NIELIT, Chandigarh

Application Form for the post of Senior / Junior Faculty for DEEEP Course at NCPUL Centre (PLEASE FILL IN CAPITAL LETTERS ONLY)
Post Applied (Senior/Junior) Faculty

______________
Mr/Ms

(Please mention the post applied)

Name of the Candidate:

PASTE YOUR RECENT PASSPORT SIZE PHOTOGRAPH HERE

Fathers / Husbands Name:

Please tick whether above name is that of Father /Husband

Father

Husband Sex (Please tick) Mobile No. Male /Female

Date of Birth(DD/MM/YYYY): Res. STD & Phone No. Nearest Fax No:(with STD) Email:--

Correspondence Address: ________________________________________________________ _______________________________________________________State: ___________________ Tehsil: __________________________District:______________________Pin:______________ Permanent Address: ______________________________________________________________ ________________________________________________________________________________

Educational Qualifications (From Xth onwards)

S.No. 1 2 3
4

Qualification

Qualification Name

University Name

Year of Percentage Passing / Grade

Registration Fees Rs 500/- Demand Draft Number: ___________ dated: ___________in favour of Director, NIELIT Chandigarh issued by Bank ______________________________________________ payable at Chandigarh. (Please write Your Name, Father / Husband Name, Address and Post Applied behind the Bank Draft)

Are you enrolled in any other Diploma /Degree at present? If Yes, give details as under:S.NO. Diploma / Degree University Name Expected Month & Year of Completion 1 2 If previously employed in any other organisation , please fill in below given columns Organisation District Designation Mobile No Joining Date State STD+Phone Fax No. Date of Relieving

Knowledge of Computer Software:

Knowledge of Urdu Language:

Order of preference for NCPUL Centres (As per the List displayed on the Website): Preference No. 1 2 3 Centre Code Name of the Centre State District Distance of your Residence from NCPUL Centre(in Km)

Date :

Signature of the Candidate