Application Form for Teaching and Administrative Posts

KUMAUN UNIVERSITY, NAINITAL (UTTARAKHAND)

(Note: Please go through instructions given in the website-www.kunainital.ac.in

carefully before filling-up the Application Form & Self Assessment API Score)

Form No……………………….

Advt. No………………………. Dated……………………………………

Post Applied For ………………………………………………………………………………

Name of the Department ………………………………………………………………………………

1. Candidate’s Name (in full) ……………………………………………………………

(In Capital Letters)

2. Father’s/Husband’s Name ……………………………………………………………

3. Mother’s Name ……………………………………………………………

4. Permanent Address ……………………………………………………………

5. Present Postal Address ……………………………………………………………

6. Date of Birth (in Christian era) ……………………………………………………………

7. Place and State of Birth ……………………………………………………………

8. Marital Status ……………………………………………………………

9. Nationality …………………………………………………………...

10. Category, mark tick (√) General SC ST OBC

(For OBC candidates- Non Creamy Layer Certificate of not more than 6 months must be

enclosed with application form)

If so, a certificate to that effect from the District Magistrate / Additional District Magistrate be

enclosed, if desired certificate is not enclosed the application will be considered under the general

category.

11. Particulars of references.

Sl.

No.

Name Occupation and Position Address

1.

2.

3.

Passport size recent

Photograph

duly signed by the

applicant

12. If any of your relatives (by blood or marriage) are in employment of the University or/and Campuses,

please give details below:

Sl.

No.

Name Occupation and Position Address

1.

2.

3.

13. Details of Enclosure*

1. ………………………………………………………………………………………………………

2. …………………………………………………………………………………………………………

3. …………………………………………………………………………………………………………

4. …………………………………………………………………………………………………………

5. …………………………………………………………………………………………………………

6. …………………………………………………………………………………………………………

7. …………………………………………………………………………………………………………

8. …………………………………………………………………………………………………………

14.

Please state clearly, if in the light

of your qualifications, experiences

etc. you have satisfied yourself that

you possess all the essential and

desirable qualifications laid down,

give explanatory note, if any

Essential Desirable

(i)

(ii)

(iii)

(iv)

(i)

(ii)

(iii)

(iv)

Candidates are advised that all enclosures viz, books, publications, manuscripts etc. are to be attached with

application forms and not to be sent separately, otherwise they are likely to be misplaced. If however, they are

sent subsequent to the submission of the application form, candidate must enclose forwarding letter giving his

full name and address and the name of the post applied for. It is also desirable to attach a slip to each publication

/ book etc. giving the name and address of the candidate and the post applied for.

15. If appointed, joining time required from the date of appointment?

16. Is he/she willing to accept the minimum initial pay in the scale? If not, the pay expected with

reason……………………………………………………………………………

17. Declaration to be signed by the candidate.

“I hereby declare that the entries in this form (Part A & B) are true to the best of my knowledge and

belief and also that I have not concealed any fact or withheld any information regarding my past service

and record and that if any entry is found to be false or incorrect or that if anything is found to have been

concealed, I shall be disqualified for selection or if appointed, shall be liable to termination without any

notice or compensation”

Date …………………. Signature …………………………………………….

Full Name ……………………………………………

FOR THE USE OF PERSONS IN EMPLOYMENT (Certified by the Head of Department or Office of Employer)

Certified that

Shri/Shrimati/Kumari……………………………………………………………………………………..

holds a post of ………………………………………………..in this Department/Office/Institution/Organization.

I have no objection to his/her application being considered for this post.

No. ……………………………….. Signature ……………………………………….

Date………………………………. Designation ……………………………………….

Office Stamp ………………………………………

PART – B (To be submitted in six copies)

(Details of academic & technical qualifications, experience - Teaching/Research/Extension etc.)

1. Name of the post applied for

2. Name of the candidate (in full)

(in Block Letters)

3. Give particulars of all examinations passed and degrees obtained from the University

or other places of higher education (commencing with matriculation or equivalent

examination in case of M.Phil/Ph.D/D.Litt./DSc. or equivalent degree, please mention

the subject and the title of thesis.

Sl

No. Examination Passed Subjects

Class/Div.

with Hons.

or distinction

Percentage

of Marks

Name of

Univ./Board

Year of

Passing Remarks

1. High School/HSC

2. Intermediate/Higher

Secondary

Examination

3. Under Graduate

4. Post Graduate

5. M. Phil.

6. NET / SET Qualified

7. Ph. D (Under UGC

Regulation 2009-10)

8. Others

4. If there has been a gap in your educational career, the reason for the same may be

given here

………………………………………………………………………………….

5. Mention the University / College / School at which you were last educated or are now

being educated, (a certificate from the Principal or Head regarding character should

be enclosed invariably)……………………………………………………………

6. Previous appointments / work experience.

Sl.

No. Post Held Employer

Period with date Last pay

drawn

with pay

scale

Nature of Duties

in brief From To

1.

2.

3.

4.

5.

6.

7. Present Occupation :

(a) Name of employer

(b) Designation or post held, if any

(c) Pay scale with present basic pay

(d) Other allowances and benefits

(e) Nature of duties

(f) Period since working on the post

8-A Have you done any research work or published any paper ? If, so please give particulars and if

possible send copies of the papers.

Sl.

No.

Title of publication Nature of publication (original

research paper, text book,

monograph, review, report,

bulletin note etc.

Name of the Journal /

Magazine published

1.

2.

3.

4.

5.

6.

8-B Total Publication

(i) No. of research papers ………………

(ii) No. of articles ………………

(iii) Others, if any ……………...

9. Give particulars of work done and experience not covered in any of the columns above.

(a) Research Guidance (indicate clearly how many research students have completed

research work and obtained Ph.D. degree under your guidance, give the particulars of the

thesis, likewise give particulars of the thesis presently working under your guidance).

(i) Ph.D. awarded

(ii) D. Phil awarded

(iii) D.Sc./D.Lit. awarded

(iv) Others, if any

(b) Books (Give separately particulars of the books written by you, for under-graduate and

post graduate levels)

(c) Sports Activities

(d) Extension Activities (Give particular of your activities, if any in the fields of

debative/dramatic/literary writing etc. and also of responsibilities shouldered by you as an

office bearer of some Societies/Proctorial Board/Students’ Welfare Board etc. of your

University /College /Institution.

(e) Any other item not covered above.

10. Have you been outside of India? If so, give the following particulars.

Countries Visited Duration of visit with dates Propose of

visit

Field of specification, if any

11. Honours and awards, membership of professional societies.

The information furnished above are correct and if at any time it is found that I have furnished false/incorrect

information, my service can be terminated without giving any notice.

Place ………………………. Signature of the applicant (in full)…………………………………….

Dated ------/------/------------- Name (in full) …………………………………………………………

(in BLOCK LETTERS)