NARAYANA ENGINEERING COLLEGE::GUDUR

FORM OF THE APPLICATION FOR STAFF RECRUITMENT BY SELECTION

(Last date for the submission of Application 30/01/2016
1. Post applied for :

Dept:

2. Name of the Candidate in Full:

(I)Address for Correspondence

(II) Official Address

Phone(R):

Phone (O)

3. Date of Birth/Age/Sex:

|M/F| 4. Community: OC/SC/ST/BC

5. Place of Birth:

6.State:

7. Language Known:
S.NO

LANGUAGES

A
B
C
D
E

ENGLISH
TELUGU
HINDI
TAMIL/KANNADA

SPEAK ONLY

READ & SPEAK

READ,WRITE &
SPEAK

EXAMS
PASSED/STANDARD
OF PROFICIENCY

8.Details of Examinations Passed and Degree/Diploma obtained:

S.NO Examination
College
Univ
Degree/Diploma
ersity
Boar
d

Cours
Class
e
Specci
Durat
ion(y alizati
ears) on

% of
Degree / Distinctions No.of
Marks Diploma If any
Supply
obtained
Exams
(Year)
Attempted

Ph.D.,
M.Phill
P.G.( )
U.G.( )
Dipl./PUC/Inter
SSC/SSLC
Note: Attested Copies of all certificates should be attached
9.Membership of Professional Bodies
10.Whether passed GATE , JRF,NET ,SLET
Etc if so give particulars

:
:

11. Present employment status : Working / Not working , If not , Fresh from college?YES/NO (Cont..2)

::2::

12.Present position(Designation)

Scale of Pay

Basic:Rs.

Total Emoluments(p.m)Rs:

13.Details of Employement /Experience :

Name and
Address of
Institution ,
Firm or
office

Post held

Scale of pay

From

To

Basic pay
last drawn

Reasons for
leaving the
post

14. Can you submit No-objection certificate from your present employer , if selected :Yes/No/Not
applicable/internal. if NoGive reasons .
15.Details of experience of employement /research /continuity education programmes.
(a).Teaching Experience in college/University
P.G:_____Yrs
UG:___Yrs
(b).Research publications :Journals:
International:________National:_______
Confrence:
International:________National:_______
(c).Refresher courses attented
:__________
(d).Industrial Experience
:__________Yrs
(e).Administrative Experience
:__________Yrs
Add separate sheet with detailed information,under annexures A,B,C,D and E.
16.Joining time required .If selected
:
Months:____Days:_____Expected Doj:___________
17.Expected salary

Total Emoluments(pm)Rs:

18.Extra curricular activities

: (use additional sheets if required under annexure F)

19.Any other relevant information

: (use additional sheets if required under annexure G)

20.Referees : ( the referees should be residing In india holding responsible position and not related to them)
S.NO
NAME
OCCUPATION/POSITION
ADDRESS/MOBILE NO.
A
B
21.Details of Enclosures: (Indicate the encl. with )Total No.of Certificates enclosed:______________
a) Date of birth certificate
b)SSC/SSLC Marks
c)PUC/Intermediate Marks
d)Diploma Marks
e)Diploma certificate
p)Annexures(A/B/C/D/E/F/G)

f)Degree marks
k)Ph.D . Certificate(OD)
g)Degree certificate(OD)
l) GATE/JRF/NET/SLELT
h)P.G.Marks
M)Service Cerficate
i)P.G.Certificate (OD)
n)Salary Certificate
j)M.Phill.certificate(OD)
o)No-objection certificate
q)other certificates if any_________

Station: Nellore

Signature of the Candidate

DECLARATION TO BE SIGNED BY THE CANDIDATE
I hereby declare that the statements made in this application are true to the best of my knowledge.

Date:

Signature of the Candidate