All India Shri Shivaji Memorial Society
55 -56, Shivajinagar, Pune : 411005.
Tel. No. (020) 26058587, 26057660 (Ext- 1001, 1103), 26058342
Tele Fax No. (020) 26058943
E-mail : [email protected]
Visit : www.aissmscoe.com
Form No.:
[I-Cad size
Photograph]
APPLICATION FORM
With reference to the advertisement dated ____________ published in _______________
I, wish to apply for the post of _______________________________________________
==============================================================================
1) Full Name
: ____________________________________________________
(Surname)
Address
(for correspondence)
(Firstname)
(Medalname)
__________________________________________
____________________________________________________
Pin :____________________ Phone :______________________
Mobile No. _________________ E-mail ____________________
2) * Date of Birth
: ______________________________________________
3) Nationality
: ______________________________________________
4) * Caste Category
: Open / Reserved (SC, ST, DTNT, OBC, etc.) Specify _________
5) Mother Tongue
: ______________________________________________
6) Languages known
Language
Speak
7) * Academic Qualifications (Starting from S.S.C.)
Sr. Exam.Passed Passing Board/University
No.
Year
Read
Main Subject
Write
Class, %
Remarks
Marks, No.of (Rank etc.if any)
Attempts
...2/-
8) * Experience
Sr. Name of Establishment
No.
Post Held
Period
From
Last
Pay
Nature of Work
To
9)*For Professor/Associate Professor post, : ________________________________________
if you are ME / M Tech First Class & from industry/
profession, please enclose proof justifying that your
experience is significant & equivalent to Ph.D.
10) * Membership of Professional bodies
: ________________________________________
11) * Achievements (Awards, medals, etc.) : ________________________________________
12) * Paper Published/Presented
(Enclose copies)
13) * Book Published, if any
: ________________________________________
14) Areas of Interest
: ________________________________________
15) * Research Experience
: _________________________________________
: ________________________________________
_________________________________________
16) * Minimum salary expected
: ________________________________________
17) Notice period required to join the post, : ________________________________________
if selected.
18) Other information, if any
19) Please specify four areas of your
probable contribution to College
: ________________________________________
1._______________________________________
2 ._______________________________________
3._______________________________________
4._______________________________________
I hereby certify that the above information given is true and correct.
( Signature of Candidate )
---------------------------------------------------------------------------------------------------------------------------------* Attested certified photo copies of the necessary certificates etc. to be enclosed. Use separate
sheet(s) wherever necessary. Strike out whichever is not applicable.
...3/-
UNDERTAKING
I, Mr/Mrs/Miss _________________________________ would like to submit that I have not
enclosed the certified photo copy of the following documents with the application:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
I, hereby give an undertaking that I will submit the certified photo copies of the above
documents at the time of interview along with my original documents. I am fully aware that if I fail
to submit the above documents I will not be eligible to appear for interview.
Place :
Date :
( Signature of Candidate )
______________________________________________________________________________
* Attested certified photo copies of the necessary certificates etc. to be enclosed. Use separate
sheet(s) wherever necessary. Strike out whichever is not applicable.