CENTRAL UNIVERSITY OF PUNJAB Application Form for Non-Teaching Position

CENTRAL UNIVERSITY OF PUNJAB
City Campus, Mansa Road
Bathinda-151 001 (Punjab) India
Website: www.cup.ac.in; www.centralunipunjab.com
Advt. No.
…………………………………..
(Office Use Only)
Regd. No.:
Application Form for Non-Teaching Position
1. Details of application fee payment (if any)
DD #
Date
Amount
Name of the Bank
2. Name of the post applied for
Issuing Branch Name
Paste your recent
passport size
photograph here
:
Personal details
First Name
3.
Name
4.
Date of birth
5.
Place of birth
6.
Father’s name
7.
Mother’s name
8.
Nationality
10.
11.
12.
Middle Name
Surname
(in Capital Letters)
Marital status
Community/ Category
(delete those not applicable)
Day
Month
Year
Years
Age as on date of
advertisement
City/ Village
State
Months
Country
9. Gender:
a. Married / Unmarried
b. If married, name of spouse:
Gen /SC /ST /OBC / Other Category
If other category, give details _________________________
If physically disabled, indicate the relevant
particulars
If applicable,
Write ‘yes’
Percentage of
disability
S.No. of
proof enclosed
a. Blindness or low vision :
b. Hearing impairment
c. Locomotor disability or cerebral palsy
(includes all cases of Orthopedically handicapped)
13. Educational qualifications (Attach additional pages, if required)
Name of the
course
CGPA
Month &
(if grading
Name of the Board /
% of
Year Division
is
University
Marks
passing
applicable)
Subjects
studied
10th Class /
equivalent
10+2 /
equivalent
Bachelor’s
Degree
Master’s
Degree
Any other
examination
passed
Incomplete Application Forms will be rejected
Page 1 of 4
S.No. of
proof
enclosed
14. Chronological list of experience (Starting with the first appointment)
Period of Experience
Designation
Scale of
pay
Name &
address of
employers
Total period of experience
From
date
To
date
No. of years /
months
(As on date of
advertisement)
Nature of
work /
duties
S.No. of
proof
enclosed
________Years _________months_________days
15. Names and complete postal addresses of 3 referees (The referee should be the last employers of the candidate
or any other person having know-how of candidate’s experience/knowledge and should not be related to the applicant)
Referee-1
Referee-2
Referee-3
Names & complete
postal addresses
Email:
Landline phone (with STD
Code)
Mobile Phone
Fax
16. Present position details / If retired, last position details
Designation
Name of the
University /
institution
Basic Pay (Rs.)
Pay Scale
(Rs.)
Gross Pay /
Total Salary
p.m. (Rs.)
Increment
date
(Date/Month)
S.No. of
proof
enclosed
17. Languages known
Language
Reading
Writing
Speaking
18. Knowledge of Computers and Typing
Incomplete Application Forms will be rejected
Page 2 of 4
19. National / International Awards/ fellowship
20. Paragraph of self-evaluation regarding different fields of activity related to the job
21. Time required for joining, if selected:
22. Any other information/ qualification relevant to the post applied for:
23. Candidate's Name & Address for correspondence :
Mailing address
Permanent address
Name
Complete Address
with pin code
Phone No.
Email:
(Landline with STD code)
Mobile No.
Fax No.
24. Check list of self-attested testimonials attached (original to be produced at the time of interview).
Please tick (P)the ones applicable
i.
Matriculation marksheet / certificate
ii.
Intermediate marksheet / certificate
iii.
B.A./ B.Sc. /B.Com (Final) marksheet/ degree
iv.
M.A./ M.Sc. /M.Com(Final) marksheet/ degree
v.
L.L.B (Final) marksheet / degree
vi.
L.L.M marksheet / degree
vii.
Caste Certificate issued by the Competent Authority (OBC/SC/ST/etc.)
viii.
Experience certificates
ix.
Recommendation letter(s)
x.
Award (s) /Fellowship (s)
xi.
Other (s)
Total Number of above self-attested testimonials attached____________ (in words_____________________________)
N.B. Applications without the above self-attested testimonials will not be entertained
Incomplete Application Forms will be rejected
Page 3 of 4
25. Declaration
I, __________________________________son/daughter of_____________________________________
hereby declare that all the entries made by me in this application are true, to the best of my knowledge
and belief. No disciplinary / vigilance case has ever been held or contemplated or is pending against me.
