DIVISION OF PLANT TISSUE CULTURE AND

BIOTECHNOLOGY, UNIT OF CCRI,

COFFEE BOARD, MYSURU, KARNATAKA

APPLICATION FORM FOR THE POST OF YOUNG PROFESSIONAL

(Temporary post)

1 Name of the candidate

Please affix
2 Permanent Address your latest
passport size
self-attested
photograph

3 Gender MALE / FEMALE / OTHERS

4 Mobile Number
5 Email ID
6 Date of birth Age as on 30.06.2023:
7 Father’s / Mother’s Name
8 Are you a citizen of India? YES / NO
9 University /
Examinations Year of Subject of Percentage
Institution /
Passed Passing specialization of marks
board
Educational Qualifications:
M.Sc.
B.Sc.
PUC
SSLC
Additional Qualifications/Project//Thesis/Dissertation

10 Experience:
Name of the Period Total
Post held Nature of duties
Institute From To period

Note: Enclose Self attested copies of Age Proof/Aadhar card, Educational and Experience certificates

Place:
Date: Name & Signature of the Candidate