Application Form for Teaching and Administrative Posts

KUMAUN UNIVERSITY, NAINITAL (UTTARAKHAND)

(Note: Please go through instructions given in the website-www.kunainital.ac.in
carefully before filling-up the Application Form & Self Assessment API Score)

Passport size recent

Photograph
duly signed by the
applicant

Form No.
Advt. No. Dated
Post Applied For

Name of the Department

1.
2.

Candidates Name (in full)

(In Capital Letters)
Fathers/Husbands Name

3.

Mothers Name

4.

Permanent Address

5.

Present Postal Address

6.

Date of Birth (in Christian era)

7.

Place and State of Birth

8.

Marital Status

9.

Nationality

...

10.

Category, mark tick ()

General

SC

ST

OBC

(For OBC candidates- Non Creamy Layer Certificate of not more than 6 months must be
enclosed with application form)
If so, a certificate to that effect from the District Magistrate / Additional District Magistrate be
enclosed, if desired certificate is not enclosed the application will be considered under the general
category.
11.
Sl.
No.
1.

2.

3.

Particulars of references.
Name

Occupation and Position

Address

12.

If any of your relatives (by blood or marriage) are in employment of the University or/and Campuses,
please give details below:

Sl.

Name

Occupation and Position

Address

No.
1.
2.
3.

13.

Details of Enclosure*
1.
2.
3.
4.
5.
6.
7.
8.

14.
Essential

Desirable

Please state clearly, if in the light

of your qualifications, experiences
etc. you have satisfied yourself that

(i)

(i)

(ii)

(ii)

(iii)

(iii)

(iv)

(iv)

you possess all the essential and

desirable qualifications laid down,
give explanatory note, if any

Candidates are advised that all enclosures viz, books, publications, manuscripts etc. are to be attached with
application forms and not to be sent separately, otherwise they are likely to be misplaced. If however, they are
sent subsequent to the submission of the application form, candidate must enclose forwarding letter giving his
full name and address and the name of the post applied for. It is also desirable to attach a slip to each publication
/ book etc. giving the name and address of the candidate and the post applied for.
15.

If appointed, joining time required from the date of appointment?

16.

Is he/she willing to accept the minimum initial pay in the scale? If not, the pay expected with
reason

17.

Declaration to be signed by the candidate.

I hereby declare that the entries in this form (Part A & B) are true to the best of my knowledge and

belief and also that I have not concealed any fact or withheld any information regarding my past service
and record and that if any entry is found to be false or incorrect or that if anything is found to have been
concealed, I shall be disqualified for selection or if appointed, shall be liable to termination without any
notice or compensation

Date .

Signature .
Full Name

FOR THE USE OF PERSONS IN EMPLOYMENT

(Certified by the Head of Department or Office of Employer)

Certified

that

Shri/Shrimati/Kumari..
holds a post of ..in this Department/Office/Institution/Organization.
I have no objection to his/her application being considered for this post.

No. ..

Signature

Date.

Designation

Office Stamp

PART B
(To be submitted in six copies)
(Details of academic & technical qualifications, experience - Teaching/Research/Extension etc.)

1. Name of the post applied for

2. Name of the candidate (in full)
(in Block Letters)
3. Give particulars of all examinations passed and degrees obtained from the University
or other places of higher education (commencing with matriculation or equivalent
examination in case of M.Phil/Ph.D/D.Litt./DSc. or equivalent degree, please mention
the subject and the title of thesis.
Sl
No.

1.
2.
3.

Examination Passed

Subjects

Class/Div.
with Hons.
or distinction

Percentage
of Marks

Name of
Univ./Board

Year of
Passing

Remarks

High School/HSC
Intermediate/Higher
Secondary
Examination
Under Graduate

4.

Post Graduate

5.

M. Phil.

6.

NET / SET Qualified

7.

Ph. D (Under UGC

Regulation 2009-10)
Others

8.

4. If there has been a gap in your educational career, the reason for the same may be
given

here

.
5.

Mention the University / College / School at which you were last educated or are now
being educated, (a certificate from the Principal or Head regarding character should
be enclosed invariably)

6. Previous appointments / work experience.

Period with date
Sl.
No.

Post Held

Employer

From

To

Last pay
drawn

Nature of Duties

with pay

in brief

scale
1.
2.
3.
4.
5.
6.

7.

Present Occupation :
(a) Name of employer
(b) Designation or post held, if any
(c) Pay scale with present basic pay
(d) Other allowances and benefits
(e) Nature of duties
(f) Period since working on the post

8-A

Have you done any research work or published any paper ? If, so please give particulars and if

possible send copies of the papers.

Sl.

Title of publication

No.

Nature of publication (original

Name of the Journal /

research paper, text book,

Magazine published

monograph, review, report,

bulletin note etc.
1.

2.

3.

4.

5.

6.

8-B Total Publication

(i)

No. of research papers

(ii)

No. of articles

(iii)

Others, if any

...

9.

Give particulars of work done and experience not covered in any of the columns above.
(a) Research Guidance (indicate clearly how many research students have completed
research work and obtained Ph.D. degree under your guidance, give the particulars of the
thesis, likewise give particulars of the thesis presently working under your guidance).
(i)

Ph.D. awarded

(ii)

D. Phil awarded

(iii)

D.Sc./D.Lit. awarded

(iv)

Others, if any

(b) Books (Give separately particulars of the books written by you, for under-graduate and
post graduate levels)

(c) Sports Activities

(d) Extension Activities (Give particular of your activities, if any in the fields of
debative/dramatic/literary writing etc. and also of responsibilities shouldered by you as an
office bearer of some Societies/Proctorial Board/Students Welfare Board etc. of your
University /College /Institution.

(e) Any other item not covered above.

10.

Have you been outside of India? If so, give the following particulars.

Countries Visited

Duration of visit with dates

Propose of

Field of specification, if any

visit

11.

Honours and awards, membership of professional societies.

The information furnished above are correct and if at any time it is found that I have furnished false/incorrect
information, my service can be terminated without giving any notice.

Place .

Signature of the applicant (in full).

Dated ------/------/-------------

Name (in full)

(in BLOCK LETTERS)