BITS, PILANI - K.K.

BIRLA GOA CAMPUS

Application Form (For Non-teaching Staff)

To,
Paste your
The Director
photograph
BITS, Pilani – K.K. Birla Goa Campus here
Zuarinagar-403726
Goa.

Advertisement Date: __________________________________

A: POST APPLIED FOR: Hostel Warden

What is your expected salary per month?

* Rs.35000

What is your current salary per month?

* Rs.28000

B: PERSONAL PARTICULARS
Surname Middle Name First Name
Full Name (Prefix Dr. / Mr. / Mrs. / Ms.) Gudavalli Nancharaiah

Maiden Name (if applicable)

Date of Birth (dd / mm / yyyy) 10/06/1984

Marital Status Married / Unmarried Un married

Contact Address
Ews-296 c/oAnitha , Near Rama reddy
chicken center Opp Tirumala parlour Road
no 3 kphb Hyderabad Pin 500072

Hyderabad Telangana 500072

City State Pin Code
9493239034
Primary Contact No.
9110391819
Alternate Contact No.
Nanch007@outlook.com
E-mail

C: LANGUAGE SKILLS (Tick as appropriate)

Name of the Language English Hindi Konkani Marathi Any other

Speaking Little bit
Speaking Speaking

Writing Writing
Writing writing

Reading Reading
Reading Reading

D: CO-CURRICULAR
ACTIVITIES

E: EDUCATIONAL QUALIFICATIONS (in chronological order)

(Please attach photocopies of certificates)

Sr. Qualification* Year of University / Institute % of Marks*

No. Passing* / Board *

* Indicates mandatory field

F: TECHNICAL / PROFESSIONAL QUALIFICATIONS

(Please provide details starting with the highest qualification. Attach photocopies of certificates)

Sr. Qualification* Year of University / Institute % of Marks*

No. Passing* / Board *
MCA 2011 Aditya Engineering college Kakinada 86

BCA 2004 A N R COLLEGE GUDIVADA 59

C.E.C 2001 B.N. G.J COLLEGE 57

SSC 1999 S S B SCHOOL 59

* Indicates mandatory field

G: COMPUTER SKILLS

Applications known
Ms office ,c,c++
Programming languages
known

Computer Courses Course University / Institute Year

Completed
H: PROFESSIONAL EXPERIENCE (in chronological order)

Sr. From To Organization, Designation Brief description of duties (in not more Reasons for
No. (mm / (mm / Location held than 3-4 lines) * leaving the
yyyy) yyyy) job
6/15 06/20 Raigarh Hostel  Before students Arrival Better
1 18 till warden Opportunity
date  At The Time of Students
Arrival
 Communication with
05/10 05/15 Rajasthan Hostel
2 warden Children
 Pastoral Care
 Suitable and safe
3 06/09 04/10 Hyderabad Hostel
Warden accommodation
Hyderabad  Support
 Record Maintenance and
4 04/08 05/09 Hyderabad Admin Analysis
&Hostel  Coordinates With the
maintainenc
e school
 Health
5 06/07 05/08 Hyderabad Hostel  Food and Nutrition
Warden
 Dorm Cleaning and
Inspection
 Laundry services
 Become familiar
 Educating Students
 Conflicts Fights and
Harassment
 knowledge of child and
strong rapport
 Promotes the use of
courteous language at all
times
 Encourages the
development of a positive
self-concept in all students
 Promotes student self-
discipline
 Saving on water and
electricity
* Additional sheets may be attached only for brief description of duties

I: NOTICE PERIOD REQUIRED FOR JOINING, IF SELECTED: _____________________________

J: PROFESSIONAL REFEREES
(Referees must not be related to you by blood or marriage. Referees should be contacts out of your
professional experience with them )
Vikas
Name of 1st Referee
3
No. of years known & how
Vice principal
Occupation

Address
Delhi Public school Raigarh

9392018699
Contact no. with STD code
vikadstemcore@gmail.com
E-mail

Mahesh
Name of 2nd Referee
 5
No. of years known & how
Administration officer
Occupation

Address
Delhi public school Rajasthan

9247365793
Contact no. with STD code
Mahesh2589@gmail.com
E-mail

H: DECLARATION

I hereby declare that the information furnished by me is correct and complete. I hereby agree that any false
statement I make in this application shall result in cancellation of my candidature. I have attached Xerox copies
of certificates as proof of my qualification and work experience.

Place: HYDERABAD Signature: ______________________

Date: _____________________ Name: _NANCHARAIAH

(Please forward e-copy of the application to hroffice@goa.bits-pilani.ac.in. Application in any format

other than the above will not be accepted)