![NATIONAL INSTITUTE OF TECHNOLOGY, RAIPUR
(Institute of National Importance)
G.E. Road, Raipur – 492010
Application for the Post of……………………………………………………………………
Regular [ ] Contract [ ] Deputation [ ] (Put √ marks)
1)Advertisement No: NITR/ R-1/Advt./……...Advt. Date: ……………2015
Note: Prospective candidates are advised to study the Instructions carefully and then fill up the application in all
respects. No column should be left blank. Incomplete application will be rejected. Attach additional sheets, if
required. However, information given must be precise to the point.
2) Fee Remittance
Bank / Place :________________________ DD No ______________Date:_______________ Amount:______________
3) Name of Applicant: : …………………………………………………………………
(in full capital)
4) Father’s Name : …………………………………………………………………
a) Spouse Name : …………………………………………………………………
5) Mother’s Name : …………………………………………………………………
6) Age : Year……………..Month…………….. Days……………
( As on last date of receipt of application)
7) Date of Birth :
Day Month Year
8) Nationality : …………………………………………………………………
9) Religion : …………………………………………………………………
10) Gender :
11) Marital Status : …………………………………………………………………
Signature of Applicant
Male Female
(Affix recent
passport size color
photograph duly
signed by applicant)](https://image.slidesharecdn.com/applicationformat-150925074342-lva1-app6891/85/Application-format-nit-1-320.jpg)
![12) Address
For Communication Permanent
State: Pin: State: Pin:
Phone (R) :………………………………... E-mail :………………………………...
Phone (O) :………………………………... Mobile :………………………………...
13)Category
(Put√ marks)
(*Attach a certificate from the competent authority prescribed by the Government of India)
14) Whether Physically Challenged (Put√ marks)
Ifyes VH [ ] OH [ ] Disability………………… (%)
(*Attach a certificate from the competent authority as prescribed under government rules)
15) Educational Qualification (10th Std onwards) (Attach attested copies)
Sr.
No
Examination/Degree Board/University Subjects
Month
and
Year of
Passing
Percentage/Division
Marks
Obtained/Total
Marks
Signature of Applicant
Page 2 of 5
SC* OBC*
ST* UR
Yes No](https://image.slidesharecdn.com/applicationformat-150925074342-lva1-app6891/85/Application-format-nit-2-320.jpg)
Application format nit
- 1. NATIONAL INSTITUTE OF TECHNOLOGY, RAIPUR (Institute of National Importance) G.E. Road, Raipur – 492010 Application for the Post of…………………………………………………………………… Regular [ ] Contract [ ] Deputation [ ] (Put √ marks) 1)Advertisement No: NITR/ R-1/Advt./……...Advt. Date: ……………2015 Note: Prospective candidates are advised to study the Instructions carefully and then fill up the application in all respects. No column should be left blank. Incomplete application will be rejected. Attach additional sheets, if required. However, information given must be precise to the point. 2) Fee Remittance Bank / Place :________________________ DD No ______________Date:_______________ Amount:______________ 3) Name of Applicant: : ………………………………………………………………… (in full capital) 4) Father’s Name : ………………………………………………………………… a) Spouse Name : ………………………………………………………………… 5) Mother’s Name : ………………………………………………………………… 6) Age : Year……………..Month…………….. Days…………… ( As on last date of receipt of application) 7) Date of Birth : Day Month Year 8) Nationality : ………………………………………………………………… 9) Religion : ………………………………………………………………… 10) Gender : 11) Marital Status : ………………………………………………………………… Signature of Applicant Male Female (Affix recent passport size color photograph duly signed by applicant)
- 2. 12) Address For Communication Permanent State: Pin: State: Pin: Phone (R) :………………………………... E-mail :………………………………... Phone (O) :………………………………... Mobile :………………………………... 13)Category (Put√ marks) (*Attach a certificate from the competent authority prescribed by the Government of India) 14) Whether Physically Challenged (Put√ marks) Ifyes VH [ ] OH [ ] Disability………………… (%) (*Attach a certificate from the competent authority as prescribed under government rules) 15) Educational Qualification (10th Std onwards) (Attach attested copies) Sr. No Examination/Degree Board/University Subjects Month and Year of Passing Percentage/Division Marks Obtained/Total Marks Signature of Applicant Page 2 of 5 SC* OBC* ST* UR Yes No
- 3. 16. Experience (Attach attested copies) Sr. No. Organization Designation Duration Pay Scale & Grade Pay Total Emolume nts Permanent/ Temporary/ Contract Length of Service in Years & Months From To 17) Present employment Name of the Organization : …………………………………………………… Post Held : …………………………………………………… Date of Appointment : …………………………………………………… Whether Permanent / Contract : …………………………………………………… Temporary/ or on Probation : …………………………………………………… Pay Band and Grade Pay/ Consolidated Pay : …………………………………………………… Length of Service : …………………………………………………… Whether State / Central : …………………………………………………… Government / PSU /Private : …………………………………………………… 18) Other Information: Refresher/Orientation Courses/Training, FDP/.Conferences/Workshop, etc., attended (Please attach sheets if required) Signature of Applicant Page 3 of 5 Sr. No. Title of programme & Name of Sponsor Institution in which attended Year Duration of Programme
- 4. 19.) Knowledge of languages 20. Character & Antecedents Report Subject Remarks Have you ever been subject to any disciplinary action? If so give full details Have you ever been dismissed/suspended from service/employment, if so please give full details Were you involved in any criminal case? If yes, give full details Is any criminal case pending against you in the court? If yes, give full details 21. Names and Addresses of minimum two Referees (including e-mail/phone) (All of them should be familiar with your Academic/Professional work) Name and Address Name and Address Phone No. Phone No. E-mail: E-mail: 22. List of enclosures: 01)………………………………………………………………. 02)………………………………………………………………. 03)………………………………………………………………. 04)………………………………………………………………. 05)………………………………………………………………. Signature of Applicant Page 4 of 5 Language Speak Read Write Ability to Speak fluency
- 5. 06)………………………………………………………………. 07)………………………………………………………………. 08)………………………………………………………………. 09)………………………………………………………………. 10)………………………………………………………………. 11)………………………………………………………………. 12)………………………………………………………………. 13)………………………………………………………………. 14)………………………………………………………………. 15)………………………………………………………………. DECLARATION I hereby declare that I have carefully read and understood the instructions and particulars supplied to me, and that all entries in this form, as well as, in attached sheets are true to the best of my knowledge and belief. At any stage if any of the information furnished by me is found to be false or incorrect, suitable action may be taken against me. If selected, I promise to abide by the rules and regulations of the NIT Raipur. Date: Signature: Endorsement of the present employer Signature of the Employer (if already employed). Name: Office seal with date: Designation: Signature of Applicant Page 5 of 5