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Mahatma Gandhi Antarrashtriya Hindi Vishwavidalaya
(laln }kjk ikfjr vf/kfu;e 1997] ekad 3 ds varxZr LFkkfir dsanzh; fo'ofo|ky;
(A Central University Established by Parliament by Act No 3 of 1997
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Gandhi Hill, Wardha-442001 (Maharashtra), INDIA
____________________________________________________________________________________
APPLICATION FORM FOR NON-TEACHING POSITIONS
Advertisement No. and Date
_____________________________________________________
Post Applied For (with the Name of School) ______________________Post Code no___________
Demand Draft ParticularsName of the Bank
DD No
Date
Value
.
1. Full Name (In Block Letters): _____________________________________________________
2. Father's /Husband's Name:
_____________________________________________________
3. Date of Birth:
_____________________________________
4. Place of Birth:
_____________________________________
5. Age (as on the last date of the advertise)_____Years_____Months____days
6. Nationality:
___________________Religion________________________
7. Sex: Male/Female
_____________________________________
Affix recent
Passport Size
Photograph with
Signature
8. Marital Status: Married/Unmarried _________________________________
9. Category: Gen/ SC/ST/OBC /PH __________________________________
1. Whether SC/ST/OBC :
1) Yes__________
2) NO ______________
(if Yes, certificate in support thereof should be enclosed)
2. Whether Physically Handicapped
1) Yes_________
2) NO ______________
(if Yes, certificate from an officer not below the rank of Civil Surgeon should be enclosed)
(i) Nature of Disability
_____________________________________________________
(ii) Percentage of Disability ___________________________________________________
10. Address for correspondence (with PIN code): ________________________________________
_______________________________________________________________________________
____________________________________________________Mob._______________________
Tel No. (with STD code):________________Fax:______________ E-Mail:___________________
11. Permanent Address (With PIN code):______________________________________________
_______________________________________________________________________________
___________________________________________________ Mob._______________________
Tel No. (With STD code):_________________Fax:____________E-Mail:____________________
12. Academic Qualifications (attached attested copies):
Examination
Passed
Year of
Passing
Board/
University
% of
Marks
Division/
Grade
Subject
Specialization/
Distinction
High School
Intermediate/PUC/
Hr. Sec.
Bachelors Degree
Masters Degree
Other
Technical Qualification (If any)
13. Special subject of Study, if any
________________________________________________________________________________
14. Details of Administrative Experience: (Please enclose relevant certificate, if any):
Designation
Name of
employer
Date of
Joining
Total Period
Salary with Grade
Leaving
Reason for
Leaving
15. Language Known
Sl
Name
Reading
Writing
Speaking
16 (a) Present Basic monthly pay and allowances :
17.
Pay scale
: _________________________________
Basic pay
: Rs ______________________________
Academic Grade Pay
: Rs ______________________________
Non-compoundable Increment
: Rs ______________________________
Dearness Allowance
: Rs ______________________________
HRA
: Rs ______________________________
Transportation Allowance
: Rs ______________________________
Any Other Allowance
: Rs ______________________________
Total emoluments
: Rs ______________________________
(b) Date of next increment
: _________________________________
(c) Age of retirement in the present post
: _________________________________
(a) Whether the candidate in receiving any pension benefit. If so, the amount of pension and
pension equivalent of gratuity must be indicated.
_______________________________________________________________________
(b) Whether the candidate would be entitled to any pension benefits on his premature retirement
from his present post. If so, the amount of pension and the pension benefits any be
indicated, if selected for appointment in the university.
______________________________________________________________________
18.
(a) Have you been debarred or punished for adopting unfair means in any Examination by the
Institution/Board or University? If so, please specify.
______________________________________________________________________
(b) Have you at any time been convicted by a court for any criminal offence? If so, give name of
the court case number and offence.
______________________________________________________________________
(c) Is any criminal case pending against you in any court of law for any criminal offence.
_____________________________________________________________________
(d) Has any disciplinary action been taken against you by any University/Institution whether you
have served
_____________________________________________________________________
(e) Is any disciplinary inquiry/action pending against you in any University / Institution /
Organisation where you have served
_____________________________________________________________________
19. Additional Information (If any): ____________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
20. Name and address with Phone No. and E-mail Ids of Two referees who are familiar with the
applicants academic work:
_______________________________
__________________________________
_______________________________
__________________________________
_______________________________
__________________________________
_______________________________
__________________________________
21. Declaration: I declare that
a. the information given above are complete and correct.
b. No disciplinary proceedings are pending or being contemplated against me.
c. I have never been dismissed from service nor debarred from holding any future appointment
nor convicted for any offence. No criminal case is pending against me.
d. in case of concealment/suppression of fact(s), which may be detected at any stage in future,
my application is liable to be cancelled, as the case may be, without notice.
Date:
Signature of the Applicant:
22. Details of enclosures
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Important:
1. Photocopies of Certificates, Mark sheets, Testimonials etc should be attached with the application
(attested by the applicant himself) and the originals must be produced at the time of Interview and
at the time of joining, if selected.
2. Applicants who are in employment should send their application through proper channel.
3. The selected candidates shall produce, in original the matriculation or equivalent certificates as
proof of the date of birth. No other evidence will be accepted.
Endorsement by Employer
Certified that, Shri / Smt / Dr _______________________________
is working in this Institute /
Organisation / University in the post of _________________________ Since ____________________ in
the Pay scale of Rs.____________________________ in a temporary / Permanent capacity.
Also Certified that, the information furnished by the applicant is verified and correct as per our
office records.
.
Signature___________________________
Designation ________________________
(Headof theUniversity/Institution/Organisation with Seal)
Address ___________________________
___________________________________
Pin _______________________________
Tel No. ____________________________
Date _________________
