Annexure – DPage - 01

PROFORMA FOR APPLICATION FOR TEACHING POSTS

Post applied Subject

FULL NAMEIn Capital letters

SexM /

FSUR NAME FIRST NAME SECOND NAME

POSTALADDRESS

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

City : ____________________ Dist : _____________________ Pin Code : ________________

CONTACTDETAILS

Phone : ______________________________________ Cell No. _____________________(With STD code)

e-mail : ___________________________________________________________________

BIRTH DATEAS PER SSC

CERTIFICATE

In Numerical : / /19

In Words : ___________________________________________________________________

Completed Age (on last day of applications) : Years - Months - Days –

Religion : Category : SC / ST / VJNT / SBC / OBC / OPEN Caste :

NATIONALITY :- DOMICILE :-

QUALIFICATIONS ( Attach attested true copies of all relevant Certificates)

COURSE Name of the Course Board / University PassingYear

% ofMarks

Class /Grade

Attempt takento pass the

course

HSC

MBBS

M.Sc.

PG Diploma(if any)

PGDEGREE

DNB

Super Speciality(if any)

Ph.D

OTHER(Please Specify)

Annexure – DPage – 02

EXPERIENCE(Attach all relevant Certificates & Approvals. Starting form Present / Latest job at Sr. No. 01)

Sr.No. Name of the College Designation

/ Post heldPeriod of Experience MUHS Approval

Letter No. & DateFrom To Duration

01

02

03

04

05

Sr.No.

Research Activities / Paper Publications in index Journals as First orSecond Author only

(State Briefly. Attach Separate list & details, if required)

Tick the appropriate boxStateLevel

NationalLevel

InternationalLevel

01

02

03

04

05

Registration State Council : Other :

MUHSActivities(State Briefly)

OtherActivities(State Briefly)

DATE : APPLICANT’S SIGNATURE

NOTE:1. Attach attested true copies of all necessary documents. Please attach separate sheet, if required.2. Attach attested true copy of Caste Certificate & Caste Validity Certificate, if applying for Reserved Posts.3. Attach the true copy of Non-Creamy layer Certificate for current Financial Year, wherever applicable.4. In-service candidates shall apply through proper channel or submit NOC at the time of Interview.5. Application should be complete in all respect. Write Not Applicable in the column which are blank.