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Indian Institute of Technology Hyderabad
APPLICATION FORM FOR APPOINTMENT BY SELECTION
Advertisement No.IITH/2013/Rec/NF/4.
[Please read General Instructions to Candidates
before filling up the application.]
For office use only
Application No.
Name of the post applied for
Area, where applicable
01. Application feeDetails of Demand Draft (DD)
DD No.
Date of issue:
Amount in Rs.
Issuing Bank Name and IFS CodeNo.
02. Name in full (in capital letters)
03. Fathers/Husbands name
04. Date of birth (DD/MM/YYYY)
05. Nationality (circle one) Indian / Other National
06. Sex (circle one) Male / Female
07. Postal address for communication
Telephone:
Mobile no:
Email:
Affix a recentpassport size
photograph dulyattested by the
candidate
4CmX5 Cm
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Sports Officer MO Other Posts
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08. Permanent address
Telephone:
Mobile no:
Email:
09. Religion
10. Category (circle one) SC / ST / OBC / UR
SC/ST/OBC candidates should attach a certificate signed by
the competent authority in the format prescribed by the
Government. OBC certificate format has been prescribed by
Government of India.
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.
11. Do you belong to (circle one) Ex-servicemen / Physically
Handicapped
If YES, please attach a certificate signed by the competent
authority on the format prescribed by the Government of
India.
12. Have you ever been convicted by a
Court of Law or is there any criminal
case/disciplinary action pending
against you? (Circle One)
Yes / No
If YES please give details in separate sheets.
13. Educational/Professional and Technical Qualifications
(Attach attested copies of Certificates and Mark
Sheets):
ExaminationPassed
Name of theBoard/University
Duration ofDegree/Diploma/Training
Year ofPassing
% ofMarks
Division/Class
Specialization
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Sports Officer MO Other Posts
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Sports Officer MO Other Posts
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18. Are you a member ofany professional body?If yes, give
details:
19. Details of enclosures. If space provided is not sufficient,
attach separate sheet in the format given
below):
Sl. Description
DECLARATION
I hereby declare that I have carefully read and understood the
General Instructions to Candidatesand that all the entries in this
form are true to the best of my knowledge and belief. I also
declarethat I have not concealed any material information that may
debar my candidature for the postapplied for. In the event of
suppression or distortion of any fact in my application form, I
understand that I will be denied any employment in the Institute
and if already employed on any ofthe posts in the Institute; my
services will be terminated forthwith.
Place:
Date:
Signature of the Applicant
