7/21/2019 Application Form for Technical Assistants Advt Nit Jsr Reg 2015 17

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NATIONAL INSTITUTE OF TECHNOLOGYJAMSHEDPUR-831014, JHARKHAND

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APPLICATION FORM FOR TECHNICAL ASSISTANTS JUNIOR ENGINEERS

(i) Post Applied for:

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(ii) Department:

(iii) Specialization (if any):

1. Name in Full2I /5 L(**()7

2. Fathers ! "us#ands Name

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Nationality:

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/. Address for

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Pin +ode:

,el.Nos.!Fa0 Nos

  mail

. Permanent Address

Pin +ode:

3. ducational 4ualifications

0amination Passed !De'ree -#tained

Specialization !Su#5ect

Name of the6ni7ersity ! 8nstitute

9ear of Passin'

of ar*s!+&PA

+lass!Di7ision

;. ,echnical ! Professional 4ualifications

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7/21/2019 Application Form for Technical Assistants Advt Nit Jsr Reg 2015 17

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Name of the +ertification !,rainin'

Specialization !Su#5ect

Name of the-r'anization

9ear of Passin'

Nature of ,rainin'

<. Present mployment =ith Salary Details

8nstitute!-r'anization Post held Start Date nd Date Duration Nature of =or* Pay Scale

1>. or* 0perience Details ,otal or* 0perience (in years):

8nstitute!-r'anization Post held Start Date nd Date Duration Nature of =or* Pay Scale

11. Num#er of A=ards! "onours!Prizes!edals! Achie7ements:

 A=arded (,itle) ? A=ardin' -r'anization

12. "a7e you e7er #een dischar'ed!suspended from any position@ 9S ! N- (if yes 'i7e reason)

1$. "a7e you e7er #een con7icted #y any court of la=@ 9S ! N- (if yes 'i7e reason)

1. ention notice period needed for 5oinin' if offered a post

1/. Name t=o referees =ith complete contact details includin' address ,el. Nos. Fa0 Nos. mail address

1. Any other rele7ant information (if any)

13. Bist of nclosures (Academic and Professional 4ualifications)

(i)

(ii)

(iii)

(i7)

(7)

2

7/21/2019 Application Form for Technical Assistants Advt Nit Jsr Reg 2015 17

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DECLARATION

8 here#y solemnly declare that the information furnished in this application are true and correct to the #est of my *no=led'e and #elief. 8f at any time 8 am found to ha7e concealed! suppressed any material! information or 'i7en any false details my appointment shall #e lia#le to #e summarily terminated =ithout notice of compensation.

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