Application Form
Advertise No. / Date : …………………………………
Post applied for: …………………………………………
Subject: PHYSICS
College Name: …………………………………...............
……………………………………………………………
.
GENERAL INFORMATION AND ACADEMIC BACKGROUND
1 Name : LAXMIKANT
(in English block letter)
2 Name (in Hindi) ………………………………………………………
3 Father’s/Husband’s Name CHHABI LAL
4 Mother’s Name INDRANI
5 Date of Birth 09/11/1992
6 Place in Birth DURG
7 Religion HINDU
8 Category OBC
9 State of Domicile CHHATTISGARH
10 Whether Physically Handicapped? NO
(If ‘yes’ state whether VH/HH/OH)
11 Gender Male
12 Nationality INDIAN
13 Contact Details
14 (a) Address for Correspondence (b) Permanent Address
S/o CHHABI LAL Verma, S/o CHHABI LAL Verma,
Vill - Suwartala, Post- Bortara, Vill - Suwartala, Post- Bortara,
Teh - Saja, Dist- Bemetara, (C.G.), Teh - Saja, Dist- Bemetara, (C.G.),
Pin No.- 491993 Pin No.- 491993
(c) Mobile/Phone (d) Email ID –
Signature of the Candidate ----------------------
12. Academic Qualification (Commencing with the intermediate/Senior Secondary Certificate
Examination) (Attach self-attested copies)
Examination/ University/ Subject Year of Marks Total % of Division/ Remakrs
Degree Board Passing Obtained Marks Marks Grade if any
10th C.G. Board ALL 2008 437 600 72.83 FIRST
Raipur
12th C.G. Board MATHS 2010 427 500 85.4 FIRST
Raipur
B.Sc. Pt. R.S.U. COMP. 2013 1238 1800 68.77 FIRST
Raipur (C.G.) SCIENCE
M.Sc. Pt. R.S.U. PHYSICS 2015 1834 2400 76.16 FIRST
Raipur (C.G.)
Other
(Enclose self-attested relevant documents in sequence)
13. Research Degree
Degree Subject University Notification No. with Date Title of the Thesis
Ph.D.
D.Litt./D.Sc.
Any Other
(Enclose self-attested relevant documents in sequence)
14. Ph.D./NET/SET/ M.Phil.
A Whether Ph.D. awarded as per UGC Regulation 2009/2016 No
B Whether qualified NET/SET/SLET? Yes (CGSET)
SET/SLET from C.G. State only (attach certificate)
C M.Phil. No
(Enclose self-attested relevant documents in sequence)
15. Teaching/Work Experience (Give particulars in descending order starting with the Current
Position)
S. Institute/ University Designation Period of Employment
No.
From To
1 Lt. Th.M.S Govt.College Than Khamaria, Guest Lect. 02-09-2016 28-02-2017
Bemetara
2 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 08-08-2017 28-02-2018
3 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 16-10-2018 09-03-2019
4 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 03-09-2019 29-02-2020
5 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 01-03-2021 31-07-2021
6 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 20-10-2021 09-04-2022
7 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 06-09-2022 28-02-2023
8 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 18-07-2023 29-02-2024
9 Govt. GMM College S/Lohara, Kabirdham Guest Lect. 20-08-2024 31-05-2025
(Enclose self-attested relevant documents in sequence)
16. Research Publication:
Author/Title of Paper Year
Journal Volume and
name page No.
Geomagnetic Storms in Relation to Magnetic Clouds, Hard X-Ray 2024 IJIRG Volume 13,
Solar Flares, and Disturbances in Interplanetary Magnetic Fields ISSN: 2455-
During 1996-2008 1848
Coronal mass ejection, solar flare and interplanetary shock 2025 IJNRD Volume 10,
caused geomagnetic storms during maxima phase of solar cycle ISSN: 2456-
24 4184
The influence of solar coronal mass ejections and interplanetary 2025 IJRTI Volume 10,
magnetic fields on forbush decreases in cosmic ray intensity during ISSN: 2456-
solar cycle 24 3315
(Enclose self-attested relevant documents in sequence)
Signature of the Candidate ----------------------
17. List of Enclosures:
1. 10TH 2. 12TH 3. B.Sc.
4. M.Sc. 5. CGSET 6. CAST CERTIFICATE
7. DOMICIAL 8. TEACHING 9. RESEARCH PAPER
CERTIFICATE EXPERIENCE
Note : All particulars should be supported by relevant documents.
18. Declaration by the Candidate: I hereby declare that:
I have read the detailed Employment Notice and I shall abide by all the Terms and
Conditions of the advertisement.
The entire information given in this application form are true to the best of my knowledge
and belief. If at any time, I am found to have declared any material/information’s or given
any false details, my appointment shall be liable to be summarily exterminated without notice
or compensation.
Date:
Place: Signature
(LAXMIKANT)
