APPLICATION FORM FOR FACULTY / TRAINEES / CENTER MANAGER

DIVISION:

AIPMT

IIT

PREFERRED LOCATION: (Please give 3 Choices)

Agra
Jammu
Ahmedabad
Jhansi
Alwar
Korba
Aurangabad
Kolkata
Bareilly
Mathura
Bhubaneswar
Meerut
Chandigarh
Nagpur
Dehradun
Pune
Jabalpur
Rourkela

Srinagar

Affix latest
Colored
Passport size
Photograph
It is Compulsory

ALL ENTRIES MUST BE IN CAPITAL LETTERS

Position Applied For : Faculty / Trainees
Subject Applied For :

Physics/Mathematics/Biology/Chemistry (Physical, Organic, Inorganic)

Name :
Gender : Male / Female
Date of Birth (DD/MM/YYYY) :
Fathers/Husbands Name :
Marital Status : Married / Single
Address :
City :
State :
PIN :
Residence Tel. No (With STD):
Mobile No. (If any) :
E-mail :
Academic Performance:
Name of
Institution

Year of
Passing

University/Board

Degree/Certificat
Discipline
e

%age

CGPA

PG
UG
XII

Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA 324005 (Raj.) INDIA.
Tel.: (0744) 2421097, 2424097, 2423738, 2423739 FAX: (0744) 2436779
Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2423245
Email: admin@bansal.ac.in
Website : www.bansal.ac.in

Experience (Starting from Present Job):

Name of Institution

From

To

(MM/YYYY)

(MM/YYYY)

Post Held

Avg. Batch
per day

Medium

Salary
Drawn

Total Experience (Years): ____________

Date:

Signature: _____________

Please bring a valid ID proof at the time of Interview.

In case of any work experience, bring experience certificate and salary proof.
Bring two passport size photographs.

Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA 324005 (Raj.) INDIA.
Tel.: (0744) 2421097, 2424097, 2423738, 2423739 FAX: (0744) 2436779
Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2423245
Email: admin@bansal.ac.in
Website : www.bansal.ac.in