Jamia Millia Islamia
(A Central University)
NAAC Accredited Grade “A++”
Jamia Nagar, New Delhi-110025
PROFORMA
(To be filled and submitted along with the Employment Application Form)
Advertisement No. & Date : ______________________________________
Post applied for : _______________________ Sl. No.________
Faculty/Deptt./Centre/Office : ______________________________________
Name of the Applicant : ______________________________________
Date & Amount of fee deposited : ______________________________________
(Plz attach payment slip)
User’s Bank & Branch Name : ______________________________________
Transaction No./ID/Ref. No. : ______________________________________
UTR No.
Valid Email (Capital Letter only) : ______________________________________
Mobile No. : ______________________________________
Dated :…………………………. …………………………….
(Signature of Applicant)
UTR No./ Ref. No.: …….
……………….…………
Date: ………………………
Affix Application Fee:-
For General: Rs. 800/500
recent passport size For SC/ST: Rs.400/ 250
photograph
here JAMIA MILLIA ISLAMIA For office use only
(A Central University) Application fee paid
NAAC Accredited Grade “A++” Call for Interview Yes
No
Jamia Nagar, New Delhi-110025
Sign ……………………….
APPLICATION FORM FOR APPOINTMENT ON THE NON-TEACHING POSITION
1. Candidate’s Full Name
2. ( i ) Advt. No.: Dated:
( i i ) Post applied for: …..…………………………………………………………………………….…………………….
( iii ) Deptt. / Office: ….……………………………………………………………………….…………………..………..
3. Father’s / Husband’s
Name in Full
4. Address:
(i) Correspondence: (ii) Permanent:
………………………………………………….. …………………………………………………..
………………………………………………….. …………………………………………………..
………………………………………………….. …………………………………………………..
Pin: ……………Mobile No: ............…………. Pin: ……………Mobile No: ............………….
Email Id: …………………………………………………………………………………..…………………………………
5. Date of Birth: (Based on Matriculation/Hr. Sec. School Certificate)
Date Month Year
6. Whether U.R. S.C. S.T. O.B.C. PWDs (Divyangjan) (Please tick the correct box)
`
7. Marital Status: Married Unmarried Widow
8. Educational Qualifications: (Enclose the self-attested copies of all the Degrees, Marksheets, Certificates, etc.)
S. No. Qualifications* Board / University Year %age Subjects
1 Matric/S.S.C.
2 Inter./Sr. Secondary
3 B.A./B.Com./B.Sc./B.E./B.Tech.
4 M.A./M.Com./M.Sc./M.E./M.Tech.
5 M.Phil.
6 Ph.D.
7 N.E.T.
8 Others
* Strike out which is not applicable (Attach enclosures, if necessary)
9. Details of Work Experience:-
Period of Service
Roles and Name and Address of the
S. No. Particulars of the Post
From To
Total Responsibilities Employer
Period
10. Research work / Published work /Scholarship / Fellowships (Attach enclosures, if necessary)
11. If employed presently, furnish the following details:-
(i) Pay Level …………………. (ii) Basic Pay Rs. ………........................... (iii) Allowances Rs………….……………..
(iv) Total Rs. : ……………………………………. (v) Date of next increment ……………………………………..
12. If appointed, time and notice required for joining the post:-
13. Name of two referees:-
Period for which the referee is
S. No. Name of Referee Address of the Referee
known to the candidate
1.
2.
* Applicant may send two testimonials from persons under whom he/she has studied or worked.
DECLARATION
I hereby declare that the entries made by me in the above columns are true to the best of my knowledge and belief.
Place: …………………….
Date: ……………………. (Signature of the Candidate)
If employed, remarks of the Forwarding Authority.
Attach separate sheet, if required.
Signature……………………………………………
Name ……………………………………………….
Designation………………………………………….
Address……………………………………………..
Place………………………
Date………………………
Jamia Millia Islamia
(A Central University) NAAC
Accredited Grade A++”
Jamia Nagar, New Delhi-110025
Advt. No…………………….…….……… Date ……………………..…
Particulars of Dr./ Mr./Mrs./Ms. ……………………………………….
IMPORTANT
1) Attach 07 duly filled in and signed copies of this proforma with the application form.
For the post of ...……………………………………..……………..
Name, Address and Academic Qualifications Details of Work Experience
Date of Birth,
Contact No. for Research and Published
Mother Tongue &
correspondence Other Languages Board / Total Post & Work
Exams. Year %age From-To Employer
University Years Level
School Cert.
Date of Birth:
……………
………………….. ……………
Age: ………Years Graduation
……………
Mother Tongue: Post
Graduation
…………………..
……………
Other
……………
Languages:
M.Phil.
……………………
Ph.D.
…………………… Others
……………………
Date: …………………. (Candidate’s Signature)
Jamia Millia Islamia
(A Central University) NAAC
Accredited Grade “A++”
Jamia Nagar, New Delhi-110025
ACKNOWLEDGEMENT
Received an application from Dr./Mr./Mrs./Ms._________________________________
for the post of _______________________________________________________________in the
Faculty/Deptt./Centre/Office __________________________________________________in
response to the Advt. No .________________________________Dated ___________________
along with payment receipt Transaction No./ID/Ref. No./UTR
No.___________________________ Dated _____________
Date:…………………………… (Signature of the
Receiver)
