Application No. :.. (For office use only) P.G.D.AV. College (Eve.) (University of Delhi) Nehru Nagar, New Delhi - 110065 Tel: 011-29845214, Fax No. 011-29840166 Website: www.pgdaveve.in Please affix a Passport Size Photograph APPLICATION FORM FOR NON-TEACHING POST (Only for PwD candidate & candidate applying for A.O. post on deputation basis) Details of Fee Paid: issuing Bank Rs.... D.D. No.. Date: Drawn on: New Delhi (NO FEE FOR PWD CANDIDATE) Last date of submission of Application Form is Wednesday, 15 th March, 2017 1. Post applied for.. Category. 2. In the Department of. 3. Advt. No. T-NT/2017/02 Dated: 15 th March, 2017 4. candidate (in Block letters) 5. Father/ Husband s name Mother s Name. 6. Date of Birth (In Figures)... (In Words). Age: Years :. Months days.. (as on 15.03.2017) 7. Nationality Sex (M/F) Married/Unmarried.. 8. Present postal address with Pin Code..... Pin Code.. 9. Permanent address with Pin Code...... Pin Code.. 10. Phone No... Mobile: 1).. 2) 11. Email ID is Mandatory
12. Do you belong to the SC/ST/OBC Category? If so, state the name of the Caste/Tribe and attach a -2- Certificate:. 13. Are you an Ex-service-man/Disabled Defence Personnel/Dependent of Defence Personnel killed in action? If so, attach a certificate:.. 14. Are you a Person with Disability (PwD) (OH/VH/HH)? If so, give details... 15. Have you been debarred or punished for adopting unfair means in any examination by any Institution/Board or University? If so, please specify... 16. Educational Qualifications in reverse chronological order: Sl. No Examination/ passed Year of Passing Board/ University % of Marks obtained Divn. Subjects 17. Professional Qualifications: Sl. No Examination/ passed Year of Passing Board/ University % of Marks obtained Divn. Subjects
-3-18. Details of Employment (Work Experience),if any. Office/Instt./Orgn. Designation From To Scale of pay/grade Pay and basic pay Status of Orgn. i.e. Govt./ Private/ PSU Total Experience: Years. Months 19. Are you attending any part-time/whole time course of study? If so, state the name of the course and the institution you have joined:.. 20. Indicate the time you will require to join, if selected 21. Do you know typewriting/shorthand? If so state speed : Typing in English. Hindi.w.p.m. Shorthand (English) w.p.m. Shorthand (Hindi) w.p.m. 22. Have you applied for any other post in the College? If so, state the name of the post and date when applied:. 23. Membership of any professional/educational/social body & your status in the organization Organization Membership No. Status Any Contribution 24. Any other information:......
-4-25. References: (one of which must be your previous employer): 1. Name: Designation:. Official Address: Tel: (Fax):. Mob: 1).. 2). Email Id: 2. Name: Designation:. Official Address: Tel: (Fax):. Mob: 1).. 2). Email Id: Dated:. Signature of the Applicant Declaration I affirm that the information given in this application is true and correct. I also fully understand that if at any stage it is discovered that any attempt has been made by me to conceal willfully or misrepresent the fact (s), my candidature may summarily be rejected or employment terminated. Place Date. Signature of the Applicant
-5- (For the candidates already employed) Forwarded with the remarks that the facts stated in the above application have been verified and found correct and this institution/organization has no objection to the candidature of the applicant being considered for the post applied for. It is further certified that particulars given by the applicant are true and have been verified from service records Designation: Signature Address: (Head of the institution/organization) (with office seal) Contact No. Date: List of enclosures:- Attachment for candidate applying for the post of Administrative Officer on deputation basis. All self-attested copies of educational qualifications, professional qualifications and experience certificates. AND Certificate to be recorded by the Head of Office/Controlling Officer while forwarding the Hard copy after online submission. Certificate that particulars given by the applicant are true and have been verified from service records. The applicant, if selected, will be relieved immediately. Attested copies of ACR/APAR (or grading) for the last three years enclosed or being forwarded. No disciplinary/vigilance case is either pending or is being contemplated against the official. No Major/Minor penalty is in force or current against the official. The department shall not ask for pre-mature repatriation of the officer during his/her deputation term. Recommendation, if any. Attachment for candidate belonging to PwD category if applying Offline. Self-attested copy of valid Disability Certificate as prescribed by the Government of India. Self-attested copy of reservation certificate (SC/ST/OBC) if belongs to. No other enclosure is required to be attached with application form.