CENTRAL INSTITUTE OF PLASTICS ENGINEERING & TECHNOLOGY
(CIPET)
(Dept. of Chemicals & Petrochemicals,
Ministry of Chemicals & Fertilizers, Govt. of India)
Advt. No. CIPET / HO-AI / 01 / 2018
APPLICATION FORM: POSITIONS (TECHNOLOGY SUPPORT)
1. Post applied for
2. Area of Specialization :
3. Full Name
(in block letters)
4. Date of Birth Blood Group
5. Community
(SC/ST/OBC/GEN)
(Enclose attested copy of certifcate)
6. Whether Physically Challenged Yes No
If yes, state % of disability
(certificate to be enclosed)
7. Sex Male Female Others
8. Marital status Married Single Others
9. Nationality Religion
10. Mother tongue
11. (a) Name and Address of Parents
(b) Name of Spouse (if applicable)
(c) If spouse is employed,
Give Employer Name & Place
12. Postal address for correspondence
Tel : e-mail :
Mob : Fax :
Nearest Relative’s Mobile Number a)
b)
13. Permanent Address
14. Present employment
15. Were you at any time declared medically unfit; asked to submit your resignation;
discharged or dismissed from Govt./Semi-Govt./Autonomous Body or Private Service?
If yes, give details in a separate sheet.
16. Have you ever faced any Vigilance Enquiry or enquiry by anti-corruption bureau/Central
Bureau of Investigation or any other Investigative Organization
Yes No
If Yes: Please indicate in brief, the details of the Vigilance Enquiry and outcome thereof
in separate page
17. Academic Qualifications (in chronological order from highest up to matriculation) :
Division/% Mode of study
Sl. College/Institute/ Subject/ Year of
Degree of Marks ( Full Time /
No. University Specialization Passing
or CGPS Part time)
(Enclose separate sheets if required)
18. Professional Qualification (e.g. Professional Training, Courses, Workshops etc.)
(Enclose as a separate sheet)
19. Employment details: (Details in chronological order, starting with present employment
upto the first employment
Position Pay Period of Place /
Name & Address of Nature
Sl. held / Scale & Employment state of
Organization / of
No. Designatio Gross (Month/Year) employ
Employer Duties
n Salary ment
From To
* Enclose separately if required
20. Details of your Ph.DThesis (If applicable)
(Enclose abstract of Thesis)
Sl.
Degree Title of Thesis University
No.
01. Ph.D.
21. If you claim Experience, please furnish details on the following,
(Use a separate sheet for each sub-heading in the format indicated)
TECHNOLOGY SUPPORT
a) Indicate general & specialized technical skills (include separate sheets, if required)
b) Experience in Shop Floor Management in Polymer Processing
c) Experience in Shop Floor Management in Tool Room, Design & CAD/CAM
d) Experience in Testing Laboratory & Quality Management
e) Knowledge of Calibration sevices if any;
f) Industrial Consultancies & Projects undertaken: Govt.
Private
(Attach details separately)
g) International Consultancies undertaken, if any ;
h) Expertise in Development of New shop-floors or Laboratories set-up if any;:
i) Indigenisation in Product Development activity undertaken, if any :
j) Involvement in Standardaization activities/formulation or SOP’s
k) Details of Hands-on-experience of sophisticated machineries& equipments:
l) Teaching-learning-Evaluation Technology Programmes, soft skill development
programmes as per NSQF guidelines :
m) NABL / ISO Audit undertaken & documentation
n) Knowlegde of Safety methods & practices
o) Knowledge of Six Sigma, TQM etc, if any :
p) Awards and Recognition :
q) Overseas Training received, if any :
22. Reference
Responsible persons not related to the applicant but closely acquainted with the applicant
Name and Designation Address
1. Phone:
Email:
2.
Phone:
Email:
Phone:
3.
Email:
23. Notice period / No. of days likely to be availed for relieve from parent organization on
selection:
24. (a).Details of relatives working at CIPET, if any :
(b) Any other information you may like to furnish to CIPET:
25. Social / Political / Religious Affiliations of the Candidate if any, Mention the name and
clear details about the affiliations:
26. Copies of documents enclosed:
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DECLARATION
I declare that the Entries made in the Columns of this proforma are correct and true to the
best of my knowledge and nothing has been either concealed or misrepresented by me. In
case of any misrepresentation, I understand that employment if any gained, is liable for
termination.
Place: Signature
Date:
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Forwarding of Application through proper channel: (To be filled in by the forwarding
authority).
(Applicable for Candidates from Central/State Govt./PSU/Autonomous/Quasi-Govt.
only)
Date: ________
Forwarded to the Central Institute of Plastics Engineering & Technology (CIPET)
The applicant has been working in this Office / Organization / Institute / University as
________________________________ since _____________________and is still in
service. We have No Objection to his/her candidature being considered for the post he / she
is applying.
Place:
Signature
(Name & Designation with seal)
N.B.: 1). Use separate sheets wherever necessary while filling application form above.
2).All entries in this application form shall be neatly typed.
