PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGY

Bengal Pailan Park,Phase-I,

Amgachia Road, (off Diamond Harbour Rd.),
Joka, Kolkata 700104.

APPLICATION FORM
Please complete each and every part,( put NA if any item is not applicable
for the applicant) of application form and submit on-line

Post Applied for

1. Name of Candidate in full

(Block Letters only)

2. Address
(a) Permanent

(First name)

( Middle name )

PIN
(b) Present

Phone

PIN
3. Contact Number
(a) For applicant

(b) For Father / Guardian

4.(a) Date of Birth

(b) Place of birth

: Land Line :

Mobile

E-mail

: Land Line :
Mobile

E-mail

: Dist.
State
Country

(c) PAN Number

(d) Addhar Card No.

5. Candidates Nationality

Phone

(dd / mm / yyyy)

Insert
Your
Photo

( Last name )

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGY

Bengal Pailan Park,Phase-I,
Amgachia Road, (off Diamond Harbour Rd.),
Joka, Kolkata 700104.

6. Religion

7. Caste

: General

SC

8. Sex

Male

Female

(please )

9. Marital Status

Married

Unmarried

(please )

10. Fathers Name &

Mothers Name

11. Husbands/Wifes Name

ST

OBC

(please )

(if married) & Occupation

12.Childrens Age & Sex

: 1.

13.(a) Candidates mother

tongue
(b) Other language known

Yrs.(M/F) 2.

Yrs (M/F)

3.

Yrs (M/F)

(Speak Read & Write)

14. Academic Qualification

Examination / Degree**
(Please specify)

Secondary or Equivalent
Higher Secondary Or
Equivalent
Graduate level : B.E /
B.Tech / B.Sc / BA/
B.Com / BCA / BBA
Post Graduate Level
ME / M.Tech. / M.Sc./
M.Com / MA / Equiv.
B.Ed / M.Ed. / Equiv.
Doctoral ( Ph.D / D.Sc)
NET / GATE / SLET

Area of
Specialization

Name of Institute /
college

Board / Council /
University

Year of
passing

Division
Class
(% marks)

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGY

Bengal Pailan Park,Phase-I,
Amgachia Road, (off Diamond Harbour Rd.),
Joka, Kolkata 700104.

** Degree on distance mode should be mentioned.

15. Extra Curricular Activities:

16. Experience Profile (Starting with appointment immediately before the present one)
Sl.
No.

Employers Name & Address

Designation

Date of
Joining /
Leaving

Experience
Teaching

Industry

Research

I
II
III
IV
V

17. Present Employment :

(a) Name and address of present employer:

(b)Date of joining and position held

(c) Present remuneration

Basic pay

details (in Rs / month) as per following:DA

HRA

Medical

Other
Reimbursable

(d) Expected joining time (in the event of selection)

(e) Expected salary Rs.

per month.

Gross Salary

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGY

Bengal Pailan Park,Phase-I,
Amgachia Road, (off Diamond Harbour Rd.),
Joka, Kolkata 700104.

1818. Academic Activities:

(a) Publications :
(Indicate numbers only)
(i) Research papers

(ii) Books :

(a) National

Nos

(b International

Nos

(c) Patents
(Edited Volumes:

Nos

19. What are your significant

Professional achievements?
20. Two Referees who should be responsible persons not related to you and known to you in a
professional capacity.
Sl. No.

Name Designation & Organization

Address

Mobile No.

1
2

21. DECLARATION
I declare that the statements made in this form are true to the best of my knowledge and belief.
Date :
Place:

_______________________________
(Name of the Candidate)