-

CSIR- CENTRAL LEATHER RESEARCH INSTITUTE

Council of Scientific & Industrial Research

,, , Adyar, Chennai-600 020 Tamil Nadu, -India

FORM OF APPLICATION FOR APPOINTMENT BY SELECTION
Application No. (For Office Use):
Receipt date:

To be filled in by the candidate in his own handwriting.
All the columns should be properly filled in.
Incomplete application form will be rejected summarily.
: 1/2015
Advt. No.: 1/2015
Name of the Post
Junior Stenographer
Assistant ( General) Gr III
Assistant (Finance & Accounts) Gr III
Assistant (Stores and Purchase) Gr III

Affix recent signed

passport size
photograph

:
Particulars of application fee: Rs 100 /Post Code
JS1 1501
AG 1502
AFA 1503
ASP 1504

(For Assistant (AG 1502, AFA 1503, ASP 1504) Posts)

/ Applied Post/ Post Code

Preference 1

(Candidates belonging to SC/ST/ PWD/

Women /CSIR Employees are exempted
from submission of application fee.)
Fee Paid

(in case exempted please mention the

category)

SC

Preference 2
Preference 3

/ Exempted

ST

PWD Women CSIR Emp.

State Bank Collect Reference No:

___________________________

/ Applied Post/ Post Code

(Copy of SBI Collect Payment Receipt

must be attached with the application
form)

(If candidate is applying for both Junior Stenographer and Assistant

posts , separate application forms are required to be submitted)

For more information regarding Payment

through SBI Collect, please Refer
Appendix A.

(For Junior Stenographer Post)

1.

( )
Name in full (In BLOCK LETTERS): ____________________________________

2.

/
Fathers / Husbands Name

: ____________________________________

3. ( / )
4.

Gender (Male/ female)

: ____________________________________

( / )
Marital Status

: _____________________________________
Contd.2/-

-25.

()

Date and place of birth

(a) Date :______________________

()
(b) Place :______________________

6.

/ Address:
()
(a) Correspondence:
______________________________________________________

______________________________________________________

______________________________________________________
:

-:

Telephone No. _______________ E-mail ____________________

:
Mobile No._______________________
()
(b) Permanent
______________________________________________

______________________________________________

______________________________________________
7.

?
Are you a citizen of India by birth or by domicile ? ___________________________________

8.

Name of State to which you belong

9.

__________________________________

/ / ?
State whether you belongs to Scheduled Caste /Scheduled Tribe / Other Backward Class.
Yes
No
( )

SC

ST OBC GEN

PH

(Tick the appropriate Category)

, -
If so, attach an attested copy of the certificate in support of your claim.
A. Religion : _______________________

B. Category : _______________________
Contd.3/-

-310. Medium of Written Test (English/ Hindi)

( / )

:______________

Note: Candidate applying for Assistant posts will have to undertake Proficiency Test in the same medium of Written Test.

:
11. a. Medium of Type writing (English/ Hindi)
( / )

:______________

b. Speed in Type writing (in words per minute)

: ______________ w.p.m

( )
12. / :
Educational / Technical Qualifications: (From Matriculation Onwards)

Sl.
No

Name of
Examination

Board/
University

Year of
Passing

Subject (s)

/

Grade/Percentage/
CGPA

13. ( )
Details of employment (in chronological order) (if applicable):
Sl.
No

Organization

Post held

Nature of duties

Exact dates to be
given

Scale of pay
& last pay
drawn

From

To

( )
Total
Period
(in
years)

Contd.4/-

.-414. / ___________________________________________
Any other additional qualification/information
15. ?
Are you related to any employees of the CSIR? _________________________________
,
If so, give details.

_____________________________________

16. :
List of enclosures:
A recent Passport sized colour photograph of the candidate pasted on the form and signed across in full
Self attested photocopy of Date of Birth Certificate.
Self attested photocopies of educational qualification(s) certificate(s).
Copy of the SBI Collect payment reciept
.
Duly completed Admit Card and Synopsis
Self attested photocopy of Latest community certificate in the prescribed form issued by the Competent
Authority, if applicable.

DECLARATION
___________________________________________
,


I ___________________________________________
hereby declare that the statements made in the
application are true, complete and correct to the best of my knowledge and belief and in the event of any of the
information being found false or incorrect or any ineligibility being detected before or after the selection, my
candidature is liable to be cancelled and action initiated against me.

Place:

Date:
Candidates Signature
Full Name

CSIR - CLRI
Advt 1/2015
Recruitment of Junior Stenographer and Assistant Gr III
Synopsis
1
2
3

Name of the post

Post Code
Name

Fathers / Husbands
name
Date of Birth
Age as on 31/12/2014

Affix
a Recent Passport
size photo

Years
6
7

Category
(SC/ST/OBC/PH/Gen)
Educational Qualification

Exam passed

Technical Qualification

Months

Days

Year of
Passing

Board/ University

Class / %

10th / SSLC
+2/XII /
Intermediate
ITI/Diploma
Graduation
Others
Exam passed

Year

Board

Class

Medium
(English/Hindi)
Speed (w.p.m)
Employers name

Position

(Typewriting/Shorthand/
Computer etc.)

Type writing

10

Experience (if any)

11

Correspondence Address

12
13
14

Mobile No./ Land line No.

E-mail ID
SBICollect Payment
RefNo

15

Date:

From

To

Signature of the applicant

Candidates are requested to fill all the columns without leaving any blank. If there is no information to fill up, it
may be filled with Nil/NA.

To be filled by candidates in Block Letters

For Office Use

1. Post applied for

1. Roll No.
2. Date of
Examination

2. Name

Photograph

3. Date of Birth
4. Sex
5. Category
6.Medium of
Examination
(English/Hindi)

-
CSIR- CENTRAL LEATHER RESEARCH INSTITUTE

Council of Scientific & Industrial Research
,, ,Adyar, Chennai-600 020 Tamil Nadu, -India

Advt No. 1/2015 : Recruitment of Assistants(Gen/F&A/S&P) and Jr. Stenographer

Admit Card
To be filled by candidates in Block Letters
Name :
Address :
------------------------------------------------------------------------

For Office Use

1. Roll No

----------------------------------------------------------------------------------------------------------------------------------------------Pincode:
1. Post Applied
for:

2. Date of
Examination

3. Venue of Examination

2. Name
Photograph

3. Date of Birth
4. Sex
5. Category
6.Medium of
Examination
(English/Hindi)

Signature of the Candidate

Signature of the Examiner