INFORMATION AND LIBRARY NETWORK CENTRE

(AN INTER-UNIVERSITY CENTRE OF UNIVERSITY GRANTS COMMISSION)

NEAR GUJARAT UNIVERSITY GUEST HOUSE, UNIVERSITY CAMPUS,

P.O. BOX. NO.4116, NAVRANGPURA

AHMEDABAD 380 009.

Web site:

Advt. No. 04/2012

POST APPLIED FOR : ______

(If applying for more than one post separate applications with

Enclousers to be submitted)

1. Full Name:

2. Father/Husband’s name:

3. Date of Birth:

4. Age as on date of publication of advt.:

5. Marital Status:

6. Whether belong to SC/ST/OBC (specify whether belong to creamy layer or not)/:

Any other(specify), (Attach attested copy of the Certificate)

7. Details of family members including dependents, if any,

with relationship, age and wholly dependent or not (enclose detail):

8. Home Town:

9. Permanent Residence address with Telephone Nos.:

10. Present Residence address with Telephone Nos.:

11. Educational qualifications (commencing from HSC):

(Attested copies of certificates to be enclosed)

Sr. No. / Examination .Passed / Name of the Board/University/ Institute / Year of passing / Percentage of marks obtained / Class/
Grade / Subject specialization

12. Employment details commencing from the latest:

(Attested copies of certificates to be enclosed)

Sr.
No. / Name of the Institution / Period / Designation / Scale of pay / Nature of Duties
  1. Training received with details of the Institutions where such training was undertaken, period and area of training.

14. Brief history of achievements:

15. Present post with basic pay, Pay Band and Grade Pay :

Please enclose a copy of latest Pay slip

16. Remarks, if any, or any other point applicant would like to apprise.:

DECLARATION

  1. I hereby certify that there is no criminal/judicial/disciplinary case pending against me as on date.
  2. I hereby declare that all the particulars submitted in the application are correct and true to the best of my knowledge and belief. In the event of any information being found false/incorrect at any later stage my candidature for the post will stand automatically cancelled.
  3. I am willing to serve anywhere in india.
  4. I accept the terms and conditions of appointment.
  5. I shall undergo all tests at my own risk and responsibility.

Date : ______Signature : ______

Name : ______

Designation : ______

Name of the serving organization : ______

Full address, intercom, phone, fax No. & e-mail address :

______

TO BE CERTIFIED BY THE CADRE CONTROLLING AUTHORITY /EMPLOYER

Certified that the particulars furnished by the officer are correct as per the records held in this office and no disciplinary / vigilance case is pending / contemplated against the officer and that no major / minor penalty has been awarded to him/her and there is no doubt about the integrity of the officer.

Place : ______(Name, Signature & Seal of the Cadre Controlling Authority / Employer)

Date : ______