Shiksha Mandal’s JANKIDEVI BAJAJ COLLEGE OF SCIENCE,

Shiksha Mandal’sJANKIDEVI BAJAJ COLLEGE OF SCIENCE, WARDHAJamnalal Bajaj Marg, Civil Lines, Wardha – 442001APPLICATION FOR APPOINTMENT (FOR EMPLOYMENT EXCHANGE CANDIDATES ONLY)(TEACHING POSTS : SENIOR COLLEGE)(To be filled in by the Candidate in his/her own handwriting)ToThe PrincipalJankidevi Bajaj College of Science,Wardha .Paste hereyour recentpassportphotographSubject : Application for the post of in subjectSir,With reference to the advertisement published in the dated forthe post of in the subject I sincerelyoffer my candidature for the said post.Details regarding my educational qualification, experience etc. are as follows1)Name in Full:Surname2)3)4)5)6)Date of BirthMarital StatusMother TongueCaste / CategoryPreferredmedium/sofinstruction (English / Hindi or:::::First Name(Father’s/Husband’s Name)/ /Marathi)7)Domicile & Nationality8)PermanentAddress:and :Contact Nos. with STD9)Address for Correspondence :and Contact Nos. with STD10 Email id:11 Mobile No.:12 Adhar Card No.:

1) Educational Qualification :Examinations DegreeYear of %of Board/ Specialization GradepassingmarksUniversity / Subjects1. SSC2. HSC3. UG4. PG5. Ph.D.6. NET/SET7. Any Other8.2) Present Position :DesignationCollegeFromBasic Pay / Pay Grade PayBand3) Teaching Experience :Sr.No.Post HeldName of Fromthe CollegeToSubjects(UG/PG)Total Year4) Research Experience :a) Topic for Ph.D. :b) Topic for M.Phil :c) Number of Research articles published (attach the list with impact factor) :(i) National Level : (ii) International level :d) Number of books / textbooks published :e) Number of research scholars / projects guided :f) Number of scholars / projects under guidance :g) Number of papers in National / International conferences (attach the list) :5) Academic Contribution :a) Innovation in T/L methods / Use of ICT etc. :b) Curriculum Design :

c) Organization of conferences / seminars :d) Any other :6) Contribution to Qualitative Growth of the Parent Institute :i)ii)7) Extension Activity / Community Work etc. :i)ii)8) Career Highlights :i)ii)9) Any other information :i)ii)10)Please state whether any vigilance case or departmentalenquiry or any legal case in any court of law ispending or being contemplated against you, give detailsYes / No(If yes, attach details)11) Declaration of family details as per G.R. – SRV2000/2000/CR(17/2000)XII, 28/03/2005 :Sr. Name of Family MemberNo.1Date of BirthRelationwith RemarksCandidate234Note : If total living children born after 28-03-2005 are more than TWO, candidate shall bedisqualified for the post,12) Name and address of TWO Referees :i) .ii) . . . . .Phone No. .Phone No. .Email : Email : *************************

DECLARATIONI hereby declare that all the entries made by me in this application are true and verifiable fromavailable sources / documents and that the applicant is prepared to face the consequences includingcancellation of candidature in case any false claim is found to have been made.Place :Date :Name and Signature of the ApplicantNote : Also fill this application online on - https://goo.gl/forms/tMPa8Jn5EJ4qixOq1

ENDORSEMENT BY THE EMPLOYER(For in-service candidates only)To be signed and forwarded by the present employerThe PrincipalJ.B. College of Science, WardhaJamnalal Bajaj Marg,Civil Line, Wardha – 442001 (M.S.)The applicant Dr./Shri/Mrs/Mswho is submitting this application for the post ofat J.B. College of Science, Wardha is working in(College) on the post of in temporary /permanent capacity w.e.f. in the pay band of withgrade pay of His/her next increment is due on .Further, it is certified that no disciplinary / vigilance case has ever been held or contemplatedor is pending against the said applicant.There is no objection for his / her application being considered by your organization.Signature of the forwarding authority / EmployerName :Designation :OFFICE SEALList of Enclosures : (if not enclosed, the application will be treated as incomplete)1.2.3.4.5.Attested copies of the statement of Marks, Certificates / Degrees of all examination.Experience Certificates, TestimonialsForwarding letter / N.O.C. from the present employer (if in service)Attested copy of the Certificate to confirm date of birth.Postal Order of Rs. 100/- in favour of Principal Jankidevi Bajaj College of Science,Wardha6.7.8.9.10.

Board / University Specialization / Subjects Grade 1. SSC 2. HSC 3. UG 4. PG 5. Ph.D. 6. NET/SET 7. Any Other 8. 2) Present Position : Designation College From Basic Pay / Pay Band Grade Pay 3) T