CHAITANYA BHARATHI INSTITUTE OF TECHNOLOGY

ChaitanyaBharathi P.o., Gandipet, Hyderabad-75 (Affiliatedto OsmaniaUniversity)

APPLICATION FOR RECRUITMENT TO THE POST: Department: Note: Please see annexure before filling up this form. 1. 2. 3. 4. 5. Name in full with surname (BLOCK LETTERS) Father's Name Date of Birth (in Christian era) .
Place of Birth

Affix your latest passport size photograph & get it attested by a Gazetted Officer with seal.

Postal address to which communications should be sent with Telephone No.

6. 7.

State whether you belong to SC/STIBC Give particulars of all examinations passed Degree/Diploma obtained (commencing with the matriculation or equivalent examination). Where a Degree/Diploma has been obtained by private appearances this should be specifically mentioned in brackets in column (2) of the table. Year of Class / Examination or Name of the College and Subjects taken Grade Degree University passmg for specialization 4 2 3 5 1

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:: 2:: 8. Have you published any papers if so, give particulars (if space here is insufficient for this purpose, please give full particulars on a sheet of paper and attach it to the application inserting here a reference to the sheet) (attached). (To be filled in for teaching posts only).

9.

Give in chronological order details of your employment: Name & . Address of Institution/Firm or Office. Scale of Pay BasiC Reasons for Pay last Drawn / leaving the Consolidated post Salarv

Designation

From

To

10.

Give below details of the experience gained during your employment: a) Teaching: i) in CollegelUniversity ii) iii) b) to Post-graduate classes Guiding Research

Industrial Experience

11.

If selected and appointed please specify the time you require for joining duty:

12.

Additional remarks if any (Applicant may mention here any special qualification or experience not covered above) (Separate sheet to be enclosed if necessary).

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:: 3:: 13. Details of enclosures: 1) (2)

.

3) 4) 5) 6)

14.

Names of two persons with their address/designation to whom reference can be made about the candidate

Place: Date: Signature of Candidate

DECLARATION TO BE SIGNED BY THE CANDIDATE I hereby declare that the particulars furnished in this application are true to the best of my knowledge. Date:

Signature of the applicant

ONLY FOR CANDIDATES ALREADY WORKING IN ORGANISATION/INSTITUTION

Endt. No.

Date:

1) Forwarded to the Principal, Chaitanya Bharathi Institute of Technology, Gandipet, Hyderabad. 2) The applicant is a permanent / temporary employee and his / her conduct and character are

3) Certified that the above particulars are correct as per our records. 4) The Organization/Institution has no objection to relieve him/her, if he/she is selected for the post. FULL SIGNATURE

DESIGNATION