Department of Virology Postgraduate Institute of Medical Education & Research Sector-12-A, Chandigarh-160012 Application Form for Research Scientist-B Please attach your passport size photograph self-attested
Ref: Advt. No. ____________________________________
1. Name of Position applied for : _________________________________ 2. Name of candidate
: _________________________________
3. Father’s Name
: _________________________________
4. Mother’s Name
: _________________________________
5. Date of Birth (DOB)
: _________________________________
6. Address for communication : _________________________________ __________________________________ Telephone no. with STD code: ______________ Mob. No: _________ E-mail id: ____________
7. Permanent address
: _________________________________ _________________________________ Telephone no. with STD code: ______________ Mob. No: _________ E-mail id: ____________
8. Educational Qualifications in tabular form from 10 th class onwards: Examina -tion
Subjects
Marks secured/Max. Marks
% of Marks/Rank/CG PA
University
Year
10th 12th B.Sc. B.Tech M.Sc. ME/M. Tech Ph.D
Contd.