Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar

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APPLICATION FORM ‘B’

For the posts from Sr. No. 4 to11 advertised vide advt. No. 2/2015

Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar

(Established by Legislature Act No. 7 of 2010)

FOR GRADE ‘A’ ‘B’ & ‘C’ NON-TEACHING POSTS

Note: (i) Fill up all columns of all sheets

1. Post applied for ______

(Mention full name of the post)

2. Name in full ______

(In block letters)

3. Present postal address (in block letters) ______

______

4. Telephone No. /Mobile No. ______

5. (a) E-Mail I.D., if any ______

(b) Details of application fee in the DD No.______Date ______

shape of bank demand draft Amount (in Rs.)______

Name of issuing bank ______

6. Permanent Home Address ______

______

7. (a) Father’s (i) Name ______

(ii) Profession ______

(b) Mother’s Name ______

8. Nationality of the candidate ______

9. (a) Date of birth ______

(b) Place of Birth ______

(d) Marital Status ______

(e) Do you belong to SC, BCA, BCB, ______

PWD, EBPGC, Sports, married women or

divorcee, legally separated/unmarried or

Ex-Servicemen category?

(f) Aadhaar Number (if any) ______

10. (a) Name, Designation and address of ______

present employer, if any

______

(b) Have you obtained the permission of your ______

present employer for submitting this

application/attending an interview, if any,

and for accepting this appointment, if selected?

channel, are you prepared to resign from

your present post, if selected.

(d) If selected, please state when you can join ______

(e) Present pay

(i) Scale of pay ______

(ii) Basic pay + Grade Pay ______

(iii) Allowances excluding house rent ______

and city compensatory allowance.

(give name and amount of each allowance) ______

(iv) Date of next increment ______

(f) Minimum pay acceptable ______

11. Names and addresses of two referees not (i) ______

related to you, to whom you are known ______

personally (if you are employed, your present (ii) ______

employer must be one of the referees) ______

12. Whether any of your relative is employed in ______

this University, if so, give name, designation

and department.

13. (a) What is your mother tongue? ______

(b) Name the languages (both Indian and Foreign) which you can read, write or speak. Give particulars and state the examinations, if any, passed in each:

Read only / Speak only / Read and speak / Read, write and speak / Examination(s) passed

14. Have you ever been prosecuted/kept under detention or bound down/fined, convicted by a Court of Law of any offence or debarred/disqualified by any University, Public Service Commission from appearing at its examinations/selection? Is any case pending against you in any court of law at the time of filling up of this application form?

If the answer is ‘Yes’ full particulars of the case, detention, fine, conviction, sentence etc. should be given.

15. Employment Record:

Designation of post held and description of work / Period / Pay scale / Pay drawn (Basic pay+GP allowances except HRA/CCA) / Full address of the office/firm or institution / Reason for leaving the post
From / To
(Give month & year both)

16. Details of academic qualifications:

Examination
Name of school or college
Name of Board or University
Year of passing
University Regn. No.
Maximum marks
Marks obtained
Percentage marks
Division obtained
Subjects studied
Medium of instruction
Position, distinction, prizes, scholarships etc.

17. Applicants for ministerial post may mention ______

here whether they know typing to basic

computer knowledge (M.S. Office, Internet

etc.) and also give details of departmental

examinations passed, if any.

18. Any other details not mentioned above, which you think, will strengthen your claim for this appointment, (Attach separate sheet, if necessary):

I certify that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been kept concealed.

I have read all the instructions/ conditions for the candidates carefully and the same are acceptable to me.

Place: ______
Date: ______/ (Thumb impression of the candidate) (Left hand for male and right hand for female) / ______
(Signature of the candidate)

CHECK LIST

(To be attached by in-service candidates with application through proper channel)

(The information in this Check List is to be furnished by the Employer in respect of the in-service candidate for the last 10 years and in case the service period is less than 10 years then from the date of joining.)

Year / Overall performance / Report about integrity / Report about work and conduct / Punishment awarded, if any / Whether any disciplinary/legal/ Vigilance proceedings are pending against the official.

2. Does he fulfil the prescribed qualifications/experience requirement for the post?

Prescribed qualifications: Yes/No

Prescribed experience: Yes/No

It is also certified that the information furnished by the official in his application form is correct as per his service record.

Head of the Institution

(SEAL)

______

(Name in block letters)

Place: ______

Date: ______