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JADAVPUR UNIVERSITY
PASSPORT SIZE
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Kolkata- 700032
APPLICATION FORM
(For Non-Teaching Post)
Post applied for : ........................................................................................................
(Advt. Ref. No. & date) ..............................................................................................
SBCollect Refarence No.(attach a copy) DU.............................................................
1. Name of the candidate in full:
(use block letters)
2. Address in full: a) Permanent ...........................................................................................................
............................................................................................................
............................................................................................................
Pin .....................................
Phone ...............................
............................................................................................................
Pin .....................................
Phone ...............................
3. a) Date of Birth :
D
b) Place of birth:
Village/Town/City.................................................Dist............................
State........................................................................................................
4.
Nationality:
By birth........................................................At present...........................
5. a) Religion:
................................................................................................................
...............................................................................................................
6.
Gender:
7.
8.
Marital Status:
Married/Unmarried
occupation or profession
....................................................................................................
and address:
....................................................................................................
....................................................................................................
and address:
....................................................................................................
9. Parent's Nationality:
Father.........................................Mother.......................................
................................................................................................
11. *Give particulars of all examinations passed and diplomas or degrees obtained at the University or other
places of higher or technical education commencing form Matriculation or equivalent examination (attached
certified copy of the University or Institution record):
University/ Board
Examination
passed
Year of
passing
Class or
Division
% of
marks
Subjects taken
Remarks
12. Have you been employed? If so, give the following details, otherwise indicate what you have been doing since
your last examination mentioned in item 11 unless the period is covered:
Nature of Post
Date of
joining
Date of
leaving
Remarks,
if any
................................................................................................
...............................................................................................
........................................................................................
..........................................................................................
if selected?
18. Give names of two referees, with address other than your relatives, who are in a position to give
information about you and your work:
Name
Position
1.
2.
.............................................................................................
Pin..........................................Phone....................................
a)
b)
c)
d)
e)
f)
D E C LA R AT I O N
I declare that the entries in this form and the additional particulars (if any) furnished in reply to the
questions above are true to the best of my knowledge and belief.
Date...........................................
Place..........................................
.......................................................
Signature of the Candidate
(in full)
N.B.
i) Papers and documents submitted with the application will not be returned.
ii) Separate sheet(s) may be attached wherever necessary.
iii) All enclosures including attested copies of testimonials are to be submitted in single copy.
iv) Without attested copies of evidences, the application will be considered incomplete.