izkstsDV esa fu;qfDr gsrq vkosnu i=

Application Form for Recruitment in Projects

viuk LokgLrk{kfjr
uohure QksVks
fpidk;saA
Stick your self signed
latest photograph

1. ifj;kstuk@,fj;k dk uke ftlds fy,

vkosnu fd;k x;kA
Name of Project/Area applied for
2. vkosfnr in dk uke
Name of the Post
3. vH;FkhZ dk uke
Name of candidate
4. firk@ifr dk uke
Father/Husband Name
5. tUefrfFk
Date of Birth
6. foKkiu dh vafre frfFk@lk{kkRdkj dh frfFk
dks vk;q ( ) ( ) ( )
Age as on date of interview o"kZ ekg fnu
Year Month Day
7. LFkk;h irk
v Permanent address

c i=kpkj dk irk
Correspondence address

8. bZ&esy
E-mail
9. VsyhQksu ua-
Telephone number
10. Js.kh lkekU; ¼ ½
category General
vkjf{kr gS] gk¡@ugha ¼ ½ vuqlwfpr tkfr ¼ ½
reserved, Yes/No Schedule Caste
¼;fn vkjf{kr gSa rks nLrkostksa ds layXu dh vuqlwfpr tutkfr ¼ ½
i`"B la------------½A Schedule Tribe
(If reserved, page no. of enclosed vU; fiNM+k oxZ ¼ ½
certificate................) Other Backward Class
vU; ¼ ½
Others

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11. ;fn ,uchvkjvkbZ@lh,lvkbZvkj esa
vkidk dksbZ lEcU/kh gS
Have to any blood relative related in
NBRI/CSIR
;fn gk¡ ¼ ½
If, Yesl
uke ------------------------------------------------------------- lac/a k----------------------------------
Name Relation
in--------------------------------------------------------------------------------------------------------------
Designation
laLFkku@ySc dk uke ,oa irk
Name and address of the Institute/Lab---------------------------------------------
--------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------

12. 'kSf{kd ;ksX;rk@Educational Qualification ¼mPpre ls izkjEHk djs@

a Start with Highest Qualification)
mRrh.kZ ijh{kk fo'ofo|ky;@cksMZ ijh{kk fo"k; vadksa dk nLrkostksa
Passed dk uke mRrh.kZ Subject izfr'kr ds layXu
Examination Name of Board/ dk o"kZ Percentage dh i`"B
University Year of of Marks la[;k
passing Page no. of
enclosed
certificate

13. D;k vkius lh,lvkbZvkj@ ;wthlh Yes/No

usV dh ijh{kk mRrh.kZ dh gSA ¼;fn gk¡ rks nLrkost ds layXu dh i`"B la[;k-------------------------------½
Have you qualified CSIR/UGC (If yes, write the page no. of enclosed documents-----------------)
NET Examination

14. dk;Z dk vuqHko@Work experience

laLFkku@ySc dk uke in dk;Z dh vof/k dqy vof/k ¼o"kZ] ekg nLrkostksa ds
Name of Lab/Institute Designation Period of time ,oa fnu½ layXu dh i`"B
ls/From rd/To Total Duration la[;k
(Y,M,D) Page no. of
enclosed
certificates

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 15. D;k vkius blls igys lh,lvkbZvkj dh fdlh Hkh iz;ksx'kkyk@laLFkku esa dk;Z fd;k gS ;fn gk¡ rks
foLr`r fooj.k izLrqr djsa@Have you worked in any CSIR Lab/Institute? If yes, give details:-
laLFkku dk uke ifj;kstuk dk uke dk;Z dh vof/k dqy vof/k o"kZ
ls/From rd/To ekg ,oa fnu
Total Duration (Y,
M,D)

eSa ;g ?kks"k.kk@djrk gw¡@djrh gw¡ fd bl vkosnu esa fn;s x;s fooj.k esjs fo'okl ds vuqlkj iw.kZ
:i ls lR; gS ;fn dksbZ lwpuk vlR;@xyr@fNikbZ x;h lkfcr gksrh gS rks vki esjk vkosnu
rqjUr@fdlh Hkh le; fujLr dj ldrs gSaA

I hereby declare that all the statements made in this application are true and
complete to the best of my knowledge and belief and nothing has been
conceal/distorted any material information, my engagement is liable to be summarily
terminated without notice.

izkFkhZ@izkfFkZuh ds gLrk{kj
Signature of candidate

fnuk¡d %
Date :

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