Centre
for Cellular and Molecular Biology (CCMB)
Uppal Road, Hyderabad - 500 007, INDIA
Advertisement No:Post Code:
Post Name: Project Number: Recent Passport size Photograph
1. Registration ID
2. Name in Full
3(a). Mother Name
3(b). Father Name
4. Category
5. Physically Handicapped Yes/ No
6(a). Date of Birth
6(b). Age as on date of interview
6(c). Place of Birth _____ Years ____ Months ___ Days
7. Gender
8. Marital Status Married/ Unmarried
9. Are you related to any employee ofCSIR/CCMB:
If yes, Name & Nature of Relationship:
10. Are you citizen of India by birth or domicile?
Yes/ No
11. Address for Communication with PIN CODE
12. Permanent Address with PIN CODE
13. Email
14. Contact No Land Line: Mobile:
15. Education Qualifications
of
Division %of Marks Main Subjects
Qualification University/ Board Year of Passing Duration
Degree/ course
SSC/ X Class Intermediate/ XII class Graduation Post Graduation Ph. D/ Any other
Centre for Cellular and Molecular Biology (CCMB)
Uppal Road, Hyderabad - 500 007, INDIA
16. Dissertation, If any
Thesis Title :
Thesis submitted :
Name of the Supervisor :
Broad Area :
University/Institution :
17. Whether qualified in NET (CSIR/UGC/GATE/Others) :
Name of the fellowship :
Year of qualifying :
Roll No :
Fellowship valid until :
18. Additional details of PhD qualification:
Thesis submitted on:
PhD awarded on:
Name of the Supervisor:
Thesis Title:
19. List of Publications
20. Conference/ proceedings participated (as presenting author only)
21. Awards / Honors
Title Authors Journal Year Doi
Title Authors Year Presented
Conference Name Place
Centre for Cellular and Molecular Biology (CCMB)
Uppal Road, Hyderabad - 500 007, INDIA
22. Details of the employment (in chronological order) if any:
Duration of service Post held Name of Organization Salary drawn Nature of duties From (dd-mm-yyyy) To (dd-mm-yyyy) In years/ months
23. Any other information you would like to furnish:
24. References
Reference1
Reference2
I _______________________ hereby declare that the statements made in the application are true , complete and correct to best of my knowledge and belief and in the event of any of the information being found false or incorrect or any ineligibility being detected before or after the selection, my candidature is liable to be cancelled and action initiated against me.
Place:
Date:
Signature of the candidate
DECLARATION