If anything is found false or incorrect at any stage, my candidature /appointment may be cancelled by the
university without assigning any reason thereof.
Signature of the applicant
Date : _____________________
_________________________________
Name as signed (in BLOCK LETTERS
Application not signed by the candidate is liable to be rejected.
26. Endorsement by the EMPLOYER
a). In case of in-service candidates in Government/Semi-Government organizations/Public Sector
Undertakings/Autonomous Organizations, the endorsement form must be signed by the employer.
b). In case of in-service candidates from Private Sector, acceptance of resignation and relieving letter from the
employer at the time of joining must be submitted.
Forwarded to the Central University of Punjab, Bathinda-151 001, India:
The applicant Dr./Mr./Mrs/Ms._____________________________________________,
who has submitted this
application for the post of __________________________ in the Central University of Punjab, Bathinda, has been
working
in
this
organization
namely
_________________________________
in
the
post
of
______________________ in a temporary / contract/ permanent capacity with effect from ________________ in
the Scale of
Pay of
Rs.____________________________. He /She is drawing a basic pay of
Rs._________________. His / Her next increment is due on________________.
Further, it is certified that no disciplinary / vigilance case has ever been held or contemplated or is pending against
the said applicant. There is no objection for his/her application being considered by the Central University of Punjab,
Bathinda.
(Signature of the forwarding officer)
Name:
__________________________
Designation: __________________________
Seal
Incomplete Application Forms will be rejected
Place:
__________________________
Date :
__________________________
Page 4 of 4
CENTRAL UNIVERSITY OF PUNJAB
Paste your
recent passport
size Photograph
here
Established vide Act No. 25 (2009) of Parliament
Non-Teaching Position – Summary Sheet
1.
Name of the post applied for
2.
Name:
(in Capital Letters)
3.
Date of birth
DD/MM/YYY
DD Number
4.
5. Educational
qualifications
:
Male/Female
Place of birth
Date
Name of the
course
Community/Category:
Age
Amount
Married / Unmarried
Name of the Bank
Name of the Board /
University
Gen/SC/ST/OBC/PWD/others
DD issuing branch’s name
Month & Year
Passed/ Award
Division
% of Marks
CGPA
(if applicable)
10th Class /
equivalent
10+2 /equivalent
Bachelor’s
degree
Master’s degree
Any other
examination
Passed
6.. Chronological list of experience
Designation
7.
Scale of pay
Total period of experience:
8. Present
Designation
(Starting with the first appointment)
Name & address of
employers
________ Years
Name of the University /
institution
From
date
To
date
_________ Months
Basic Pay
(Rs.)
9. Name & Address for correspondence :
Mailing address
Name
Pay Scale (Rs.)
Nature of work / duties
No. of years/
months
_________ Days
Gross / Total
Salary p.m. (Rs.)
Increment date
(Date/Month)
Permanent address
Complete Address
with pin code
Email:
10.
Applied
(Through Proper Channel)
Phone No.
(Landline with STD code)
Mobile No.
Fax No.
Yes / No
Signature of the applicant
Incomplete Application Forms will be rejected
… Page 5 of 4
CENTRAL UNIVERSITY OF PUNJAB
Established vide Act No. 25 (2009) of Parliament
(For office use only)
Hall Ticket No.________________ (to be filled by office)
Photo to be
pasted
Advt. No. _____________________ Post Applied for: ______________________
Name of the Applicant (in block letters):________________________________
Father’s Name (In block letters): _______________________________________
Date of Birth (DD/MM/YYY):__________________Ph/Mob: _________________
Email ID:
______________________________________________________
Office Seal
Signature of the Candidate
CENTRAL UNIVERSITY OF PUNJAB
Established vide Act No. 25 (2009) of Parliament
HALL TICKET
(Candidate Copy)
Hall Ticket No.________________ (to be filled by office)
Photo to be
pasted
Advt. No. _____________________ Post Applied for: ______________________
Name of the Applicant (in block letters):__________________________________
Phone/ Mobile:______________________________________________________
Email ID:
______________________________________________________
Office Seal
Signature of the Candidate
Note: This hall ticket is valid for the interview process.
…
Incomplete Application Forms will be rejected
Page 6 of 4