ Commission/ Authority of Government of Haryana or any other State Government or Government of India. (YES/NO) B. Orphan/ Widow: -

i) Whether the applicant ( ) is a widow. (YES/NO) ii) Whether the applicant ( ) is the first or the second child and his father had died before attaining the age of 42 years. (YES/NO) iii) Whether the applicant ( ) is the first or the second child and his father had died before the applicant had attained the age of 15 years.

(YES/ NO)

C. Whether the applicant ( ) belongs to such a denotified tribe

(Vimukt Jatis and Tapriwas Jatis) or Nomadic tribe of Haryana which is neither a Schedule Caste nor a Backward Class. (YES/NO)

I hereby undertake that the information stated above is true and correct to the best of my knowledge, and nothing has been concealed therein. I hold myself liable for perjury, falsehood, misrepresentation and/or omission and/or falsification or act of dishonesty for any fraudulent, fake or tampered documents that have been submitted. Further, I shall not take advantage of the certificate(s) issued by the Competent Authority if in the meantime any other eligible person in any family obtains the benefits thereof in the recruitment.

Signature of the Applicant

Name of the Applicant:

Father/Husband Name:

Address:

Contact this candidate