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S
KOLHAN UNIVERSITY,CHAIBASA
Application Form for Contractual Appointment
PLEASE FILL UP THE APPLICATION IN CAPITAL LETTER IN
OWNHANDWRITING. (Except Signature)
(ALL APPLICATIONS MUST BE SUBMITTED IN A4 SIZE 80 GSM PAPER)
NAME OF POST APPLIED FOR:
1. NAME OF CANDIDATE:
FIRST NAME:
MIDDLE NAME :
SURNAME:
2. F ATHERS NAME:
3. MOTHERS NAME:
4. a) CATEGORY (TICK ) General SC ST OBC
5) GENDER: MALE FEMALE
6) DATE OF BIRTH (DD/MM/YYYY)
7) AGE (as on 01-07-2014) Years Months Days
8) PERMANENT ADDRESS:
PASTE (Do no t Pin orSt ap le here).Past e
recent pass por t
size
color photographof size 4.5 cmX 3.5 cm.The
Color pho t ograph shou ld not bemor e t han
3 mon t hs old.
Ple ase putyour signa t ur eacrosst he pho t ograph .
P.O
City
District.
Pincode:
State.
House Lane Street:
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9) ADDRESS FOR CORRESPONDENCE :
P.O
City.
District.
State.
Pin Code
10) MOBILE NUMBER:
11) E MAIL ID:
12) EDUCATIONAL QUALIFICATIONS.
ACADEMIC QUALIFICATION/NAME OF COURSE UNIVERSITY/BOARD
SUBJECTS
EAR OFPASSING
GRADE /PERCENTAGE
SSC/X/Matric
HigherSecondary / XII
Graduation.
Post Graduation
Any Others.
13) PROFESSIONAL EXPERIENCE:
Employment details (Post Qualification only)
SLNO
DESIGNATION ORGANIZATION. DURATION
NATURE OF DUTIES From
To
Total (in Months) Total Exp.
House Lane Street:
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14) TRAINING AND OTHER COURSES ATTENDED.
SLNO
NAME OF TRAINING / OTHERCOURSES ATTENDED
NAME OF INSTITUTE DURATION
From To Total
15) LANGUAGE KNOWN: (PLEASE TICK )
SL NO LANGUAGE RITING READING SPEAKING
Declaration:
I hereby declare that all the statements made by me in the
application form and information sheet are true andcomplete to the
best of my knowledge and belief and nothing has been concealed or
suppressed. I also understandthat in case, any of my statements is
found untrue during any stage of recruitment and thereafter, I
shall bedisqualified for the post applied for and I shall be liable
for any penal action. I also understand that the vacancy
againstwhich I am applying is contractual one and I undertake that
I will not claim for any appointment in the University on thebasis
of it. I undertake to abide by all the rules/regulations and
instructions issued by the University.
Date: Full Signature of the Candidate
Place:
(Name of the Candidate)
