DR.
BABASAHEB AMBEDKAR OPEN UNIVERSITY
(Established by Government of Gujarat)
“Jyotirmay Parisar”
Dr. Babasaheb Ambedkar Open University Marg,
Sarkhej - Gandhinagar Highway, Chharodi, Ahmedabad-382 481
Website: www.baou.edu.in
Advertisement Date: 15/06/2019.
Application form
Name of the contractual post applied for: ________________________ Sub: _________________________
1. Name of applicant _________________________________________________ Please affix your
recent passport size
(Surname) (Name) (Father’s/Husband’s Name) colour Photograph
& sign across
2. Address:-
(1) For correspondence: (2) Permanent Address
_____________________________ ______________________________
_____________________________ ______________________________
_____________________________ ______________________________
PIN:- _____________ Ph: __________ PIN:- _____________ Ph: ___________
3. Mobile Number: _________________________________
4. E-mail: ____________________________________ Aadhar No: __________________
5. Mother tongue: ____________________________ 6. Nationality: ______________
7. Date of Birth: __________________ Age as on Dt. ………….: Year _____ Month______
8. Category:- (Attach latest recognized certificate for the reserved candidates)
SC [ ] ST [ ] SEBC [ ] D.A.( Physical Handicapped) [ ]General [ ]
9. Proficiency in language:
Language Writing Reading Speaking
(1) Gujarati ___________ ___________ ____________
(2) __________ ___________ ___________ ____________
(3) __________ ___________ ___________ ____________
(4) __________ ___________ ___________ ____________
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10. Educational Qualifications: (from S.S.C.)
Examination Board / University Year of Marks/Grade, Main subject Remarks
Passing Percentage
S.S.C.
H.S.C.
Graduation:
Degree :__________
st
1 Year
nd
2 Year
rd
3 Year
Post-Graduation
Degree :__________
st
1 Year
nd
2 Year
M. Phil.
Ph.D.
11. Other educational achievements: (Award, Prize, Medal, etc.)
12. Proficiency in Computer (Give details)
13. Details of UGC/CSIR or similarly recognized / NET/ SLET exam, if passed.
Year of examination passed: ________________ Regn. No. ____________________
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14. Details of experience: (Kindly fill up the table )
Name of the Designation Pay scale and basic Duration
Institution pay as on
application date,
Grade Pay
16. Details of Publication and Research work:
S. No. Title Year of Publisher ISBN / ISSN Author/Co
publication No. author
(Please use separate sheet if needed)
17. Details of Seminar / Workshop / Orientation / Refresher Course:
Sr. Category State/National/
No. Name of Institution Programme Duration Whether paper International
submitted
(Please use separate sheet if needed)
18. Please give name, address and contact number of two persons for reference.
(1) ________________________________ (2) __________________________________
______________________________ ___________________________________
________________________________ ___________________________________
________________________________ ___________________________________
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19. Details of attachments: (Attach self-attested Xerox copies)
(1) Proof of Date of Birth.
(2) Latest Certificate of SC/ST/SEBC/Handicapped
Certificate No.____________ Date of Issue of Certificate _______________
(3) Proofs of Educational qualifications
(4) Experience certificates – If your teaching experience is in a Self Finance Institution, please
submit copy of approval of your appointment / profile of the concerned University.
(5) NET / SLET examination pass certificate
(6) Details of guidance to M.Phil./Ph.D. category students.
(7) M.Phil. / Ph.D., Thesis, Titles of Publications.
(8) Details of Seminars / Workshops / Orientation programme / Refresher Course.
(9) Others.
20. Other information.
CERTIFICATE
I hereby declare that the information provided by me in the application from is true according to my
knowledge and belief. I have not given any wrong or incomplete information. I know that in case of any false
information found on my part after my appointment, my service is liable to be terminated without any notice.
I affirm that there is no criminal case/civil case or warrant or departmental proceedings pending against me
in any court of law. If any departmental proceedings or civil or criminal case found against me I will be
responsible for that, in that case, I know that, my service is liable to be terminated without any notice.
I have read the instructions given along with the application form and understood the same and I am abide
by it.
Date ___________________________ _______________________________
Place __________________________ (Signature of the applicant)
