JAMIA MILLIA ISLAMIA

Centre for Distance and Open Learning

earning
Jamia Nagar, new Delhi-110025
Application Form for Contractual Appointment
ppointment

(All the particulars must be filled in capital letters by the candidate in her/his own handwriting)

1. Candidate’s Name:

2. (i) Advt. No.: Dated: 2 0 1 7

(ii) Post applied for:

3. Father’s/Husband’s name in full:

full

4. Address:
(i) Correspondence: (ii) Permanent:
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Pin: ...................
..... Mobile No.:................................ Pin: ................. Mobile No.:.........................

Email Address........................................................................................................................
Address....................................................... ......................................................................

5. Date of Birth:: (Based on Matriculation/ Hr. Sec. School Certificate)

Date Month Year

6. Whether S.C. S.T. O.B.C. PWD (LV/HILD) (Please tick the correct block)
7. Marital Status: Married Unmarried Widow

8. Educational Qualifications: (Enclose attested copies of Marksheets & Certificates etc.)

Sr. *Exams. Passed Board/ Year Div./%age Subjects

No. University
1. Secondary
2. Senior Secondary
3. Graduation
4 Masters
5. M.Phil
6. Ph.D.
7. Any Other
(Attach enclosures, if necessary)

9. Appointments held so far:

Sr. Particulars of Period of Service Particulars of duties Name and

No. post From To Total address of
Period employer

10. Research work/Published Work/Scholarship/Fellowships (attach enclosures, if

necessary):

11. If employed at present, state separately basic pay and allowances :

(i) Basic Pay Rs.: ________ (ii) Scale of Pay: ________ (iii) Allowances Rs.: _____

(iv) Total Rs.: ________ (v) Date of next increment: ________

12. If appointed, time and notice required for joining the post:
13. Name of two Referees:

Sr. Name of Referee Address Period for

No. which he has
known the
candidate
1.

2.

* Applicant may sent two testimonials from persons under whom she/he has studied or worked.
NOTE : Books, research papers and typescripts should be sent with the application and not separately.

DECLARATION

I hereby declare that the entries made by me in the above columns are true to the best of my
knowledge and belief.

Place: ………………………… (Signature of the candidate )

Date: ………………………….

If employed, remarks of the forwarding authority. Attach separate sheet, if requried.

Signature: …………………………......

Name: …………………………...........

Designation: ………………………

Address: …………………………..

Place: …………………………

Date: ………………………….
 JAMIA MILLIA ISLAMIA, JAMIA NAGAR, NEW DELHI-110025
(A Central University by an Act of Parliament)

ACKNOWLEDGEMENT

Received application from Dr./Mr./Ms. _______________________ for the post of

________ in response to the Advt. No. ____________________ dated ________ alongwith a

D.D. bearing No. __________________ Dated ____________ for Rs. 500/- drawn on

______________.

Date: (Signature of the Receiver)

 Jamia Millia Islamia
Centre for Distance and Open Learning
Jamia Nagar, New Delhi-110025
IMPORTANT
Attach 5 typed copies of this proforma with the application from duly filled in and signed Advt. No. __________________ Date _________

Particulars of ______________________________

For the post of _____________________________

Name and Address Date of Qualifications Experience Any other Information

for Correspondence Birth
and Phone No.
Exams Board/University Year Distance Education Other Institution(s)
Instution(s)

Secondary

Senior Secondary

Bachelors

Masters

M.Phil

Ph.D

Any Other

Date ........................ Candidate's Signature ...........................