-1- Application Form No.
(For office use only)
NATIONAL INSTITUTE OF PHARMACEUTICAL EDUCATION & RESEARCH HYDERABAD
BALANAGAR, HYDERABAD
(Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, GoI)
www.niperhyd.ac.in, E-mail: recruitment.niperhyd@gov.in
APPLICATION FORM FOR NON-FACULTY POSTS
(TO BE TYPED BY THE APPLICANT IN BLOCK LETTERS, NO PART OF THE FORM SHOULD BE LEFT BLANK)
Advertisement No.: NIPER-HYD/2025/ADM/NON-FAC/01
Please affix
Name of the Post applied for: a recent
passport size
photograph
Post Code: NT -
1. Fee Paid: OR EXEMPTED SC ST Female PwBD
If paid, SBCollect Reference Number :________________________________ Date : / /2025
2. Name of the applicant:
3. Martial Status (please tick):
Married Single
4. Gender (please tick):
Male Female Transgender
5. Mother’s Name:
6. Father’s Name / Husband’s Name (please tick):
7. Present Address (for communication):
PIN
8. Permanent Address:
PIN
Mobile No.:
E-Mail:
Telephone Office: Residence:
No., if any:
-2-
Day Month Year
9. Date of Birth 10. Age as on closing Years/months/days
date of application
11. Category (please tick): (Please attach a copy of the supporting document)
GEN EWS SC ST OBC PwBD ExSM
12. Nationality: Indian
13. Aadhaar Card No.:
14. Present Employment details, if any:
Organization
Designation
Date of Joining
Employment Type (Temporary/Adhoc/Regular)
Pay Band (PB)/Pay Level
Basic Pay
Total Emoluments (Per month)(in Rupees)
Date of next Increment
15. Total years of experience as on the last date of receipt of application, DD MM YY
(Please attach proof)
16. Areas of specialization:
-3-
17. Educational Qualifications (in Reverse Chronological Order):
(Please attach photo copies of certificates/Mark Sheets etc.)
Year of
Board/College/ Univ./ passing/Date %age of
Examination Subjects Division
Institution. of result, if marks
available
18. Employment details (in Reverse Chronological Order): [Please attach photo copies of experience certificates]:
Duration Detailed
(Exact dates to be given) Basic pay description
Position held
Total with about nature of
Employer (Regular /
period scale of duties performed
Contractual) From To
(yy/mm/dd) pay & performing*
(Mandatory)
/ / / /
/ / / /
/ / / /
/ / / /
* Please attach separate sheet (s) with complete description of the duties performed & being performed, failing which, application
may not be considered.
-4-
19. Name & Address of two Referees (should be your reporting officer(s) and/or employer(s) in the previous and present employment(
(Mandatory):
Occupation/
Sl. No. Name Official Address Contact Information
Position
Phone:
Fax:
1.
Email:
Phone:
Fax:
2.
Email:
20. Statement of objectives (If required, use separate sheet):
a) Please indicate as to why you wish to join NIPER Hyderabad?
b) How do you meet the job requirements, as advertised?
Use Separate sheet, if required
-5-
21. Details of any pending Vigilance/Departmental Inquiry/ Civil Police/ Criminal case/ CBI case etc.:
_______________________________________________________________________________________________
________________________________________________________________________________________________.
22. Details of penalties imposed, if any, during last ten years: _________________________________________
________________________________________________________________________________________________.
DECLARATION
I do hereby solemnly declare that the information given, the statements made and documents attached
with this application form are correct and true to the best of my knowledge and belief. If any
information/statement/document is found to be incorrect/false in any stage, my
candidature/appointment is liable to be cancelled and that I stand to be subjected to legal/disciplinary
proceedings.
There are __________ attached sheets along with this form.
Date:
Place: (Signature of the applicant)
(Note: Use separate sheet, if necessary, for any of the above items.)
-6-
SYNOPSIS
(To be filled and submitted alongwith the completed application form) (Advt.No. NIPER-HYD/2025/ADM/NON-FAC/01)
1. Name of the Post applied for Post Code: NT -
2. Applicant’s Name
3. Complete address for communication
4. Contact No.
5. Email Id
6. Date of Birth
7. Category (UR/SC/ST/OBC/EWS) Sub Category (PH/XSM)
(Copy of valid caste certificate is to be attached)
8. Age as on last date of receipt of applications (Copy of YY MM DD
matriculation certificate is to be attached)
9. Details of application fee SBCollect Ref. No. Date: Amount:
Fee Exempted
paid
10. Whether application sent through proper channel in prescribed
format (Yes / No)
EXPERIENCE
(Details should be exactly as per certificate(s) attached)
[Exact dates to be given – in sequence starting from present employment]
Pay band (PB) & EXACT TOTAL
FROM TO
Grade Pay/Pay Complete Office address with contact numbers DURATION
Designation
Level and email id of the Employer & Reporting Officer
Date Month Year Date Month Year Years Months Days
and Gross salary
(Signature of the candidate)
-7-
Educational Qualifications
(Details should be exactly as per final mark-sheet/certificate(s) and degrees attached)
[Exact month and year of passing the examination should be given]
Examination Month and year Month & Year of %age
Branch/ Board/College/
(From 10th Subjects of passing exam degree awarded of Division
onwards)
Specialization Univ./ Institution (Copy of final Marksheet attached) (Copy of degree attached) marks
(Signature of the candidate)
REMARKS:
(FOR OFFICE USE ONLY)
Qualification: Through proper channel:
Experience: Received on:
Age: Notes:
Fees:
