VIDYAMANDIR SOCIETY’S

Smt.TANUBEN & Dr.MANUBHAI TRIVEDI COLLEGE OF INFORMATION SCIENCE

Z.F.Wadia Women’s College Campus, Website : www.vidyamandirsoc.org

Jawaharlal Nehru Marg,

Athwalines, SURAT 395 001.

JOB APPLICATION FORM

[Fill up all the details correctly & carefully]

Date of advertisement : _____________________________________________

Name of Institute: __________________________________________________

Applied for the Post of : _____________________________________________

Department : ____________________________________________________

1. (i) Full Name (in block letters) : _______________________________________________________

(as in HSC Mark Sheet)

(ii) Father’s / Name : _______________________________________________________________

(iii) Mother’s Name : ________________________________________________________________ 2. Present Address : __________________________________________________________________

_________________________________________________________________________________

___________________________________________________________ Pin ___________________

3 Permanent Address : ________________________________________________________________

_________________________________________________________________________________

___________________________________________________________ Pin ___________________ 4 Phone No. :Res with STD Code : ___________________________ Mobile: _____________________

✓ Pan card: _______________________ (Its Compulsory).

✓ Aadhar Card no: _______________________ (Its Compulsory).

✓

✓ E-mail ID : _______________________

________________________________________________________

5 Date of Birth : ________________________ Age [(as on date) completed years] _________________ 6 Nationality : ___________________ Gender: Male / Female Marital Status: Married / Unmarried

✓ Native Place: _______________________________________ (Town, Village, District & State).

7 Religion: ____________________________ Caste: ____________________________________

E- mail : info@vidyamandirsoc.org

Phone No.: [0261] 2460995

Please Affix Recent Passport Size Photograph

8. Do you belong to (Please tick) : OPEN SC ST SEBC

If yes, Whether certificate attached from :Certificate in Hindi / English / Gujarati competent authority (please tick) Physically Handicapped: YES / NO.

9. Educational Qualification: (All Details are Compulsory Filled)

Education Board/Uni. Passing Percentage CGPA Class Subject with

Year (%) Specialization

S.S.C.

H.S.C.

U.G. __________

P.G. __________

M.Phill

Ph.D.

NET/SLET Score

Other

Attach self attested Photo copies

10. Post held at present

Post held at Date of Nature of the Post (Temporary / Name & Address of

present Appointment Probation/ Permanent) Employers

Note: Please Attach No Objection Certificate (NOC).

11. Prizes, Awards, etc. : _______________________________________________________________

12. Academic Experience Details : (From Present to Past)

Sr.

Post

Total Length of

Employer’s Name Pay Scale Service (date) Nature of work No. held Emolument

From To

1

2

3

4

5

6

13 (a.) U.G. _________________ Year(s) _________________ Month(s)

P.G. _________________ Year(s) _________________ Month(s)

Total Experience _________________ Year(s) _________________ Month(s)

Other (if any) _________________ Year(s) _________________ Month(s)

(b) Research Activities:

Sr. Degree Registered / Duration

University / Funds Present (date)

No. Project under taken Sponsoring Authority sanctions Status From To

(c) Publication: No of Books Published__________________________________

National Journal

Sr. Name of Journal Volume No. Month / Year Title (in short)

No.

International Journal

Sr. Name of Journal Volume No. Month / Year venue Title

No.

Conference / Seminar

(Applicable if full text of paper is published)

Sr. Name of Conference / Seminar Month / Year Venue Title

No.

National Conference/ Seminar

International Conference/ Seminar

(d) Other Activities:

(i) Number of Expert Lectures Delivered : ___________________________________________

(ii) Number of Summer / Winter schools / Training Programmes : _________________________

Organized

(iii) Number of Seminar / Conference / Workshop / Networking : __________________________

Programme Organized

Administrative & Community Services: (e.g. Dean/ Vice-Principal/ Principal/ Hostel warden/

HOD/ Prof. Incharge/ Chairman, Board of Studies/

Self Development Programmes for community

Services)

Sr. Name of Assignment Duration Name of responsibility shared / service offered

No.

14. Member of Technical Societies : _____________________________________________

_____________________________________________

15. Extra Curricular activities / Hobbies : _____________________________________________

DECLARATION

I declare that the statements made in this application are true to the best of my knowledge and belief.

I understand that misleading or wrong information supplied may lead to summarily rejection of application / appointment if found subsequently.

Date: __________________

Place: _________________ (Signature of Applicant)

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WITHOUTFAIL FILL UP THE FOLLOWING DETAILS CAREFULLY

Name: __________________________________________________________________________

Correspondence Address: _________________________________________________________

________________________________________________________________________________

____________________________________________________ Pin ___________________ _______

Phone/Mobile No. : _________________/ _________________/ _________________

Document attachment

Sr. Document Yes/No Sr. Document Yes/No

No No

1 S.S.C. Mark sheet 8 NET/SLET Score

2 H.S.C. Mark sheet 9 M.Phill Certificate

3 Leaving Certificate 10 Ph.D. Notification/Certificate

4 Graduation Mark Sheet (All) 11 Experience Certificate (All)

5 Graduation Certificate 12 Research and Publication

6 Post Graduation Mark Sheet (All) 13 Paper Presentation

7 Post Graduation Certificate 14 Aadhar Card Copy

Document to be attached:

1 MARKSHEETS ✓

1 HSC

2 First Year

3 Second Year

4 Third Year

5 All The Marksheet Of Post Gradution

2 Leaving Certificate

3 Caste Certificate

4 Net / Slet Certificate

5 Ph.D / M.Phil Certificate / Notification

6 All The Teaching Experience Certificate

7 No Objection Certificate From Current Employer

8 Other Certificates / Achivement

9 Score Card Proforma

10 Self Address Envelope With Postal Stamps Worth Rs.25 -Affixed there on

11 Passport Size photo Affixed on Application.

12 Submission of form to be made in 3 copies with all relavant documents