7/29/2019 Application Form Non Academic

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School of Planning and Architecture (SPA), BhopalNeelbad Road, Bhauri, Bhopal-462030 (M.P) INDIA

APPLICATION FORM FOR NON ACADEMIC POSITION

Advt. No.Rect./01/2013 dated 23.01.2013

DD No. Name of Bank Date of Draft

Serial No. Post Applied For

1. Name in Full :______________________________________________________(in capital letters)

2. Father's Name :______________________________________________________

3. Name of Spouse :_______________________Occupation______________________

4. Date & Place of Birth :______________________________________________________

5. Nationality :______________________________________________________

6. Sex (Male/Female) ;______________________________________________________

7. Postal Address:Present Permanent

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PIN _________________ Mobile__________________

Phone _______________ Fax ____________________

E-mail _______________________________________

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PIN _________________ Mobile__________________

Phone _______________ Fax ____________________

E-mail _______________________________________

8. Nearest Railway Station : _______________________________________________________________________

9. Name of the State to which you belong (Domicile):_______________________________________________________________

10. Name of the religion to which you belong: _____________________________________________________________________

11. Do you belong to category of SC/ST/OBC ? :___________________________________________________________________(If yes, enclose certificate issued by the competent authority on the format prescribed by the Government of India)

12. Do you belong to the sub-category of Ex-servicemen /Physically Handicapped ?_______________________________________(If yes, please mention the category and attach a certificate signed by the competent authority on the format prescribed by theGovernment of India)

13 Whether claiming reservation under SC/ST/ OBC/Ex-servicemen/Physically Handicapped category?_______________________(Please note that the benefit of reservation can only be claimed by the candidate when the post(s) has been reserved as such

and the candidate has furnished the requisite certificate)

14. Have you ever been convicted by a court of Law or is there any criminal case/disciplinary action/vigilance enquiry pending/contemplated against you? If yes, specify: _______________________________________________________

15. Educational/Professional/Technical Qualifications: (Attach attested copies of certificates/mark sheets etc.)

Examinationpassed

Board/University.

Duration ofDegree/Dip./Training

Year ofpassing

Divisionwith % of

Marks

Subject(s)studied

Specialization

(Please attach a brief synopsis of project done in PG/Research Work.)Cont'd.....2/-

Affix a recentpassport size

photograph dulyattested by the

candidate

Appl No.

7/29/2019 Application Form Non Academic

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16. Details of employment in reverse chronological order (attach separate sheet, if necessary).

Deptt./ Institute Post held

Regular/Temporary/Permanent/

Contract

Period ofemployment

Period ofeach

employmentin year/month

Scale of Payand Basicpay/Gross

pay

Nature of Duty

From To

17. If appointed, how much time would you require for joining the post?________________________________________________

18. Are you willing to accept the minimum of pay scale as initial basic pay? If not, specify the reason________________________

19. Referees:(These should be persons resident in India and holders of responsible position, and should be intimately acquainted withapplicants character and work, but must not be relatives. Where the candidate has been in employment S/he should eithergive his present or the most recent employer or immediate superior as a referee or produce a testimonial from him in regard to

his/her fitness for the post for which S/he is an applicant.)(a) Name

Occupation or PositionAddress alongwith Phone No & E-mail

(b) NameOccupation or PositionAddress alongwith Phone No & E-mail

20. Additional Remarks, such as special qualification or experience etc which has not been covered above (if required, attach aseparate sheet).

_____________________________________________________________________________________________________21. Details of enclosures: (attach separate sheet)

22. would you like to treat your personal information in this application with enclosures asconfidential for RTI Act 2005 provisions(Write Yes or NO)______________________________________________________________________________________________________________

DECLARATION

I hereby declare that I have carefully read and understood the instructions and particulars supplied to me and that all the entries inthis form are true to the best of my knowledge and belief. I also declare that I have not concealed any material information whichmay debar my candidature for the post applied for. In the event of suppression or distortion of any fact like category or educational

qualification etc. made in my application form, I understand that I will be denied any employment in the Institute and if alreadyemployed on any of the posts in the Institute; my services will be terminated forthwith.

Place..

Date.. Signature of the Candidate