-1-
4. Whether you belong to any reserved category mentioned below. If so, endorse certificate from
competent authority.
(k{u rLkBLkrrk yLkk{k koLkk Aku? u nk, kku ku MkkkrfkheLkwt {kkk hsq fhwt.)
SC ST OBC/SEBC NT NT
(y..) (y.s..) (yku.e.e.q yuMk.E.ke.Mke.) (yu.xe)
5. Are you physically handicapped.? If yes, endorse certificate from competent authority. Yes / No
(k{u kherhf kuzktk hkku Aku?u nk, ku MkkkrfkheLkwt {kkk hsq fhwt.) nk / k
6. Mother tongue ___________________
({kk]kkk)
7. Sr. No. Other Languages known Speak Read Write
{ keS kkkLke fkhe kkukk kt[kk kk
8.1. Typing and Computer knowledge ? Yes / No (If yes, attach certificate)
(xkRkk yLku fBqxh kkLkLke rkk) nk/Lkk (u nk, kku {kkk hsq fhku)
1. Typing (WPM): Gujarati _________Hindi _________English _________
xkRkk (.r{.zk) : kwshkke rnLe ytkuS
+
2. Computer : CCC____________CCC __________ PGDCA ________
fBqxh : Mke.Mke.Mke. Mke.Mke.Mke.+ ke.S.ze.Mke.yu.
9. If you have published articles or research papers or books, give details.
(uku ykk MktkuLk kkku ykk kwMkfku rMk fko nku kku kuLke rkk)
___________________________________________________________________________
10. Expected salary including allowances :
(yukWLMk Mkn yufthu fuxku kkkh {kLke khk hkku Aku.)
___________________________________________________________________________
11. When can you join if offered an appointment?
(u Lke{k{kt yku kku khke uzkE fku?) 2
___________________________________________________________________________
-2-
12. Please state previous experince or training in the follwing columns. (Attach separate sheet for
more details, if required)
(yLkw ykh kke{ ee nku kku kuLke rkk Lke[uLkk Lk{qLkk{kt ykkku. sYh sku khkLke {krnke
yk kkLkk{kt hsq fhe)
Sr. Name & Address Designation From Left on Pay Reason for Remarks
No. of the employer nkuku rLk{qf Akuzk Scale leaving Part / Full
{ LkkufhekkkLkwt kkhe kkhe kkkh kuh AkuzkLkwt fkh time
Lkk{ yLku MkhLkk{wt LkkU
kkxo/Vw xkR{
1
2
3
4
5
13. Are you having service agreement/bond with your present employer? Yes / No
If yes, please mention period etc., and give details separately.
(k{khe nkLke Lkkufhe{kt k{u fkuE fhkh fkuo Au? u nk nku kku kuLke {wk kuhu ykke ykkku.) nk / k
____________________________________________________________________________
14. Have you applied or been interviewed for any post in this University in the past? Yes / No
If yes, please mention post, and date of interview.
(yk knuk yk wrLkMkxe{kt k{u fkuR skk {kxu yhS fhue ykk YkY {wkfkk {kxu kkukk{kt
ykuk?u nk, nku kku fE skk {kxu yLku fE kkheu kuLke rkkku ykkku.) nk / k
___________________________________________________________________________
15. Please mention name of two reference who are not your relative and who can certify your
work and conduct.
(ku rkrck kykuLkk Lkk{ku ykkku fu suyku k{khk Mkkk Lk nku yLku k{khk fk{ yLku [krhkT ru
yrk ykke fu.)
1. 2.
-3-
19. List of Self attested copies of certificates/documents attached:
(M {krk MkxrVfux/MkkusLke LkfkuLkk rkzkLke rkk)
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
20. I ___________________________________________solemnly declare that the particulars
Furnished in this application are true and correct. I clearly understand that any misstatement
of fact contained herein or willful concealment of any material fact will render me liable to
Appropriate action as may be decided by University.
