Gautam Buddha University

Gautam Budh Nagar- (U.P.)

Application Form for Staff (Maintenance)
On Contractual Basis

Advt. No. GBU/Admn./01/2015

IMPORTANT
Post Applied for

:-

Photograph
Pasteherefirmly your recent
passportsize Photograph
(Donotstaple)

To be filled in by the Candidate

.............................

1.

Name (in Block letters)

_______________________________________________

2.

Fathers/Husbands Name

_______________________________________________

3.

A) Date of Birth

_______________________________________________

B) Date of Retirement

_______________________________________________

4.

Category (SC/ST/OBC/UR)
(Pl. enclose certificate)

_______________________________________________

5.

If Physically Handicapped
(Pl. enclose certificate)

_______________________________________________

6.

Gender (Male/Female)

_______________________________________________

7.

Marital Status

_______________________________________________

8.

Highest Qualification

_______________________________________________

9.

Mobile No. & E-mail ID

_______________________________________________

10.

Postal Address

_______________________________________________
_______________________________________________
_______________________________________________

11.

Permanent Address

_______________________________________________
_______________________________________________

12.

Academic Qualifications Record:

S. No.

Exam

_______________________________________________

Board/ University

Year of Passing

% Marks

Div./Grade

1.
2.
3.
4.
5.
6.
(Please enclose self attested copies of certificates for all above mentioned academic qualifications)

13.

Experience in job and maintenance works with type & period:

S.
No.

Name of Organisation

Designation

Type of
maintenance
work (if any)

Duration
From
To

Achievements
(if any)

1.
2.
3.
4.
5.
6.
7.
8.
(Please enclose all above mention certificates, if any)
14.

State any other information not covered elsewhere (Please attach a sheet, if required)
_______________________________________________________________________________________
_______________________________________________________________________________________

DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby declare that the details given above are correct to the best of my knowledge and belief. I declare
that in case an opportunity is given, I shall join Gautam Buddha University, G.B. Nagar within ................ days. I
understand that if any information provided above is found to be false or inaccurate my candidature shall be
treated as cancelled.
Dated:.................................
Place:...................................

Signature)
Name:...................... .

Iknksa gsrq izLrkfor vgZrk;sa

1-

vH;FkhZ ftl in ds fy, vkosnu dj jgk gS] og U;wure led{k in ls jkT; ljdkj
vFkok dsUnz ljdkj ds foHkkx ls lsok fuo`Rr gqvk gksA

2-

leLr inksa ds fy, MkQ~V~leSu ds vfrfjDr vH;FkhZ U;wure fMIyksek /kkjd vFkok
led{k gksuk pkfg,A

3-

j[k&j[kko Hkou@fodkl dk;Z ds dk;ksZa ds vuqHko okys vH;fFkZ;ksa dks izkFkfedrk nh

tk;sxhA

4-

HkRrs ,oa vodkk foofo|ky; ds fu;ekuqlkj ns; gksaxsA

5-

mijksDr lesfdr osru ds vfrfjDr bUgsa vgZrkuqlkj foofo|ky; ifjlj esa vkokl
vuqeU; gksxk ftlesa vkokflr gksuk vfuok;Z gksxkA dehZ }kjk fu;ekuqlkj ykbZlsal Qhl
rFkk okLrfod fctyh dk Hkqxrku ns; gksxkA

6-

vH;FkhZ dh vk;q 65 okZ ls vf/kd u gks ,oa og Hkkjr okZ dk ukxfjd gksuk pkfg,A

7-

leLr izkIr vkosnuksa dh LdzwVuh ds Ikpkr~ lk{kkRdkj fy;k tk;sxA vfUre p;u izkFkhZ ds
;ksX;rk;sa@vuqHko@lk{kkRdkj ds vk/kkj ij fd;k tk;sxkA

8-

izkFkhZ dh fdlh izdkj dh tkWap yfEcr ugha gksuh pkfg,A izkFkhZ }kjk bl vkk; dk kiFk
i= layXu fd;k tkuk vko;d gksxkA

9-

vH;FkhZ dks vkosnu ds lkFk bl vkk; dk fpfdRlk izek.k i= layXu fd;k tkuk
vko;d gksxk fd og kkjhfjd :Ik ls LoLFk gSA ;g izek.k i= ,d okZ ds dk;Z lsok
iw.kZ djus ds mijkUr iqu% izLrqr fd;k tkuk gksxkA fpfdRlk izek.k i= ljdkjh vLirky
ds fpfdRlkf/kdkjh tks fd Dy. CMO ls de Lrj dk u gks] ds }kjk tkjh fd;k x;k gksuk
pkfg,A

10-

lafonk dh vof/k rSukrh dh frfFk ls nks okZ gksxh ijUrq ,d okZ dh lsokvksa dks iw.kZ
djus ds mijkUr lsok vof/k ds vkWdyu ds Ikpkr~ ,d okZ c<k;h tk ldrh gSA

11-

izkFkhZ dks lsok fuo`fRr dk izek.k i= layXu djuk vfuok;Z gksxkA

12-

of.kZr inksa dh la[;k ?kVkbZ vFkok c<kbZ tk ldrh gSA ek= vgZrk;sa iw.kZ fd;s tkus ds
vk/kkj ij vkosnd }kjk fu;qfDRk gsrq nkok ugha izLrqr fd;k tk ldsxkA fu;qfDr ds
lEcU/k esa l{ke izkf/kdkjh dk fu.kZ; vafre gksxkA