6/2/22, 8:14 AM Application Form Print | Non-Teaching Staff Recruitment | IIT Bhubaneswar

 
Application For Non Teaching Staff Recruitment

Post Applied For: Junior Technician [ Regular/Deputation] Advertisement Num.:

Rectt./02/Non-Teaching/2022
 
Discipline:
NA Type of Post Applied:
Regular
Application Num.:
NT-240522-4601-JT-0336 Applied Date:
02-06-2022
Applied previous advertisement: No IIT Bhubaneswar Employee: No
1 .  Personal Details

 Full Name MR. PRASANTA KUMAR DAS  Name of

Father  DAITARI DAS

 Date of Birth  30-04-1977  Age  45 Years 1 Months 25 Days

 Gender  Male  Nationality  INDIAN

Presently working in
 NO  Ex-Serviceman  YES
IIT Systems

 Category  UR  Marital Status  MARRIED

 PWD  NO  Type of Disability  

 Contact No  9821734725  Email Id  daspk1463@gmail.com

 Alternate Contact No  8847802636  Alternate Email Id  prasantakumard1977@gmai.com
Correspondance Address Permanent Address
POLOT NO 2/4874 VILL PARBATPANSUA
NUASAHI Post Office : RATNAGIRI
Post Office : BIDANASI City : JAJPUR
City : CUTTACK State : ODISHA
State : ODISHA Pin : 754214
Pin : 753014

2 .  Application Fee Payment Details

Candidates belonging to SC/ST/PWD/Ex-servicemen/IIT BBS Employee/Transgender category and women candidates are not required to pay
application fee.

3 .  Educational Qualifications
GPA/CGPA or
Year of %Marks
Examination Discipline/ Subjects Board/ University/ Institute Division/Class
Passing
GPA/CGPA %Marks
ODIA HINDI ENGLISH MATH BOARD OF SECONDRY EDUCATION
Matriculation/10th 1991 / 47 THIRD
SCIENCE HISTORY GEOGRAPHAY EDUCATION OF ODISHA
COMMUNICATION AND MILITARY COLLAGE OF ELECTRONICS
Diploma 2009 / 68.08 FIRST
ELECTRONIC AND MECHANICAL ENGINEERING

4 .  Professional Experience

Full name of the Organization/Deptt. Organization Date- Total Payband with Grade pay / Scale of Pay /
Designation Type Date-To
Institute type From (dd/mm/yyyy) Period Consolidated Pay
(dd/mm/yyyy)

NA NA NA NA NA NA

Total Experience of Govt./Semi Govt./Central or State Autonomous body/PSUs:CENTRALGOV IN INDIAN ARMY

Total Experience of others:26 YEARS 4 DAYS

5 .  Name of two references

Name Designation Organization Name Email ID Phone
NO NO NO NO NA
NO NO NO NO NA

6.  If selected , time required to join for the post ? NO TIME REQURED
7.  Have you ever been convicted by a court of law or is there any criminal case/ disciplinary action/ vigilance enquiry pending against you?
NO

Declaration

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6/2/22, 8:14 AM Application Form Print | Non-Teaching Staff Recruitment | IIT Bhubaneswar
I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief. In the
event of information being found false or incorrect, or ineligibilty being detected before or after the examination, action can be taken against
me by the Institute.

I have read the General instructions of this Advertisement issued for the candidates and agreed to abide by this.

Date: _ _ _ _ _ _ _ _ _ _

Place: _ _ _ _ _ _ _ _ _ _ Signature of the Candidate

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