Professional Documents
Culture Documents
Non-Faculty Application 1
Non-Faculty Application 1
Particulars of the attached D.D : Name of Bank: ___________ D.D. No. _________ Dt:_______
1.
:______________________________________________
2.
3.
:_________________
Building/H.No :______________________________________________
Street/Colony :______________________________________________
City/Town
:______________________________________________
State
:______________________________________________
Pin
:______________
Phone
: _______________
: ______________________________________________
Permanent Address:
Building/H.No :______________________________________________
Street/Colony :______________________________________________
City/Town
:______________________________________________
State
:______________________________________________
Pin
:______________
Phone
: _______________
: ______________________________________________
5.
Married:
6.
7.
Nationality of:
8.
Single :
a) Applicant
:______________
b) Father
:______________
Name:___________________
c) Mother
:______________
Name:___________________
d) Husband/Spouse :______________
Name:___________________
Father`s/Husband`s:
a) Name in full
:___________________
:___________________
:___________________
___________________
Mother`s :
a)
Name in full
:___________________
b)
Profession
:___________________
___________________
designation and
___________________
office address)
10.
Examination
passed
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Name of the
University/Board
School/
college
attended
Division with
percentage of
marks
obtained
Year of
passing
Subjects
11.
Examination
passed
12.
Name of the
University/Board
School/ college
attended
Division with
percentage of
marks
obtained
Year of
passing
Subject
Employers
Name and
Address
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Designation
Regular/
Temporary/
Permanent/
Contract
Scale of
pay
Basic
pay
Total
emoluments
Length of
experience
From
To
Nature of
work
13.
i) a) Name
:__________________
ii) a) Name
:__________________
b) Position
:__________________
b) Position
:__________________
c) Address
:__________________
c) Address
:__________________
__________________
d) E-mail
:__________________
__________________
d) E-mail
:__________________
f) Fax
:__________________
f) Fax
iii) a) Name
:__________________
b) Position
:__________________
c) Address
:__________________
:__________________
__________________
d) E-mail
:__________________
:__________________
14.
15.
(a) Post held, if any, at the time of sending the application with date of appointment (State
whether permanent, or temporary) :
(b) Name of Employing Authority :
16.
17.
18.
Number of literacy, cultural or other activities (e.g. attainment in sports etc. in which the
applicant is interested and distinctions, if any, obtained in the same :
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19.
20.
Are you a Physically Handicapped person ? If so give details of Medical Certificate issued
by Competent Authority:
21.
Have you been debarred or punished for adopting unfair means in any examination by the
institution/Board or University? If so, please specify :
22.
Have you been imprisoned by and Court of Law for any criminal or civil act? If so, give
details:
23.
Are you related to anybody employed in School of Planning and Architecture, Vijayawada
presently. YES/NO:
If YES, indicate (i) Name of employee
24.
Would you like to treat your personal information in this application with enclosures as
confidential for RTI Act 2005 provisions (Write Yes or No) _______
25.
-------------------------------------------------------------------------------------------------------------------------------
APPLICANT`S DECLARATION
(a)
I hereby declare that the information provided in this form is true to the best of my
knowledge and belief. I have satisfied myself that I fulfill all the eligibility requirements.
(b)
I shall submit myself to the disciplinary jurisdiction of the competent authorities of the
School who may be vested with the authority to exercise discipline under the
Act/Statutes/Ordinances and the Rules that have been framed by the School.
(c)
I agree that the decision of the School on all matters will be final and binding on me.
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(d)
___________________
Date: _________
Forwarded with the remarks that the facts stated in the above, application have been verified
and found correct and this Institution/Organization has no objection to the candidate of the
applicant being consider for the post applied for. It is certified that no vigilance/disciplinary case
is pending or contemplated or initiated against the official. The integrity of the official is certified.
Forwarded:
_____________________
Signature of the
Forwarding authority
Dated: _________
Designation :__________________
Address
:__________________
__________________
___________________
Pin Code
:___________________
Telephone :___________________
Fax
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:___________________
List of enclosures:
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
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20)
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