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    Application Fornat 2011

    Uploaded by

    Krishna Anumalasetty
    1. The applicant is applying for the post advertised in Advt. No. SMR(K)/Rec-1/11-12. The name of the applicant is ______ and date of birth is ________. 2. The applicant's highest qualification is _________ obtained from _________ university with _______% marks. 3. The applicant has ______ years of work experience in _________.

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    Application Fornat 2011

    Uploaded by

    Krishna Anumalasetty
    100 views4 pages
    1. The applicant is applying for the post advertised in Advt. No. SMR(K)/Rec-1/11-12. The name of the applicant is ______ and date of birth is ________. 2. The applicant's highest qualification is _________ obtained from _________ university with _______% marks. 3. The applicant has ______ years of work experience in _________.

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    1. The applicant is applying for the post advertised in Advt. No. SMR(K)/Rec-1/11-12. The name of the applicant is ______ and date of birth is ________. 2. The applicant's highest qualification is _________ obtained from _________ university with _______% marks. 3. The applicant has ______ years of work experience in _________.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    100 views4 pages

    Application Fornat 2011

    Uploaded by

    Krishna Anumalasetty
    1. The applicant is applying for the post advertised in Advt. No. SMR(K)/Rec-1/11-12. The name of the applicant is ______ and date of birth is ________. 2. The applicant's highest qualification is _________ obtained from _________ university with _______% marks. 3. The applicant has ______ years of work experience in _________.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 4

    Society for Applied Microwave Electronics Engineering & Research

    (SAMEER)
    Plot-L2, Block-GP, Sec-V, Salt Lake Electronics Complex, Kolkata- 700091

    APPLICATION FORM
    (TO BE FILLED IN BY APPLICANT IN BLOCK LETTERS ONLY)

    Advt.No SMR(K)/Rec-1/11-12
    Post Applied for :__________________

    Affix Recent
    Passport
    Size Photograph

    1. Name in full(Shri/Smt/Km) : _______________________________________________


    -----------------------------------------------------------------------------------------------------------------------2. a) Fathers name: __________________________ b) Mothers name: _________________________________
    3. a) Date of Birth:
    (in Christian era in figures)

    ___________________19 _______
    Date
    Month
    Year

    b) Age as on closing date mentioned in Advt.: _________Years _________Months _________ Days


    4. a) Sex (Male/Female) : _________________

    b) Marital Status : ________________________________

    5. Nationality: _____________________________
    6. Reservation Category (SC/ ST/OBC): _____________________6 (a) Religion :_______________________________
    (attach certificates if applicable)
    7. Type of Present Employment, if employed (Central / State Govt / PSUs/Others): _________________________
    (If employed Central /State Govt./PSU etc. submit N.O.C alongwith your application)
    8. Address for correspondence(with Pin Code)
    (Tele No., Mob. No., Fax & e-mail, if any)

    _____________________________________________________

    9.Permanent Address (with Pin Code)

    _____________________________________________________

    (Tele No., Mob. No., Fax & e-mail, if any)


    10.Nearest Railway Station

    _____________________________________________________
    _____________________________________________________

    11.Educational Qualifications #:
    ----------------------------------------------------------------------------------------------------------------------------------------------------------*Exam
    University/ Date of Date of
    Subject Specialization **Percentage Division
    Rank/Position
    passed
    Institution/ Joining Passing
    in which as reqd. in
    of Marks
    in the Univ.
    Board
    degree is advt. (if any)
    awarded
    -----------------------------------------------------------------------------------------------------------------------------------------------------------

    ---------------------------------------------------------------------------------------------------------------------------------------------------------- In chronological order from X Standard (SSLC/HS/HSC) onwards, ** In case of CGPA/CPI, please give
    marks in percentage also along with the conversion formula, # Specify the gap with reasons in
    Education career, if any.

    12. Professional Training :


    -----------------------------------------------------------------------------------------------------------------------------------------------------Name of organization
    From
    To
    Details of Training

    -----------------------------------------------------------------------------------------------------------------------------------------------------

    13.
    Research /Project Work (To be filled up by Scientist -B only) :
    Title of the project /Dissertation /Thesis No of paper published (separate sheet may be attached) :

    14.

    Have you qualified GATE/NET(JRF)/NET (To be filled up by Scientist- B) :


    a) If yes, give name of Test & Year (with percentile for GATE) :
    b) if registered for a higher degree, please indicate Title of degree, University, date of registration and
    likely date of completion

    15(a). Employment Record* (Attach separate sheet in following format, if necessary):--------------------------------------------------------------------------------------------------------------------------------------------------------Name &
    Period of
    Designation
    Scale of
    Detailed
    Reason for leaving
    address of
    service
    of the post
    pay of
    description
    employer/
    From
    To
    held
    each post
    of work
    Orgn/Institution
    --------------------------------------------------------------------------------------------------------------------------------------------------------

    -------------------------------------------------------------------------------------------------------------------------------------------------------* Specify the gap, if any

    16. Present Basic pay:

    Total Emoluments:

    17. Are you under any contractual obligations to serve Central/State Govt./Any other Public Sector Undertaking
    or Autonomous body and if so, give details :
    (attach NOC if applicable)

    18. Have you been interviewed for any recruitment/selection by SAMEER during the past one year?
    If yes, give particulars:
    ------------------------------------------------------------------------------------------------------------------------------------------------------Sr
    Particulars
    Name of Posts &
    Date of
    Result
    No.
    (eg. Date of Advt, Advt. No.)
    Discipline
    Interview

    -----------------------------------------------------------------------------------------------------------------------------

    19. Give two referees name & address and attach certificate from them: ________________________________
    (Not related to the candidates) (Gazetted Officers/Professors of
    reputed academic Institutions/Public Sector Executives etc)
    ________________________________

    20. Any other information you may wish to add, including extra curricular activities (use separate sheet if necessary).

    Declaration
    I declare that the foregoing information is correct and complete to the best of my knowledge and belief
    and nothing has been concealed/distorted. If at any time, I am found to have concealed/distorted any material
    information, my appointment shall be liable to summary termination without notice. If offered appointment, I will
    join on specified date and subsequently, take up duty in the discharge of SAMEER assignments anywhere in
    India as and when required.

    Place:
    Date:

    ------------------------------------------Signature of Candidate

    Note : (Please use a4 size paper only for application and other testimonials)

    SUMMARY
    (Use Separate Sheet)
    Advt. No. :

    Discipline :

    SMR(K)/Rec-1/11-12

    Post :
    Sr. No.
    Name :

    DOB:

    Nationality:
    Month Year

    Category:

    SC/ST/OBC/Gen

    Age as on Closing Date:

    Central/State Govt./Armed Forces/ PSUs/Others:


    Exam

    University

    Subject

    Month Year

    %age

    Div/Gde

    Essential Qualification (EQ)

    Highest Qualification (HQ)

    Qualified :

    GATE

    NET(JRF)

    NET

    Year:

    Score:

    Postal Address:
    City:
    Tele. No.
    (with STD code)

    E.Mail :

    Mobile:

    PIN:
    FAX:

    University Rank

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