jehL ma bjhEg ika

(jHf murh WtglJ )

fhklg rhiy
brid - 600 025.

Tamilnadu Science and Technology Centre

(Established by the Government of Tamilnadu)
Gandhi Mandapam Road, Chennai-600 025.
bjhiyng / Phone No. : + 91 - 44 24410025
(Reference to the advertisement published in the
Newspapers Indian Express and Dinamani Dt:23.02.2015)

Affix
a recent
passport size
photo

zF gj bga :
APPLICATION FOR THE POST OF :
1. zgjhu bga :

(jiybgGJf W tuntL)

NAME OF THE CANDIDATE : (initials at the End)

2. jij / fzt bga ( $ /U / Kidt nghwtiw vGjh )

FATHERS / HUSBANDS NAME : (Do not write Shri / Mr / Dr etc.)

3. wj nj / DATE OF BIRTH :

4. ehod / NATIONALITY

5. brhj l / NATIVITY

a / Indian

------------------

w / Others

2
6. jhbkh

/ MOTHER TONGUE

7. mj bkhf
LANGUAGES KNOWN

ngr
To Speak

vGj
Write

gof
Read

iy

1.
2.

3.

8. khW wdhah? / Differently Abled ?

(M v, tu izf)
(If Yes, Please enclose the details)

9. ghd / SEX :

M/ Male

bg / Female

Ukzkhfhjt

10 Ukzkhdtuh / MARITAL STATUS : UNMARRIED

Ukzkhdt
MARRIED

11. tF / COMMUNITY : OC / BC / MBC / DNC / SC / SC(A) /ST

(Ra rhbwhglgl efiy izf) (Please enclose self Attested Photocopy)
12. a) bjhl bfhtjfhd Kft : (jf bga kW jij bga
F Fl ntlh)
ADDRESS FOR CORRESPONDENCE : (Do not write your name or fathers name)

mr FpL
Pin Code

3
12 b) bjhiyng v /

ifng v

mr Kft :

TELEPHONE NUMBER / MOBILE NUMBER

E.Mail Address

[[

13. f jF / EDUCATIONAL QUALIFICATION :

m) f / ACADEMIC :
t
v.
Sl.No.

nj nj tu
Examination Passed

tUl
Year

kbg /
ju tF /
ju tir
Marks / Grade Class/
Rank

siy
Lower

13 (M) jlR iy / Typing Grade

(thf g zgjhufSF kL)
j
Tamil

My
English
13 () f fa / mDgt :
Computer Knowledge / Experience

-------------------

f iya /
gfiy fHf
Institution /
University

KJiy
Higher

4
14 (m) bjh Eg / TECHNICAL :
t
v.
Sl.No.

nj nj tu /
Examination Passed

tUl
Year

kbg /
ju tF /
ju tir
Marks /
Grade Class /
Rank

f iya /
FG
Institution /
Board

14 (M) mDgt / EXPERIENCE :

t
v.
Sl.No.

gahW myJ
gaha Wtd
bgaU gj bgaU.
jfhf / uju
Name of the post holding /
held with name of the
Institution.
Temporary / Permanent

g a
ga
tuf
Nature of Duties

fhy ms

bkhj tUlf

Duration

Total No. of Years

Kj
From

tiu
To

5
15. w jftf / ANY OTHER INFORMATION :

16. izfgLs rhjf goa : ( tir r vw F Lf)

CHECK-LIST OF ENCLOSURE : ( Tick in the Appropriate Column)
t.
v.
Sl.No.
1.
2.
3.
4.

iz
(Ra rhbwhgl eff kL)
Enclosure
( Self-attested photocopies only)
taJ rhW w rhj / Age Proof Birth
Certificate
gf rhj Kj gf / SSLC First
page
rh rhj / Community Certificate
caiy g / nkiy g / gla/
sfiy/
KJfiy rhjf / siy MtP /
Kidt
SSLC / +2 / Diploma / UG / PG Degree Certificates /
M.Phil / Ph.D

5.

jil ik rhW ( g U)
No Objection Certificate if already employed

izfgLsJ
Attached

6.

Wahf bgw Ca rhW ( g U)

Last Pay Drawn Certificate if already employed

7.

Ul rhW / Proof of Address

8.

edlij rhW / Conduct Certificate

9.

ntiy th mYtyf g mil

Employment Registration Card

10

jlR, f f rhjf
Typewriting , Computer Education Certificates

cW bkh / DECLARATION
nkny
bfhLfgLs
midJ
cikahdit vd rhwnw.

gufS

rahdit

kW

I declare that all the information given above are true and correct to the best of
my knowledge.

eh / DATE :

zgjhu ifbahg
SIGNATURE OF THE CANDIDATE

mYtyf cgnahfF kL : FOR OFFICE USE ONLY

zgjhu mr (cik) rhjf neKf nj nghJ rghfglJ

ORIGINAL CERTIFICATES SUBMITTED BY THE CANDIDATE AT THE TIME OF
INTERVIEW WERE VERIFIED

bra aFe

GENERAL CONDITIONS :
1. Employees of Government Departments / Government Undertakings should
send their application through proper channel (OR) they should produce No
Objection Certificate from their employers at the time of interview. No
Travelling Allowance / Daily Allowance will be paid for attending the interview.
2. The envelope containing application should be superscribed Application for
the post of --------------------------------------------.
3. The Department reserves the right to fill or not to fill any of the post(s) without
giving any reason whatsoever therefor.
4. The filled-in applications should be addressed to The Executive Director,
Tamilnadu Science and Technology Centre, Gandhimandapam Road,
Chennai 600 025 and sent under Registered Post. Application should
reach the addressee on or before 18.03.2015 before 5.45. p.m.
5. The last date is extended to 31.3.2015. i.e. the filled-in applications
should be sent under Registered Post and the applications should reach the
above address on or before 31.03.2015 before 5.45. p.m.
6. Age - Relaxable in deserving cases by the Chairman, on the recommendation
of the Executive Director.
7. Age is relaxable in the case of BC, MBC, SC / ST as per the existing order of
the Government.
8. Applications with incomplete details and not made in the required manner are
liable to be rejected.
9. No correspondence of any kind will be entertained.
10. Applications will not be received at the office in person.
11. Before the interview, trade test / written test as the case may be will be
conducted and candidates selected accordingly.

EXECUTIVE DIRECTOR