राजीव गाांधी राष्ट्रीय युवा ववकास सांस्थान

Rajiv Gandhi National Institute of Youth Development

युवा काययक्रम ववभाग / Department of Youth Affairs
युवा काययक्रम और खेल मांत्रालय, भारत सरकार
Ministry of Youth Affairs & Sports, Government of India
श्रीपेरुम्बुदरू Sriperumbudur – 602105 / तवमल नाडु /Tamil Nadu
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For office use Application for the post of Training Associate/ Junior Assistant/
APPL. No: Physical Training Instructor (On Contract)
[Purely Temporary position on Contract basis]

Please read the information carefully on website prior to filling up this application form. You
may use separate sheet/s wherever required. Documentary evidence(s) is/are to be
attached for the data provided in this application failing which due weightage will not be
given during scrutiny.

Advertisement No & Date: …………………………………………………… Please affix recent

passport size
photograph
Department:
Venue:

1. (i) Full Name (in BLOCK letters) : ………………………………………………………...…...………............

(ii) Father’s/Husband’s Name: ….………………………………………………………………......................

(iii) Category: …………………………………………….

Whether belonging to SC/ST/OBC/PWD, Attach Certificate.

2. Date of Birth : ……………………………… Age : ………….………. 3. (a) Nationality:…………………….…….

(b) Gender: Male / Female / Others (c) State/UT to which you belong: ……………………………….......

(d)Marital Status: ………………………………………………….............

4. Postal Address for correspondence. 5. Permanent Address (with Phone no. & Mobile):

..…………………………………………………….. ....……………………………………………………..……......

………………………………………………..…..... …...………………………………...............................

……………………………………………………..... …...………………………………..................................

..…………………...Pin Code: ………........... ……………………....Pin Code: ……….....................

Mobile No.: ………...……………….....….... E-mail ID: ……………………..………………………………

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 6. Educational Qualifications (Start with SSLC):

Sl. Examination Name of the Month & Subject / % of Marks Division /

No. Passed University/Board Year of Specialization / Grade
Passing (CGPA) Class

7. Prizes, Awards, Rank received etc. (if any, attach certificate): ……………………...……….................

………………………………………………………………………………...................................................................

………………………………………………………………………………..........................................................................

8. (a) Post held at present:

Name & Address of Salary per month (Rs.)

Post held Date of Appointment Employer

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 9. Experience (In chronological order):

Sl. Name of the Employer Period of Employment Salary per

No Post held month (Rs.)
From To

10. Any other details:

(Attach separate sheet if required)

11. Please give details of three referees (Not from the blood relation to the
candidate), At least one should be the current / previous employer:

(i) Name: ……………………………….............. (i) Name: ………………………………...................................

Designation: ………………………….............Designation: …………….……………………………………….......

Full Address: ……………………………........Full Address: ……………………………..…………..…………......

……………………………………................ …………………………………….............................................

……………………………………................... ……………………………………..............................

Contact No. …………………………….......... Contact No. ……………………………...................

E-mail: ………………………………….......... E-mail: ……………………………………………….........

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11. Any other relevant information: …………………………………………………..…………………....................
………………………………………………………………………………………………………..………………….........................
…………………………………………………………………………………………………………...........................................

DECLARATION

"I hereby declare that all the statements made in this application are true and complete to the best
of my knowledge, belief and nothing has been concealed / distorted. I am aware that, if at any time
I am found to have concealed / distorted any material information, my appointment is liable to be
summarily terminated without any notice. Moreover, if any information is found incorrect/wrong, I
shall be liable for action as decided by the Institute authority”.

Date:

Place: (Signature of Applicant)

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Enclosure:

S. No Description Enclosed
1. Self-attested 10 , 12th Marks statements
th
Yes / No
2. Self-attested UG, PG Degree Certificates Yes / No
3. Self-attested UG, PG Mark Statements Yes / No
4. Self-attested Community Certificate Yes / No
5. Self-attested Experience Certificates Yes / No
6. Any other certificates Yes / No

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