Inter University Accelerator Centre

(An Autonomous Research facility of University Grant Commission, New Delhi,

India)
Post o! No" #$%$&, Aruna Asaf Ali 'ar(, New Delhi)##$$*+
Application form
Advertisement No" $&,&$#-
1. NA'. /0 12. P/31 APP4I.D 0/R :
2. Full Name (in Capital letters) :
3. Fathers Name :
4. Mothers Name :
5 us!an"s Name (#n case of female marrie"
can"i"ates )
$. Nationalit%
&. (a) A""ress for communication ('ith (in
Co"e)
(!) (ermanent A""ress
(c) )*mail #+
(") Mo!ile phone No.
,. +ate of -irth (++.MM.////)
0. A1e as on the "ate of last "ate of receipt of
application
12
.
Cate1or% (3C.34.5-C.6)N.()
(Certificate o!taine" from 7e8enue 5fficial not
!elo9 the ran: of +eput% 4ahsil"ar . Competent
Me"ical Authorit% in case of ( shoul" !e attache"
as e8i"ence)
##
5
Details of .ducational 6ualifications (3tartin( from class 7 onwards5 All columns
are to 8e filled u9)
);am
(asse"
#nstitution.<ni8ersit
%
3u!=ect stu"ie" /ear of
(assin1
> of mar:s
#&5 Details of Professional , 1echnical .ducational 6ualifications Additional 3heet may 8e
added, if re:uired" (All columns are to 8e filled)
);am
(asse"
#nstitution.<ni8ersit
%
3u!=ect
stu"ie"
+uration of
3tu"%
/ear of
(assin1
> of mar:s
7ecent
(assport
si?e
(hoto1raph
*2*
13. +etails of );perience (Can"i"ates are a"8ise" to fill*up this column carefull% an" in terms of
con"itions stipulate" in the A"8ertisement to a8oi" re=ection) A""itional sheet ma% !e a""e"@ if
reAuire".
Name of
/r(ani;ation
Post
held
Pay 3cale Duration of 3ervice Nature of
a99ointment
whether
re(ular or
adhoc
Remar<s
(If any) From 4o
14. 3cholarships.fello9ships.A9ar"s recei8e" 9ith
"etails:
15. 3tate !riefl% 9h% "o %ou consi"er %ourself fit for
the post applie" (use separate sheet in
necessar%)
1$. #s there an% "epartmental inAuir% pen"in1 or
contemplate" a1ainst %ou. #f %es please 1i8e
"etails B
1&. a8e %ou e8er !een impose" an% penalt% B #f
%es please 1i8e "etails
1,. Name an" a""ress of t9o referees (9ith e*
mail)9ho shoul" !e a responsi!le person@ not
relate" to the can"i"ates !ut 9ell acAuainte"
9ith him.her 9or:.stu"%
10 D.C4ARA1I/N: (i) # here!% "eclare that # fulfill the eli1i!ilit% con"itions as per the
a"8ertisement an" that all the statements ma"e in this application are true@ complete an"
correct to the !est of m% :no9le"1e an" !elief. # un"erstan" that in the e8ent of an%
information !ein1 foun" false or incorrect at an% sta1e or not satisf%in1 the eli1i!ilit%
con"itions accor"in1 to the reAuirement mentione" in the a"8ertisement@ m% can"i"ature .
appointment is lia!le to !e cancelle" . terminate". (ii) # ha8e enclose" the reAuire" atteste"
copies of the certificates.
(lace : .....................
+ate : .....................
3i1nature of the Applicant