COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY

APPLICATION FOR CONTRACT APPOINTMENT TO TEACHING POST

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Affix a recent photograph

and self attest the same

Post applied for with subject of specialization (if any):

Dept./School for which applied :

Notification No. and Date :

1

Name (In English Block Letters)

2 Address for Communications :

3 Permanent Address:

4 Phone No: Email ID:

5 Date of Birth (In Figures and in words- attach proof)

6 Sex

7 Religion

8

Caste/Community (Attach Proof)

9 Category (Put ‘X’ mark in the appropriate column.

SC

ST

OBC

GENERAL PHISICALLY

CHALLENGED Ex- Service

10 Basic Qualification for the post as per notification (Attach proof):

Marks/Grade/Class : (Attach copy of Marklist)

11 Additional Qualifications, if any, (Attach proof):

DECLARATION

I……………………………………………………….S/o/D/o/W/o……………………………….do herby declare that all particulars furnished above are correct and complete to the best of my knowledge and belief. I am in possession of the claims made in the application as on date of this application.

Place: Date : Signature of Applicant

N:B (1) Candidates who do not specify Religion/Caste in the appropriate space will not be entitled

to any communal reservation which they would, otherwise, be eligible. (2) Candidates should attach self attested copies of certificates as proof of qualifications

(Degree Certificate & Marklist) and experience. (3) Copies of Community Certificate and Non-Creamylayer Certificate for jobs under

Government of Kerala should be attached for claiming Communal reservation.

12 Experience: (Attach separate sheets, if required)

Name of the Institution

Post held

Period

13 List of Publications: (Attach separate sheets, if required)

14 List of enclosures:

15 Details of remittance of application fee

DD No.& date/ Receipt No. & date Amount (Rs.)