JS S MA HA V I D YA PE E T H A

Jagadguru Dr. Sri Shivarathri Rajendra Circle, Mysore- 570 004

FORM OF APPLICATION FOR APPOINTMENT O F OFFICERS

Serial No.

Application for the post of Probationary Assistant Administrative Officers

1. (a) Name in full :

(in Block letters)

(b) Name of the Father :

2. (a) Permanent Address :

(b) Present Address :

3. (a) Age :

(b) Date of Birth :

(c) Place of Birth :

..2

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4. (a) Nationality : ____________ (b) Religion & Caste : ___________
(c) Sex : ____________ (d) Marital Status : ___________
(e) Languages Known : ____________

Speak Read Write

(f) Mother tongue : ________________

5. Academic qualification commencing from Matriculation or equivalent examination :

Name of the
University/ Class/Grade
Institution in Year of Specialization
Course Board/ if any with
which passing if any
Institution % of marks
studied

6. Experience Particulars :

No. of
Post held From To Institution/ Industry
years

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7. Membership of professional bodies :

8. List out the Sports, Games and other :

extra-curricular activities in which you
have participated

9 Give a list of honours/distinction/prizes :

in studies or sports if any

10. (a) Are you in service presently, : Yes/ No

If so give details of :

i) Name of the Employer

ii) Designation :
iii) Basic Pay & Gross Salary Drawn :
iv) Scale of Pay :
v) Total service in the present cadre :
:
11. Joining time required, if selected :

12. Additional information the applicant wishes to furnish if any –

13. List of enclosures : (a) Age proof Certificate

(b) Degree Certificates and Marks cards of all the years
(c) Experience Certificate
(d) Certificates relating to extracurricular activities
(e) Photos

I hereby declare that the statements made in this application are true and correct to the
best of my knowledge and belief .

Place :
Date : Signature of the Candidate

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