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Central Silk Board Recruitment 2015-2016 Application Form Format

Affix your
latest passport
size
photograph

Application Form
(To be filled in by the candidate)
Post Applied for
Advertisement Number

Name of the candidate


(in Block Letters)

2
3

Sex

4
5

Date of birth (Date-Month-Year)

Male / Female
Married / Unmarried

Marital Status

Age as on closing date for receipt of


application
in India (Years/Months/Days)

Fathers Name

Designation of the candidate, if employed

Name of the Office/Institution/Organization,


if employed.

10(a)

Present place of posting


Full postal address for correspondence with
pin Code

10(b)

Permanent address

10(c)

Contact details

Mobile
No.
Tel.
No.
Fax No.
E-mail
ID

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11

Are you a citizen of India by birth / domicile?

12

a) Category (SC/ST/OBC/General)

Yes
Yes

b) whether belongs to Minority Community?


c) Whether belongs to Persons with Disabilities
category,

OH

If Yes, please indicate whether

Have you ever been convicted by a court of


law for any offence? If so, give details thereof.

14

Have you ever been punished or debarred


from service of G ovt . or ot h e r
organizations.
If so, details thereof.

15

Whether any disciplinary case is pending


against you? Has any major/minor penalty
been imposed on you?
If s e l e c t e d , a r e y o u p r e p a r e d t o
accept the minimum initial pay offered?
If not, state the lowest initial pay that you
would accept.

16

17.
Level

VH

HH

Percentage

Departmental / Other Govt. / External

d) Whether Departmental / Other Govt./


External

13

/ No
/ No

Academic Qualifications
Degree

Institute/
University

Year

Subject(s)
with
major
field

Fellowship/
Scholarship

Class/
Division/
Grade/
Marks

Rank/
Medal/
Award

Graduation
Masters
Ph.D*
Post-Doc
Others

Title of Ph.D Thesis :

Note : Please enclose self-attested photocopies of (i) Date of Birth Certificate / Matriculation Marks Sheet
(ii) B.Sc. degree
(iii) M.Sc. / M.Phil. / Ph.D degree.
* Date of completion of Ph.D

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18.

Employment Record & Experience in Relevant Field

i (a) Employment Record (Starting from the present position)


Designation

Pay
Scale/
Pay
Band
with
Grade
Pay

Nature of
Work

Organization

Place of
posting

Period
(From-To)

Actual
Duration
(Years &
Months)

(b) Training attended in the relevant field of specialization in India/abroad


Title
(i) TRAINING
IN INDIA

(ii) TRAINING
ABORAD

Duration

Institution

Year

(d) Experience in Relevant Field/Contributions


Details of 5 most significant contributions (in bullet form) relating to the relevant field
of specialization (MAXIMUM 200 WORDS) .

ii. Service in Remote Areas


Designation

Name of the Institution and Location


Of the remote Area

Period
(From - To)

Duration
(Years,
Months)

iii. Recognitions & Awards/Special Attainments &


Achievements of Practical Importance
(a) Recognitions
Items of Recognition

Year

Organization
(National/International,
Institutional/Professional
Society/Academy)

Individual/ Collaborative

Year

Awarding Organization
(National/International,
Institutional/Professional
Society/Academy)

Individual/ Collaborative

(b) Awards
Items of Awards

(c)Special
Attainments & Achievements of Practical Importance
(i) patents Commercialized
Category Title

Year

Individual/
Collaborative

Additional Details/Information

(ii) Technologies, Varieties, products, concepts, methodologies etc.


Category Title

Year

Individual/
Collaborative

Additional Details/Information

iv. Symposia/Conference etc.


Name
of
the Function(s)
programme organized/ performed
attended

Title

Year Duration

v. International Recognitions
Country

Type of Recognition

Year

Duration

19. Publications including papers in refereed journals:


(a) Publications International(Indicate only 20 best publications
Authors

Year

Title with full reference*

Journal
with
volume &
page
number

(b) Publications National(Indicate only 20 best publications

*Publications will not be considered if references (information furnished above) are incomplete

(c ) Other Publications
Item

Year

Details

Publisher

Pages

i) Books Published
Books Authored

ii) Books Edited

iii) Book Chapters/Manuals

iv) Conference Proceeding Papers, Popular Articles, Bulletins, Short Communications,


Research Notes, Abstracts

20. Institution Building


Item

Details of Activity

Level of Involvement

a) Infrastructure
& Farm
Development
b)Laboratory
Development
c)
Structural
changes in
research
and
management
d) Administration
and
financial
reforms
e) Others

21. Any other specific information in support of outstanding contribution if not


covered earlier. (Do not attach annexure or supporting documents)

I hereby declare that the statements made in the application are true

Date :
Place :

Candidates Signature

Certificate of Verification by the Employer


1. The entries made in the application of Dr. ........................................................................... .......

who has

applied for the post of Director under Central Silk Board have b een ve rified and are co rre ct.
2. There is no vigilance / disciplinary case pending against him / her.
3. Details of the Minor / Major penalties imposed during the last ten years, if any (furnish details).
4. Certified that the work and conduct of Dr. ..................................................................................
average for the last five years.

is above

The gist of APAR / ACR gradings / ratings for the preceding five years is as follows:-

Year

Grading/Rating by Reporting Officer


Grading/Rating by Reviewing Officer

Office File/Ref No.

Signature
Name
Designation with office seal

Office Seal

Date

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