INDIAN INSTITUTE OF SCIENCE EDUCATION AND
RESEARCH MOHALI
MGSIPAP Complex Sector 26, Chandigarh- 160 019
Recent Passport
size photograph
(5 cm X 4.5 cm)
to be affixed.
APPLICATION FOR THE POST OF ________________________
1.
Advt. No. & Date
2.
Name in Full (Capital Letters)
3.
Date of Birth
(enclose copy of 10th Class/
Matriculation Certificate)
4.
Citizenship Status
(tick the appropriate box)
Day
Month
Citizen of India
by Birth
5.
Member of Scheduled Caste/
Scheduled Tribe/OBC/PD
Year
by Domicile
Write SC or ST/OBC (Attach Certificate) Please indicate whether Ex Serviceman /
Person with Disability.
6.
Address to which communications
should be sent (Also furnish email,
fax, telephone number, if any)
7.
Permanent Home Address
8.
Name and Address of Father/ Husband
(Incase of married Please mention the
name of husband)
9. Details of Educational Qualifications starting from 10th Standard/ Matriculation
Name of the
Board/College/University
Examination/
Degree
Subjects
(Class / Division/
Percentage)
Year of Passing
10. Experience in chronological order upto the present post
Organisation
11.
Designation
Present Basic Pay
(In the scale of )
From
To
Scale of Pay
Minimum Basic Pay expected
(in the present scale offered)
Experience in the field of
Time required to join if offered the post
12. Names of Referees (for Group A Posts only)
Name and Designation
Current Address
(a)
(b)
(c)
In the case of Group A Posts, Referees' reports have to be sent to the Director by email: director@iisermohali.ac.in or
by post.
Any other relevant information (attach sheets if necessary)
13.
14. I hereby declare that the information given above is correct to the best of my knowledge and belief and I
fully understand that if it is found at a later date that any information given in the application is incorrect / false
or if I do not satisfy the eligibility criteria, my candidature / appointment is liable to be cancelled / terminated.
Place :
Date :
15.
Signature of the Applicant
Endorsement of the Present Employer :
The application of Shri / Ms. __________________________________(Name and Designation of the
applicant) for the post of ________________________________, at IISER Mohali is forwarded to the
Director, Indian Institute of Science Education and Research Mohali (MGSIPAP Complex, Sector-26,
Chandigarh 160 019).
Date:
Signature of the Head of the Institution with Seal