भारतीयप्रौद्योगिकी संस्थान रोपड़
INDIANINSTITUTE OFTECHNOLOGYROPAR
नंगलमार्ग, रूपनगर,पंजाब-140001/ Nangal Road, Rupnagar, Punjab-140001
दूरभाष/Tele: +91-1881-242216,फैक्स/Fax : +91-1881-223395
APPLICATIONFORM
(Tobefilled incandidate’sown handwritingor printedonA-4size paper)
12 / Educational/Professional/Technical Qualifications starting with highest: Attach attested copies of certificates/ markssheets,etc. (Encloseseparatesheet, dulyauthenticated byyoursignatures,ifspaceis insufficient)Examination
Passed / Board/University/
Institute / Duration
of Degree/ Diploma/ Training / Yearof
Passing / Division
with% of marks / SubjectStudied/
Specialization
13 / Detailsof employment startingwith themostrecent(Encloseseparatesheet,dulyauthenticatedby
your signatures,ifspaceisinsufficient):
Org./Deptt./
Institute / Designation/ Post held / Temporary/
Permanent/ Contract / Period / Pay
Band/ Pay Scale/ Grade Pay / Gross
monthly emoluments / Dutiesperformed
From / To / No.
of years
14 / Timerequiredtojointhe postintheeventof selection
15 / Whetheranyofyourcloserelative(s)is/are employedin
IITRopar?Ifyes,givedetails
16 / Anyother relevantinformation:
17 / DetailsofEnclosures
1 / 5
2 / 6
3 / 7
4 / 8
18 / Name,Address,TelephoneNo.andE-mailaddressofatleastthreerefereeswhoarenotyour
relatives
Sr.
No. / Name &Designation / Address / TelephoneNo. / E-mailaddress
1
2
3
19 / Pleaseattach a briefwrite upin not morethan200words justifying your candidaturefor thepostapplied for.
I herebydeclarethatIhavecarefullyreadandfullyunderstoodalltheinstructionsanddetailspertainingto thepost beingappliedfor by meandallstatements madeandinformation furnishedin thisapplicationistrueand completeto the bestofmyknowledgeandbelief. IalsodeclarethatIhavenotconcealedanymaterialinformation whichmaydebarmycandidatureforthepostappliedfor. Intheeventofsuppressionordistortionofanyfactlike categoryoreducationalqualification,etc.,madeinmyapplication form,IunderstandthatIwillbedeniedany employmentintheInstituteandifalreadyemployedonanyofthepostsinthe Institute,myserviceswillbeterminatedforthwith.
Place:
Date:
Signatureof theApplicant
FORWARDING(forthose whoare inGovt.service)
Certifiedthattheparticularsmentionedbythecandidatearecorrect.Itisfurthercertifiedthatthereisno vigilance case/disciplinary case contemplated/pending against the incumbent and that the candidate will be
relieved onselection.
No.: Date:
Signature
Designation andSealof ControllingOfficer