Shikshan Prasarak Mandal Rajgurunagar, Tal.Khed, Dist. 410505, Tel.:(02135) 222099 _ _ _ Photo

Application Form To, The Hon. Secretary, Khed Taluka Shikshan Prasarak Mandal Rajgurunagar, Tal.Khed, Dist.Pune 410505

Sir,

With reference to your advertisement in dated _ I wish to apply for the post of _ in Hutatma Rajguru Mahavidyalaya, Rajgurunagar. I am submitting herewith my candidature for the same.

My particulars are given below :

1. Full Name : _ _ (Beginning with Surname and in Block Letters) 2. Full Address for correspondence :

Pin code

3. Contact Details : Telephone No. (Residence) (Office)

Mobile No. : _ e-mail ID :

4. Date of Birth : Age as on date : Years Month/s

5. Place of Birth : _ _

6. Sex (Male/Female) : 7. Married / Unmarried : _

8. Nationality :

1 9. Whether belongs to : _ ( Scheduled Caste, Scheduled Tribes, De-notified Tribes, Nomadic Tribes, Other Backward Class, Special Backward Class, Open )

10. Educational Qualification : ( Pls attach all relevant Documents )

University Class / Month & Percentage/ Division Examination / Board Year of Subjects Marks / Passing obtained Grade

Higher Secondary / H.S.C.

UG Degree +

PG Degree+

M. Phil.+

Ph.D.+

NET / SET / SLET

Any other Degree/ Diploma

Note : ( + Pls. state the Faculty ) 2 11. Reason(s) for breaks in service, (if any)

12. Teaching / Technical / Professional Experience at UG and PG level _Years

College / Subject Position Nature of Period of Institution held appointment Appointment Permanent/ with Dates Temporary From : To :

3 13. Research work done : ( Pls. Attach separate sheet, if required ) _

_

_

14. Number of Students successfully guided (Ph.D): _ M.Phil.

15.(i) No. of Publications in Journals of concerned subject : National Level :- _ International Level (ii) No. of Books Published: _ (iii) No. of Articles: _

16. Academic Performance Indicator (API Score):- ( Attach API Score certificate from University)

17. Patents, if any : Give details

_

_

_

_

_

_

18.Pls. state information regarding Court Case / Criminal proceeding / Disciplinary action:

_

_

_

4 19.(a) Present Position held :

(b) Service : (Govt./ Aided/ Self Financed/ Private/ Public Sector ) _

(c) Name of the Institution employed: _

(d)Date of Appointment : _

20. Declarations:

a) I have read the eligibility criteria for the post of Principal, terms & conditions and all the instructions properly. They are all acceptable to me and I shall abide by them. b)The responsibility of producing Caste validity certificate is mine and I abide by it. c) I understand that in the event of any information being found false, incomplete or incorrect my candidature / appointment is liable to be cancelled / terminated without any notice. d) I understand that incomplete applications, applications without required enclosures, and applications not submitted in the manner and procedure prescribed by the university shall be summarily rejected. g)I hereby declare that all statements made by me in this application are true, complete and correct to the best of my knowledge and belief.

Place:

Date: Signature of candidate Candidate's Name:

Forwarded through the Present Employer

Name & Designation of the Employer Seal & Signature of the Employer

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