SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY, TRIVANDRUM Thiruvananthapuram — 695011, KERALA, INDIA APPLICATION FORM. Latest APPLICATION FOR THE POST OF : Passport size photograph 1. Full Name (in BLOCK Letters) 2. Father's Name 3. Age & Date of Birth 4. Sex Male/Female 5, Address for correspondence 6. Permanent Address 7. — Religion/Caste 8. Whether you belong to any reservation : category as per GOI orders (SCIST/OBC-non creamy layer, etc.) 9. Ifyes, please specify10. Educational Qualifications: Name of examination passed Year of | %ofmarks Passing 11. Experience: Name and address of | Designation Period Nature of the employer Experience & From Te Remarks ‘Note : Copy of all relevant certificates are to be enclosed along with the application. 12. Any other information : Declaration |, hereby, declare that the information furnished by me are true and correct to the best of my knowledge and belief. | understand that in case the information furnished above is found to be not correct, my candidature is liable to be rejected. Place : Date : ‘Signature of the Candidate