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NATIONAL INSTITUTE OF TECHNOLOGY DURGAPUR MAHATMA GANDHI AVENUE DURGAPUR -713209(WEST BENGAL)
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APPLICATION FORM (FOR NON-TEACHING POSTS) NOTE: (Incomplete applications may be reiected) Adv. No. & date of publication Post applied for
01. Name of the Candidate in full (In Block letters) 02. (a) Present address with Contact No, Email ID

(b) Permanent Address

03. (a) Date of Birth (With Supporting documents) (b) Age as on 15/07/2013 (Relaxation of age as per GOI norms)

04. (a) Religion, Caste, Sex 05. 06. 07. 08. Whether belongs to SC/ST/OBC Category(with Supporting documents) Father'siHusband's Name, Address and Occupation Nationality Marital status

09. (a) Candidate's mother tongue

contd

2.

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(b) Other language Known (He/She can speak, read and write)

10.

Academic Qualification
Name of University or other examination body 2 Year Subjects Marks obtained Div. with % of marks.

Name of the Examination/Degree Passed

II.

TechnicalIProfessional Qualification
Name of University or other examination body 2 Year Subjects Marks obtained Div. with % of marks.

Name of the Examination Passed

contd

3.

3 12. SI.No. Work Experience Name and address of employer 2 ( Starting from Present Organization) Nature of Post Date of Joining 4 Date of leaving 5 Salary, Basic & allowance 6 Reasons for leaving the post 7 Remarks if any 8

13. 14.

If higher initial salary is expected grounds for such salary. Any other work done relevant to the Qualificationfor the post applied for Since leaving college, with duties.
List of attested testimonials from school or college authorities, or former employers, attached with the application, originals to be produced when required

15.

1. 2. 3. 4. 5. 6.

contd

4.

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Names, address and professions of two referees, who should be responsible persons and related to the candidate but well acquainted with him in private life, and not connected with his school or college. Name & Profession of referee 2 Address 3 Period for which he has known the candidate 4

S1.No. I

17.

18.

Name & Address of the Employment Exchange and Registration No. with date. Details of Application Fee:
Bank Draft of Rupees

(in words), Bank Draft No. Drawn on:

Dated

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DECLARATION
I declare that the entries mode in this form are true to the best of my knowledge and belief.

Date Signature of Candidate N.R. : Paper and documents submitted with the application will not be returned.

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