/ Indian Institute of Information Technology Vadodara
Block No. 9, Government Engineering College, Sector 28,
Gandhinagar, Gujarat, India - Contact No. 079-2397 7511

Application form for the Recruitment of Officer/ Non-Teaching Staff Positions

(Attach extra sheet where ever required;each page of the application should

be signed; Feel free to add extra information as Annexure)

Advertisement No. ______

Post applied for ______GP______

Demand Draft Details ______

1. Name in Full: ______2. Gender: ______

(In Block Letters) (Male/Female)

3. a) Father’s Name: ______Occupation: ______

b) Mother’s Name: ______Occupation: ______

c) Spouse Name ______Occupation: ______

4. Nationality: ______5. Date of Birth: ______6. Age: ______

7. Marital Status: ______(Married/ Unmarried/ Separated/ Divorcee)

8. Category: / SC / ST / OBC / PwD / UR

(Tick the applicable box)

In case of OBC, whether belong to creamy layer: YES/NO

Details of Disability (In Case of PWD candidate) ______

8. i) Present Address with Pin Code: ______

______

______

E-mail : ______Phone No./Mobile No. :______

ii) Permanent Address with Pin Code: ______

______

______

Phone No./Mobile No. (if any):______

9. Particulars of Educational Qualifications: (Please attach extra sheet, if required)

Ser.
No. / Degree Obtained &
Branch/ Specialization / Name of the
University/Institute / Year of
Passing / % of
Marks/
CGPA / Class/
Division / Specialization/ Subjects of Specialization
1 / MBA
2 / Master’s Degree
3 / Bachelor’s Degree
4 / 10+2
5 / 10 th
6 / Others (if any)

10. Details of Experience (Start from current employment):

i) Total Experience:______Years _____ Months

Ser.
No. / Name of the
organization where
employed / Designation / Date of
Joining / Date of
leaving / Last Pay Band
and Gr. Pay
1
2
3
4

Note: Attach a write up on experience with each job responsibility in terms of suitability for this application/ position).

11. Languages you can read, write & speak:

Name of
Languages / Read / Write / Speak / Examination passed if any

12. Are you a member of any professional body?If so give details:

(i)

(ii)

(iii)

13. Have you been a member of the N.C.C. or anyother similar organization?

14. Have you been outside India? If so, list details

Time of Visit
(MM-YY) / Country visited / Purpose of visit / Duration in Months / Remarks

15. Provide particulars of places where you resided for more than 1 year during the preceding 5 years

From / To / Residential Address in Full

16. Summary of Total Working Experience

Experience / Yrs - Months
Total experience in Govt. organization on regular basis
Total experience in Govt. organization on adhoc basis
Other Experience

17. Additional Remarks:

(Applicant may provide details of other special qualifications or experience including that of Computerknowledge, which has not been included under the heads given above).

19. Reference

(These should be persons resident in India and holders of responsible positions, and they should

be intimately acquitted with the applicant’s character and work, but must not be relations. If the

candidate has been in employment, he/she should either give his/her present or most recent

employer or immediate supervising officer as a reference)

Reference -1 / Reference -2
Name :
Occupation:
Address:
Email:
Phone with STD code/ Mobile:
Relationship:

UNDERTAKING

I, ______give the undertaking that I have read all the information and instructions given in Advertisement on the Institute website and the information given by me is correct. I also understand that my application shall be rejected if (i) the information is found not correct or (ii) all the required certificates and documents are not attached or (iii) application is incomplete.

Date:

Place:

Signature of Candidate