NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY
(An institute of National Importance under MHRD, Govt. of India)
Nagar, Karaikal - 609 605
Application Form for Non - Te aching Post
For office use
APPL. No:
WALK IN INTERVIEW
[Purly Temporary position on Contract basis]
Please read the information carefully on website prior to filling up this application form. You may use separate
sheet/s wherever required. Docume ntary e vide nce (s) is/are to be attache d for the data provide d in this
application failing which due we ightage will not be give n during scrutiny.
Advertisement No. & Date:
Post Applied for:
Department:
---------------------------------------------------------------------------------------------------------------------------------1. (i) Full Name (in BLOCK letters) : ......
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(ii) Fathers/Husbands Name :
.:
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(iii) Whether belonging to GEN/ SC/ST/OBC/PH:
..........
(Attach Certificate)
2. Date of Birth: 3. (a) Nationality: .... (b) Gender: Male / Female
(c) State/UT to which you belong:
........
(d)Marital Status: Married / Unmarried / Divorced
.............
4. Postal Address for correspondence.
Mobile):
5. Permanent Address (with Phone no. &
....
......
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.....
...........................
...
.....
............................
...
.....Pin Code: ...........
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....Pin Code:
Phone No.: Office: ...
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Phone No.: Office:
Res.: ......
Res.: ..
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(With STD Code)
Mobile No.: ....... .... E-mail ID: ..
6. Educational Qualifications (Start with Highest Qualification):
Sl.
No.
Examination Name of the
Passed
University/Board
Year of
admission
Year of
Subject/ % of Marks/
Passing Specializati Grade (CGPA)
on
Division /
Class
7. (a) Post held at present: (if any)
Post held
Date of
Appointment
Nature of the Post
(Temporary/Probation/
Permanent)
Name & Address Responsibilities in
of Employer *
the present job
* Copy of appointment order to be attached
(b) Present Pay Scale: AGP/GP Any other Pay:..
........
Basic Pay: ........ Dearness Allowance: ..... Gross Pay
.. Total Emolument: ..
(c) Type of organization (Government/Semi-Government/Govt. Aided/Autonomous Body/ Private etc.)
.............
...
8. Professional Experience (In the reverse chronological order): (Attach extra sheet if required)
Sl.
No.
Name of the
Employer
Post
held/nature of
duties
Period of Employment
From
Pay Scale and
Basic Pay
drawn
Total
Emolument
Reasons for
Leaving
To
9. List of actual expertise you have related with post applied for:
Sl.
No.
Name of work
Your role
Duration
Organization
Detail
Status of Work
Remarks
10. Prizes, Awards, Rank received etc. (if any, attach certificate):
.................................................
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11. Training Programmes organized / attended: (Attach extra sheet if required)
Sl.
No.
Title
Venue
Duration
Sponsoring Authority
12. Languages Known:
Sl.
No.
Read
Write
Speak
13. Extra Curricular Activities:
..........
.
...........
.
..........
14. Please give details of three referees (Not related to the candidate), At least one should be the current /
previous employer:
(i) Name: ..............
..................
(ii) Name:
Designation: .............
........
Designation:
Full Address:........
......
Full Address:
...................
.....................
...................
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Contact No. ..........
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E-mail:..........
......
(iii) Name:..
Contact No.
E-mail:
15. Any other relevant information
Designation:...
.......................
Full Address:......
.......................
...
.......................
Contact No.
.......................
E-mail:.
.......................
DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief.
I understand that misleading or wrong information supplied may lead to summarily rejection of application
/appointment (if found subsequently).
Date:
Place:
Applicant)
(Signature of
------------------------------------------------------------------------------------------------------------------------------Forwarde d through He ad of the Institute / Organization
The application of Dr. / Mr. / Ms. .........for
the post of at National Institute of Technology Puducherry, Karaikal is
hereby forwarded.
Date
Place:
..
(Signature and Se al of the forwarding Authority)
Summary Sheet for Non - Teaching Posts
National Institute of Technology Puducherry, Karaikal 609 605
(All data to be filled by the candidate with documentary evidence for scrutiny)
Name of the Candidate :
Post applie d for:
Sl No
1.
Degree
De partme nt:
Name of Institute/
University
Subjects Studied Year of Passing
% of Marks / For Office
Grade (CGPA) Use
High School (10th )
Intermediate
(10+2)
ITI/Diploma/
Certificate
UG
PG
Ph.D/Any other
Qualification
2.
Post held
Organization
Years/Months
Salary Drawn
Total Experience
3.
4.
5.
Technical/Computer Skills e.g.MS
Office/Excel/Any writing skill certificate
in (English/Hindi), Hindi Typing
Any other relevant Qualifications
deemed fit as per applied post
Providing this information is Mandatory. If space is left blank answer will be
considered as NO.
(i) Have you worked on any post in IIT / NIT/ IISc /Govt. Organization?
(ii) Have you been awarded at State / National level in Academics / Sports?
(iii) Have you been a rank holder during Academic Career? Specify level & rank.
Answer
Yes / No
6.
7.
(iv)Are you holding an analogous post?
Any other skilled education:
Kindly write in 100 words, how you feel yourself more suitable for this post(should not exceed more than
100 words)
Above information should be supported with Certificates/Degrees/Documents & All the above information
written by me are correct
Date :
Signature of the candidate
