INDIAN INSTITUTE OF TECHNOLOGY KANPUR

Application form for the post of JUNIOR ASSISTANT

Regn. No._________________________________

Date _________________________________
(For Office Use Only)

Application Reference No: ONLINE/Advt. No. 1/2022/12195

Application Apply Date: 13-OCT-2022
Application Status: Applied
Post Name: JUNIOR ASSISTANT
Department Name: Institute
Post Sl No.: 1
Category: OBC_PWD

1: Personal Details:

Name: Anup kumar Father Ashok prasad DOB.: 15-JAN-1997

Name:
Gender: Male Marital Single Spouse -
Status: Name:
Place of Bettiah Nationality: Indian Religion: Hindu
Birth:

2: Postal Address:

Present Address:
Address: Purani gudari mahavir chowk , near dr. District: West champaran State: Bihar
Dinesh rai bettiah
Pin: 845438 Mobile: 7279853824 Phone: -
Email: Kuanup21@gmail.com Fax: -
Nearest Railway Station: Bettiah
Permanent Address :
Address: Purani gudari mahavir chowk , near dr. District: West champaran State: Bihar
Dinesh rai bettiah
Pin: 845438 Mobile: 7279853824 Phone: -
Email: Kuanup21@gmail.com Fax: -
Nearest Railway Station: Bettiah

3: Educational/Professional/Technical qualifications

Exam Passed Board/Univ. Duration Passing Division/Grade %age of Subject Specialization

year marks
High B.S.E.B PATNA 1 2011 First 66.8 Math, science, All
School/10th hindi, sanskrit,
social science
and english
Intermediate/10+ B.S.E.B PATNA 2 2013 Second 56.4 PCM All
2
Graduation B R.B.A.U 3 2017 Second 55.25 Arts Economics
MUZAFFARPU
R
Computer OPTIMA 1 2018 First 70 ADCA ADCA
COMPUTER
4: Employment Details

Employer Position Job Type From(m To(mm- Period of Scale of pay/Pay Nature of duty
name m-yyyy) yyyy) Employment(I level
n Months)

General Details:

1) Do you belong to category of SC/ST/OBC/GEN/EWS or sub-category of PwD/ESM ? : PwD

2) Whether claming reservation under SC/ST/OBC/Ex-serviceman/PwD/EWS category ?: YES
3) Person with Disabilities ? : YES
3A.) If Yes,Disabilities Category? : VH
4) Have you ever been convicted by a court of law or is there any - criminal NO
case/disciplinary action/vigilance enquiry pending against you ? :
(If Yes,Furnish Details ?) :-
5) Are you regular employees of other IITs : NO
6) Are you regular employees of IIT Kanpur : NO
7) If appointed how much time would you require for joining the post : 30(days)
8) Are you willing to accept the minimum of pay scale as initial basic pay : YES
9) Are you a corporate member of any professional institute : -
10) Are you Project employees of IIT Kanpur : NO

DECLARATION:
I hereby declare that I have carefully read and understood the instructions attached to the advertisement as available on IITK website
and that all the entries in this form are true to the best of my knowledge and belief. I also declare that I have not concealed any material
information which may debar my candidature for the post applied for.In the event of suppression or distortion of any fact like category
or educational qualification etc.made in my application form,I understand that I will be denied any employment in the institute and if
already employed on any of the posts in the institute ,my services will be terminated forthwith.

Place:
Date:
Signature of Candidate
 ENDORSEMENT BY FORWARDING AUTHORITY
Only for applicants who are in service of Govt./Semi Govt./Autonomous Orgs./Public Sector Undertakings

Date:..............................
Forwarded...................................................................................................................................................................................
......................................................................................................................................................................................................
......................................................................................................................................................................................................
.

(Forwarding Authority)

(Offical Seal With Name)

 ADMIT CARD
For Selection Procedure
Post Applied :JUNIOR ASSISTANT

Regn. No.:______________

Date :______________
(For Office Use Only)

Roll No.____________

1A. Advt. No: Advt. No. 1/2022

1B. Advt. date: 10-10-2022
1C. Application Ref. No.: ONLINE/Advt. No. 1/2022/12195
2A. Name Of the post: JUNIOR ASSISTANT
2B. Department Section: Institute
3. Full Name: Anup kumar
4. Father's Name: Ashok prasad
5. Date Of Birth: 15-JAN-1997
6. Place of Birth: Bettiah
7. Postal Address: Purani gudari mahavir chowk , near dr. Dinesh rai bettiah
West champaran-845438, Bihar
8. Mobile: 7279853824
9. Email: Kuanup21@gmail.com
10. Category: OBC_PWD
11. Sub-Category(PH/ESM,if applicable): PwD
12. Gender: Male
13. Marital status: Single
14.Spouse Name: -

Signature of Candidate