8/9/2019 Www.esic.Nic.in CV Form Rec Civil 28.1.2015

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  PPEND IX II

  UR RI U LU M V IT E P RO FO RM

1.

Name and

Address

 in Block Letters)

2. Date

of

Birth

 in Christian era)

3. Date

of

retirement under

Central

State Government

Rules

4 Educational Qualifications

 

Whether Educational and other

qualifications required for the

post

are

satisfied. if

any

qualification has been treated

as

equivalent

to the one

prescribed in the Rules, state

the authority for the same)

Qualifications/

Qualifications/

Experience

Experience possessed by the officer

Required

Essential

 1)

 2)

 3)

Desired

 1)

 2)

6

Please state clearly whether in

the light of entries made by

you above, you meet the

requirement of the post

 

Details of Employment, in chronological order.

Enclose a separate sheet duly authenticated by your signature, if

the space below is insuff icient

Office/Institution

Post held

From To Scale of Pay and Nature of duties

Basic Pay in detail)

8

Nature of present employment

i.e.

Ad-hoc or

Temporary or Quasi-Permanent or Permanent

9

In case the present employment is held on deputation/

contract basis, please state:-

 a) The date of initial appoi tment

 b) Period of appointment on deputation/contract

 c) Name of the parent office/organization to which

you belong

10.

Additional details about present employment.

Please state whether working under indicate

the

name of your employer against the relevant column)

 a)Central

Government.

 b)State

Government

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WW

c)

Autonomous

 d )

Government

Organization

 e)

Universit ies

Undertaking

 f) O thers

  l

Please state whether you are w orking in the sam e

Departm ent and are in the feeder grade or feeder to

f ee d er g ra d e

  2

A re you ~n R evised S cale of P ay? If yes, g ive the date

from whlc~ the revision took place and also indicate

t he p re -re vis ed s ca le

  3

T ota l e mo lu me nts p er m on th n ow d ra wn

  4

In

case of other than C entra l Governm ent pay

s tru ctu re e qu iva le nt p ay a nd C en tra l G ov ern me nt m ay

a ls o b e i nt im a te d

  5

A dd it~ on ~1 in fo rm atio n, if a ny , w hic h y ou w ou ld lik e to

m en tio n In s up po rt o f yo ur su ita bility fo r th e p os t.

 T his a mo ng o th er th in gs m ay p ro vid e in fo rm atio n w ith

regard . to i) .a~ ditional academ ic qualifications ii)

p ro fe ss io na l tra in in g a nd iii) w ork e xp erie nc e o ve r a nd

above prescribed in the Vacancy C ircular/

A dv ertis em en t) N ote : E nc lo se a s ep ara te s he et, if th e

space is insu f fi c ien t ).

  6

P le as e s ta te w he th er y ou a re a pp ly in g fo r d ep uta tio n

  IS T C)/ A b so rp ti on /

re -e m plo ym en t B as is .

 Officers

u nd er C en tra l S ta te G ov ern me nts a re o nly e lig ib le fo r

+Absorpt ion+.

candidates

of

non=Government

Organizations

ar e

eligible

only

fo r

Shor t

Term

Contract.)

  7

W h eth er b elo ng s to S C/S T

  8

R em ark s T he c an did ate s m ay in dic ate in fo rm atio n

w ith regard to i) R esearch publications and reports

a nd s pe cia l p ro je cts  ii) Awards/ Scho la r ship /O f fi c ia l

A p pr ec ia ti on i ii) A ff ili ati on w it h t he p ro fe ss io na l b od ie s/

in stitu tio ns / so cie tie s a nd iv) a ny o th er in fo rm atio n

Note:

Enclose

a

separate

sheet

if the

space

is

insuff icient)

 have care fu ll y gone th rough the vacancy c i rcu la r l advert isementand   a m w e ll a w a re t ha t t he C u rr ic u lu m V i ta e d u ly

s up po rt ed b y d oc um e nts s ub m itt ed b y m e w il l a ls o b e a ss es se d b y th e S e le ct io n C o m mi tt ee a t t he ti me o f s ele ct io n f or th e

post.

S ignatu re o f the Cand ida te

Address- · · · · · · · · · · ·_ · · ·

Date__

Countersigned

  Employerw i th Sea l)