(nwt .............................................................................rkkkkqof nuh
ft Awt fu yk yhS{kt
k{kt yku k{k{ nfefk Mkk[e yLku he Au. nwt Mkkhe heku Mk{swt Awt fu kuxe nfefk ykh kku
ekqeLku k{kt yku kuxe nfefk {kxu wrLkMkxe Lke fhu ku kkkt {khe Mkk{u uu.)
Place: ______________Date: ______________ Signature of the Candidate: _______________
(Mk) (kkhe) (W{ukhLke Mkne)
21. No Objection Certificate:
This is to certify that Mr./Mrs........................................................................................is serving
in this institute / Organization from.....................................as.....................................................
......................................................................................................................................................
This is to further certify that there is no departmental inquiry/proceeding or vigilance inquiry or
contempt of court against the employee is pending.
Date :
Place : Signature of Employer with Seal
-4-
N.B. 1. Application with incomplete information will not be accepted.
kk.f. 1. yqhe nfefkke yhS Mefkhk{kt yku Lkn.
2. The application should be in the candidates own handwriting.
2. W{ukhu kkukkLkk nMkkkh{kt s yhS he
3. A candidate who is employed elsewhere should forward the application through his/her employer or should
attach a certificate (No Objection Certificate) from the employer that he/she has been permitted to apply for the
post in question, otherwise the application will not be considered.
3. u fkuE W{ukh keS fkuE MktMkk{kt Lkkufhe fhkku nu kku ku{u ku{Lke yhS kkukkLkk kkkrfkhe {khVk {kufe
ykk ku{u Mkh skk {kxu yhS fhk {kxu khkLkke ykk kLkwt {kkk (Lkk ktk {kkk)hsq fhwt, Lkn
kku yhS kkk hkk{kt yku Lkn.
-5-
***
(FOR OFFICE USE ONLY)
WHETHER ELIGIBLE BY :
(1) Name of the Applicant :
-6-
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
Minimum API Score Required for Direct Recruitment in Minimum Essential Qualification and Consolidated API
Professor/ Director. Score of 400 Points from Category III API
Date of Birth:
Page1of6Name&SignatureofCandidate
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
Note:incasethreeauthorsforoneresearchpublication,theprincipleauthorget4pointswhileotherauthorseligiblefor2points
Page2of6Name&SignatureofCandidate
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
III(C) RESEARCHPROJECTS
III(C) SponsoredProjectscarried (a) MajorProjectsamountmobilizedwith 20/eachProject P1X20=
(i) out/ongoing grantsabove30.0lakhsNoofProject(s)=
P1
(b) MajorProjectsamountmobilizedwith 15/eachProject P2X15=
grantsabove5.0lakhsupto30.00lakhs
NoofProject(s)=P2
(c) MinorProjects(Amountmobilizedwith 10/eachProject P3X10=
grantsuptoRs.5lakh)
NoofProject(s)=P3
III(C) ConsultancyProjectscarried AmountmobilizedwithminimumofRs.10.00 10perevery RX10=
(ii) out/ongoing lakhs
Noof10Lakh(s)=R
CompletedprojectReport(Acceptancefrom 20/eachmajorproject Q1X20=
fundingagency) and10/eachminor
III(C) Completedprojects:Quality a) No.ofcompleted&acceptedMajor project Q2X10=
(iii) Evaluation project(s)=Q1
b) No.ofcompleted&acceptedMajor
project(s)=Q2
30/eachnationallevel O1X30=
outputorpatent/50
Patent/Technologytransfer/Product/Process /eachforInternational
III(C)
ProjectsOutcome/Outputs a) No.ofnationalleveloutput=O1 level,(outputorpatient)
(iv)
b) No.ofinternationalleveloutput=O2
O2X50=
TotalofIIIC
Page3of6Name&SignatureofCandidate
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
III(D) RESEARCHGUIDANCE
Page4of6Name&SignatureofCandidate
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
Page5of6Name&SignatureofCandidate
I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform
Note:fortheeachcategoryunderIII(E)(i,ii,iii,iv)maximum2presentationand/orparticipationofpapersin
trainingcourse,conference,seminarandworkshopwillbeconsidered.
Page6of6Name&SignatureofCandidate