INTER UNIVERSITY ACCELERATOR CENTRE

NEW DELHI
ADVERTISEMENT NO:______

Affix latest
passport
size
photograph

1)
Name of the post Applied
for...................
2)

Name of Candidate:...

3)
Fathers / Husbands Name:
..
4)

Date of Birth:.

5)

Place of Birth Dist:.State:

Country:.

6)

Marital Status.

7)

Sex

8)

Permanent Address:....
..

9) Correspondence Address:.
.
Telephone No.. E-mail: ...
10)

Do you belong to SC/ST/OBC/PH category (if Yes mention

the category and attach certificate from District Magistrate/
Tehsildar or the concerned Competent Authority)
.

.2

-211)
Sl.
No.
1.
2.
3.
4.
5.

Qualification: (Highest qualification first)

Qualification
Board/Unive Division/%
rsity
of Marks

Yr. of
Passing

12)

Awards/prizes:

13)

Scholarships/fellowships received with details

14)
Sl.
No.

Experience (Current occupation first)

Name of
Organization

Post held
&
Duration

Scale of pay
& basic pay
drawn

Nature of
Duties

1.
2.
3.
4

-315) State briefly why do you consider yourself fit for the post
applied(Use separate sheet and enclose if necessary)
..

...
.
16) a)
Have you ever been arrested/ prosecuted/kept in
detention/bound down/fined/convicted by a court of law or
whether any case pending against you in court of law? Yes/NO
(
if
yes,
please
provide
details)

b)
Have ever been debarred from any fellowship/
examination/ rusticated by any University or any other
educational institution or whether any case is pending against
you in any University or any other educational institution? Yes/No
( if yes please provide details) ..

17) Name & Address of two referees who should be a

responsible person, not related to the candidate but well
acquainted with him/her work/study.
1. Name
Address.......
.
.
Email: .
Phone no.
2. Name..
Address..
...
Email: ..
Phone no...

..4

-418) Any other details relevant to the post applied:

Declaration:I do hereby solemnly declare the details stated herein

above are true to the best of my knowledge & belief. In the event
of anything found false/concealed at any stage my candidature
shall stand cancelled.

Date:
Place:
Applicant

Signature

of

NOTE:-Candidates
already
employed
in
Central/State
Government/Autonomous Bodies/PSUs should get the application
forwarded through proper channel and required to produce NOC
at the time of interview, failing which his candidature will not be
considered and no TA will be paid.