Govt WII, MSc & PhD Life Sciences Project Scientist Job

APPLICATION FORM

Name of the Project: Please affix a recent passport size photograph

Post Applied: Category: General/SC/ST/OBC/Physically Handicapped, please indicate _______________________ 1.

Name of the applicant: _______________________________________________ A. Present Postal Address with Pin Code _________________________________________________________________________________________ _________________________________________________________________________________________ Phone/Fax________________________________________________________________________________ Email ____________________________________________________________________________________ B. Permanent Residential Address with Pin Code ________________________________________________________________________________________ ________________________________________________________________________________________ Phone/Fax_______________________________________________________________________________ E-mail __________________________________________________________________________________ Nearest Railway Station for undertaking the Journey _______________________

2.

Date of birth __________________ Age (as on 1st May 2019) ___________________ (in Years, Months and Days)

3.

If belonging to SC/ST/OBC, state name of the caste/Tribe_______________________ A photo copy of the original caste certificate issued by competent authorities may be attached.

4.

(a) Academic Achievements: Examination Passed Higher Secondary Bachelor’s Degree Master’s Degree

Year

University

Subject

Percentage of marks obtained

(b) Creative Achievement (State briefly your bio data as research worker/giving details of research papers, participation in Seminar, Symposium, Conference, etc.). Furnish this information in a separate sheet.

5.

If Ph.D., mention the following: i. Title of thesis: ii. University: iii. Name of Supervisor(s): iv. Year of award of the degree: (please attach copy of doctorate degree) v. Date of submission (if viva awaited) vi. Summary (maximum 2 pages):

6.

Have you received any scholarship/fellowship? (If so, please give its source, value, period and details of work done under that award) ___________________

Name of the Scholarship

Awarding Agency

Period

Amount

From

7.

To

Total experience as on 01 May 2019 in years and months (a) After M.Sc : (b) After Ph.D :

8.

Employment held so far (up to date):

Name of the Employer

Position held

Period

Emoluments per month

From

9.

To

Research publications, title of the publication, year of publication, journal, etc., may be indicated (reprints may be enclosed). Details may be given in a separate sheet.

10. Secondary and Tertiary skills: (Details may be given in a separate sheet).

11. Name, Complete Postal Address and Phone Number of three referees should be given below.

1.

2.

3.

12. Any other information: Certified that information furnished above are correct to the best of my knowledge.

Place:

Date:

(Signature of the Applicant)