INDIAN INSTITUTE OF MANAGEMENT LUCKNOW

NOIDA CAMPUS,

Institutional Areas, B-1, Sector-62, Noida 201307 (UP) India

APPLICATION FORM FOR THE POST OF
PROGRAMME ASSISTANT (ON CONTRACT)

Please Note:1. For submission of Application Form, please follow instructions/guidelines provided online at home page at
http://www.iiml.ac.in
2. Submit your Application as per prescribed format on or before 10th October 2016 to the e-mail id
admin_nc@iiml.ac.in Complete and accurate information are therefore, extremely important. Incomplete or false
information will make your candidature null and void.
3. The post of Programme Assistant is on purely Contractual basis for a period of upto three (3) years.
4. You are required to show all relevant testimonials in original at the time of Personal Interview.

Paste Recent
Photograph
(Passport Size)

PERSONAL DATA
1. Name

____________________________________________________________________________

2. Fathers Name

____________________________________________________________________________

3. Gender
4. Date of Birth
DD

MM

YYYY

5. Age as on 10th October 2016: Years _____ Months _____

6. Address for correspondence

PIN
7. E-mail id:
8. Mobile No.____________________
9. Nationality -------------------

Contact Telephone No. with STD Code _____________________

10. Category _____________
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ACADEMIC AND PROFESSIONAL QUALIFICATIONs

11. (a) Educational Qualifications
S.
Exam
Year of
Board/ Institute/
No.
Passed
passing
University
th
1. 10 Class
2.

12th Class

3.

Graduation

4.

Post
Graduation
(If any)

Subjects

11. (b) Knowledge of Computer Applications

S.
Name of Course
Year of passing
No
1.

Marks Obtained/
Maximum Marks

Board/ Institute/
University

Percentage

Grade

WORK EXPERIENCE
12. Total Work Experience as on 10th October 2016 _

Years

Months. Mention Latest work experiences

first.
From

To

Name & Address of the

Office/Organization

Designation

Salary drawn
monthly (in Rs)

Brief Job Profile

DECLARATION
I have carefully read the instructions and agree to abide by the decision of the Indian Institute of
Management Lucknow authorities regarding my selection for the post of Programme Assistant is
on purely contractual basis. I certify that the particulars given by me in this form are true to the best of
my knowledge and belief. I know that at any time if the information furnished by me is found incorrect
my candidature will be stands cancelled immediately without assigning any notice.
Place:
Date:

/
______________________________________
Signature of Applicant

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