Translational Health Science and Technology Institute

(An autonomous institute of Department of Biotechnology, Govt. of India)

496, Udyog Vihar Phase III, Gurgaon-122016

PLEASE FILL IN THE PROVIDED SPACE. ATTACH EXTRA SHEETS FOR MORE INFORMATION

APPLICATION FOR PH.D. STUDENTSHIP BY JUNIOR RESEARCH FELLOW  

 
FULL NAME ------------------------------------------------------------------------------------
Affix passport size 
FATHER’S NAME ------------------------------------------------------------------------------------
photograph 
MOTHER’S NAME ------------------------------------------------------------------------------------

DATE OF BIRTH ------------------------------------------------------------------------------------

GENDER MALE / FEMALE

CATEGORY GEN / SC / ST / OBC / PH

ADDRESS FOR

CORRESPONDENCE ----------------------------------------------------------------------------------

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PHONE --------------------------------------------- EMAIL --------------------------------------

ACADEMIC QULAIFICATIONS

NAME OF THE BOARD / % MARKS

YEAR DEGREE AND SUBJECTS
EXAMINATION PASSED UNIVERSITY AND DIVISION

SECONDARY

SENIOR SECONDARY

GRADUATION

POST-GRADUATION

OTHERS
FELLOWSHIP DETAILS
(PLEASE ATTACH A COPY OF THE AWARD LETTER)

FELLOWSHIP EXAMINATION PASSED CSIR / DBT / ICMR

YEAR -------------------------

ALL INDIA RANK (IF KNOWN) -------------------------

EXPERIENCE / TRAINING

DESIGNATION PERIOD OF EMPLOYMENT / ORGANIZATION SALARY /

TRAINING FELLOWSHIP

PRESENT EMPLOYMENT

DESIGNATION EMPLOYED SINCE ORGANIZATION SALARY

DECLARATION

I declare that I fulfil the eligibility conditions as per the advertisement and that all the statements made in this application are true,
complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false
or incorrect at any stage or not satisfying the eligibility conditions according to the requirements mentioned in the advertisement,
my candidature/appointment is liable to be cancelled/terminated.

Date ---------------------------

Place ---------------------------- Signature of the candidate --------------------------------------

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