JOB APPLICATION FORM
1. Advertisement Number & Sr. No.            :
2. Application for the post of               :
3. Name of the applicant                     :
4. Date and place of birth                   :
5. Age                                       :
6. Nationality                               :
7. Marital Status                            :
8. Whether belongs to SC/ST/OBC              :
   community (if so, give details and
   attach copy of certificate)
9. Religion                                  :
10. Disability                               :
   (attach photocopy of certificate)
11. Permanent address                       :
12. Address for correspondence              :
    with telephone/mobile
    number and e-mail address
13. Qualifications (beginning with SSC or equivalent. Attach photocopies of all certificates and mark
    lists of all semesters/years) :
    Examination         University/              Subjects        Year of    %of marks & Class/
   Degree/Diploma        Institute                               Passing     Grade/distinction
                                                                                 obtained
14. Other qualification (if any)                   :
15. Details of projects done( if any)              :
16. Details of publications (if any)               :
17. Are you employed in a Govt./Semi-Govt./:
    Public Sector Undertaking/Autonomous
    body? (If yes, you are required to forward
    your application through proper channel)
18. Are you under any contractual obligation :
    to serve the Govt./Semi-Govt./Public Sector
    Undertaking/Autonomous body? If yes, give
    details.
19. Experience/Details of present and previous employment (attach photocopies
    of experience certificates) :
          Name of Employer           Designation of              Period of Service          Salary
                                      the post held           From          To
20. Names and addresses of two referees                     : 1)
                                                              2)
21. Have you at any time been called:
    for interview in the Centre?
     If so, give details:
  I' hereby declare that the statements made in this application are true, complete and
  correct to the best of my knowledge and belief.
  Place:
  Date:                                                         (Signature of the candidate)
  NOTE : Applications giving full details together with copies of relevant certificates/testimonials in the
  above format and superscribing the post applied for & Serial Number of the post on the envelope should
  reach Registrar, UM-DAE Centre for Excellence in Basic Sciences, “Nalanda”, Opp Nano Sciences
  Building, University of Mumbai, Vidyanagari, Mumbai 400098, India.