GONDWANA UNIVERSITY GADCHIROLI

(A State University Established by Government of Maharashtra)

Application Form No. _______
(For office use only)

Employment Notice No. GUG/34/2020 Date:- 28/08/2020

To, Passport
THE REGISTRAR
Size
Gondwana University, Gadchiroli,
Photograph
M.I.D.C. Road, Complex, Gadchiroli,
Dist-Gadchiroli, PinCode-442605.

Subject: - Application for the Post of:- ----------------------------------------------

Name of the Post :-

Post Advt. No. :-
Subject/Department :-
Sir,

I hereby submit my application for the post mentioned above with the
following details.

APPLICATION FORM

1. Personal Details (In Capital Letter's) Enclosure

No.
Full Name
(Surname First)
Date of Birth Age (In Years) as
(dd/mm/yy) on 11/09/2020

Gender Marital Status

(Male/Female)
Nationality Religion
Category With Caste
(SC/ST/VJ-A/NT-
(B/C/D)/OBC/OPEN/Divyang,etc.
Particulars of Physical
Disability, if Applicable
2. Address
Address for Correspondence Permanent Address

Pin Code: Pin Code:

 3. Communication Details(Should not be change during process)
E-mail ID
Phone No.
Mobile No.

4. Educational Qualifications (Matriculation onward) Enclosure

Name of University/ Year of Percentage Division No.
Exam/Degree Institution/Board Passing of Marks /Class/CGPA

(Please use an additional sheet, if required, retaining the above tabular format)
Ph. D. Degree
(Mark    M. Phil. Degree  
in Appropriate Box)
Awarded Awarded
Title of Thesis/Dissertation (If Published, give details on a separate Enclosure
sheet) No.

Ph. D.
M. Phil.
P. G.
Particulars of NET / SET /
SLET/ GATE or Equivalent
Examinations

5. Teaching Experience as an Approved Full-Time Teacher

Basic Pay & Teaching Enclosure
University / Period No.
Post Held Pay Band Experience
Institution
with A.G.P. From To Y M D
[Attach Appointment Order & University Approval]

Total Teaching Experience : ____Y(years) _____M(months) ______D(days)

[Attach Experience Certificate]
Special contributions, if any :
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(Enclose additional sheet, if required, in the same format)

6. EXPERIENCE IN RESEARCH ESTABLISHMENT / INSTITUTIONS

OF HIGHER EDUCATION/INDUSTRIES/PROFESSONAL
Enclosure
Basic Pay & Period Experience
Post University / No.
Pay Band From To Y M D
Held Institution
with A.G.P.
Total Experience :  -------Y(Years) -------M(Months) -------D(Days)
Special contributions, if any :
…………………………………………………………………………………………………………

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(Enclose additional sheet, if required, in the same format)

7. Research Experience : Enclosure

No.
Number of Ph. D./M.Phil. Degrees Awarded
Ph.D , M.Phil [ ]
under Supervision
Number of Ph. D. Thesis Submitted under
 
Supervision
Number of Ph. D. Students Registered under
 
Supervision
Total Research
 -------Y(Years) -------M(Months) -------D(Days)
Experience

Enclosure
08. Publications :
No.
Number of Books Published :   Own   Joint Authorship

Number of Books Edited :   Own   Joint Authorship

Number of Research Papers   Own   Joint Authorship

Published :
Own Joint Authorship
International National International National
International National conference / conference / International National conference / conference /
Journals Journals Seminars / Seminars / Journals Journals Seminars / Seminars /
Symposium Symposium Symposium Symposium
               
Note : Give the details of Publications on separate sheets
09. Competence in Computer Applications : Enclosure
No.
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10. Additional Information about representing the University/
College at the inter-university/intercollegiate competitions or the
Enclosure
State and/or National Championships and Extracurricular, Co- No.
curricular and extension Activities, if any : ( Use separate sheets, if
necessary)
……………………………………………………………………………………
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11. Total No. of Enclosure Attached :- ______________________________

(Attach the list of enclosures along with page numbers for convenience)

Date :- ________________

Place :- _______________

______________________
(Name & Signature of Applicant)
 DECLARATION - I

I, hereby, declare that, all information submitted in this application and in its
accompaniments is true, complete and correct to the best of my knowledge and
belief. I accept that in the event of any information being found false, incomplete, or
incorrect, my candidature/appointment for the post of -----------------------------------
------------------------------------------ is liable to be cancelled / terminated at any
stage. I further understand that no cognizance shall be taken of any request for
withdrawal of my application. I have read carefully all instructions given in the
employment Notice No. ------------------------------------------ Dated ----------------------
------------------------------ on the website of the University.

DATE :- ------------------------
PLACE :- ---------------------- ________________________________
(Name & Signature of Applicant)

DECLARATION - II

I, Dr./Shri/Mrs./Ms. -----------------------------------------------------------------------
Son / Daughter / Husband / Wife of Shri ----------------------------------------------
aged --------------- years resident at -----------------------------------------------------------
------------------------------------------------------------------------------------------------------
do hereby declare as follows :-
1. That I have filled my application for the post of ------------------------------------
2. I have -------------------- (----------Number) living children as on today, out of
which number of children born after 28th March, 2005 is / are ----------------
--------------------------------------------------- (Mention date of Birth, if any.)
3. I am aware that if total number of living children are more than two, due to
the children born after 28th March, 2006, I am liable to be disqualified for
the same post.

DATE :- ------------------------
PLACE :- ---------------------- ________________________________
(Name & Signature of Applicant)