MLNC, Yamunanagar
APPLICATION FORM
DATE…………..
(TEACHING/NON-TEACHING)
(To be filled by the applicant in his/her own handwriting in block letters)
1. (a) Post ……..………………….…… (b) Subject/Department:…......................................... Photograph
2. Name in Block letters………….……………….......................................................................
3. (a) Father’s Name ………………..…...................... (b) Mother’s Name……………………………….…
(c) Date of Birth…...........…............... (d)Place of Birth…………................… (e) Sex………......................
(f) Nationality:…….............. (g) Category(GEN/SC/ST/OBC/PH):……….... (h) Blood Group:...................
(i) Identification Marks:......................................... (j) PAN No.……................(k) Voter ID. No......................
(l) Aadhar No:.:.................................... (m) Driving License No……………..…… (n) Passport No.:..............
(Enclose any two I .D. Proof :-Ration Card /Voter card/Driving License/PAN Card/Passport)
4. (a) Name of Spouse (if married) ……........................……(b) Occupation of Spouse/father…….……...........
(c) Contact No. & Email of father/ spouse ………………………… …………………………………………
(d) Family Details: .............................................................................................................................................
5. (a) If selected, when you can join?:…………………….. (b) Salary Acceptable:……..…………….........
6. (a) Present place of residence: ……………………….... (b) Preference for Campus residence : Yes/ No
7. (a) Present Postal Address ( in block letters):………………............................................................................
………..………………………………….................................……….…Pin Code….…………………….
Phone…………………..Mobile No.……………..………E-mail…………….……………………………..
(b) Permanent Home Address (in block letters): .........................................................................................….
…………………..............................................................................Pin Code:...............................................
Phone…………………..…Mobile No.……………..………E-mail …….…………………………………
8. Bank Account details :
(a) Name & address of the Bank…………………………….. (b) Account No.…………………………
(c) IFSC Code……………………………(d) Nature of account: (Saving Account/ Current Account)
9. (a) Do you have any relative working in Seth Jai Parkash Mukand Lal Institutions of Knowledge and
Service or any relation with any member of the Managing Committee (if yes, furnish details)
………………………………………………………………………
(b) Please state whether you are pursuing any course of studies at present? If yes , give
details………………………………………………………………..
(c) Kindly mention the medical history if any (undergone any major surgery or suffering from any
serious ailment)…………………………………....................................................................................
(d) Have you ever been connected with any political party? If yes, give details……………………..…….
(e) Do you have any contract/ bond with your present employer ? if yes, give details……………………
(f) Do you consume liquor ? Yes/ No (g) Are you used to gambling? Yes/ No
(h) Have you ever been prosecuted/detained/fined/convicted by a Court of Law or debarred/disqualified
by any University, Public Service Commission from appearing at examinations/selection? Is any
case pending against you in any Court of law at the time of filling up of this application form? If
‘Yes’ full details of the case/detention/fine/sentence etc.:
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10. (a) Educational Qualifications (from Matriculation onwards) (Annexures _____ to _______):
Sr. Exam Passed Name of the City Univer- Year of % age of Regular/Corres-
No. Institute sity/ Passing Marks& pondence/Part
Board Division time
(i) Matric
(ii) 10+2/ Diploma/ITI
(iii) Graduation:_________
Spl:______________
(iv) Post Graduation:_______
Spl:______________
(v) Ph.D.
(vi) Any other Exam.
(NET/ GATE)/Course
(b) M. Tech./ M.Phil Dissertation title………………………………………………………………
(c) Ph.D Thesis title: ……………………………………………………………………………….
11. Experience (write from first employment onwards) (Annexures _____ to _______)
Sr. Institute/ Duration Designation/ Emoluments& Reason for
No. Industry & Address From To Total Period nature of duties Scale etc. leaving
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
Total Experience: UG…………………………… PG…………………….. Industry………………….
(Enclose copies of all certificates/DMC and testimonials)
12. Result of classes taught (last three years): (Annexures _____ to _______)
Year: Year: Year: Year:
Semester : Semester : Semester : Semester :
Subject Sem. % Subject Sem % Subject Sem. % Subject Sem. %
13. Extra Curricular Activities (Sports, Social, Literary Activities, N.C.C./N.S.S.) etc. (Annexures ___ to _____)
Name of Level/Name of the Competition Year Position Achieved
Activity
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Any other achievement you would like to mention:…………………………………………………………
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
14. (a). Total number of publications (Annexures _____ to _______):
Journal Conferences Seminars
National
International
* Attach a list with Name, ISSN No & Impact Factor
(b) No. of books published (Annexures _____ to ______) ………………..…………………………………...
(Attach the list with title of book, Detail of publisher& ISSN No.)
(c) Detail of Patents………………………………………………………………………………………………
15. Conference/Seminar / Training programme attended by you: (Attach list) (Annexures ____ to ____)
Conference Name of Place Date Sponsoring body
Conference
National
International
Please note that:
You will not be allowed to undertake any further studies during your employment without prior
written permission of the competent authority.
You will not undertake any part-time job including coaching/tuition etc.
16. References:
Name & Addresses of two references, not relatives (preferably employer/ supervisor/ teacher)
Name:_______________________ Name:_______________________
Designation: __________________ Designation: __________________
Affiliation____________________ Affiliation____________________
Contact No.___________________ Contact No.___________________
Email ID: ____________________ Email ID: ____________________
I declare that the information given above is true and correct to the best of my knowledge and belief &
nothing has been concealed therein. I am aware that any false or incorrect information by me may result in
termination of my service with the institute. I have no objection, if you enquire from any of my previous
employers on any matter pertaining to me, if I join your institute.
Place:____________
Date:_____________
(APPLICANT SIGNATURE WITH DATE)
