(INDIANCOUNCILOFMEDICALRESEARCH) No.1,MAYORSATHIYAMOORTHYROAD CHETPUT,CHENNAI–600031 1. NameoftheProject : 2. ApplyingforthePostof : 3. NameoftheCandidate : (InBlockLetters) 4. Father’sName : 5. Dateofbirth/ : _____________/_______________Yrs. Ageincompletedyears 6. Sex : Male/Female 7. Category : SC/ST/OBC/Others 8. FeeParticulars : 9. PermanentAddress : ---------------------------------------------------------------------------------------------------------------------------------PresentAddress : -----------------------------------------------------------------------------------------------------------------------------------10 MobileNumberand : E-mailID : EducationalQualification a)EssentialQualification Sl. No Exampassed Yearof passing Board/University %ofMarks Photo ICMR-NATIONAL INSTITUTE FOR RESEARCH IN TUBERCULOSIS
b)DesirableQualification
WorkExperience
Sl. No Exampassed Yearof passing Board/University %ofMarks
Sl No NameoftheEmployer (Nameofthe office/Institution) Period (Date/month/year) Postheld From To
Iherebydeclarethattheinformationfurnishedaboveistrue,completeandcorrecttothebest ofmyknowledgeandbelief.Iunderstandthatintheeventofanyoftheinformationprovided bymearefoundfalseorincorrectatanystage,mycandidature/appointmentshallbeliable forcancellation/terminationwithoutnoticeoranycompensationinlieuthereof.
Place: SignatureoftheCandidate
Date:
Willyouacceptforbeingconsideredand OfferedappointmentforaLowerGrade? Yes/No
WhetheranyrelativeisemployedinICMR? Yes/No Ifyesgivedetails
AnyotherResearchExperience
Paperpublications
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DECLARATION