INDIAN INSTITUTE OF SCIENCE EDUCATION

AND RESEARCH MOHALI

MGSIPAP Complex Sector 26, Chandigarh- 160 019

APPLICATION FOR THE POST OF ________________________

Recent Passport
size photograph
(5 cm X 4.5 cm) to
be affixed.
1. Advt. No. & Date

2. Name in Full (Capital Letters)

3. Date of Birth Day Month Year

(enclose copy of 10th Class/
Matriculation Certificate)

4. Citizenship Status Citizen of India

(tick the appropriate box)
by Birth by Domicile

5. Member of Scheduled Caste/ Write SC or ST/OBC (Attach Certificate) -

Scheduled Tribe/OBC/PD

Please indicate whether Ex Serviceman /

Person with Disability.
6. Address to which communications
should be sent (Also furnish email,
fax, telephone number, if any)
7. Permanent Home Address

8. Name and Address of Father/ Husband

(Incase of married Please mention the
name of husband)
9. Details of Educational Qualifications starting from 10th Standard/ Matriculation
Name of the Examination/ Subjects (Class / Division/ Year of Passing
Board/College/University Degree Percentage)
10. Experience in chronological order upto the present post
Organization Designation From To Scale of Pay Experience in the field of

11. Present Basic Pay Minimum Basic Pay expected Time required to join if offered the post
(In the scale of ) (in the present scale offered)

12. Names of Referees (for Group A Posts only)

Name and Designation Current Address
(a)

(b)

(c)
In the case of Group A Posts, Referees' reports have to be sent to the Director by email: director@iisermohali.ac.in
or by post.

13. D.D. No.____________ Dated_____________Name of Bank________________Amount (in Rs.)______

14 Any other relevant information (attach sheets if necessary)

15. I hereby declare that the information given above is correct to the best of my knowledge and belief and I
fully understand that if it is found at a later date that any information given in the application is incorrect/ false
or if I do not satisfy the eligibility criteria, my candidature / appointment is liable to be cancelled/ terminated.

Place :
Date : Signature of the Applicant
16. Endorsement of the Present Employer :

The application of Shri / Ms. __________________________________(Name and Designation of the

applicant) for the post of ________________________________, at IISER Mohali is forwarded to the
Director, Indian Institute of Science Education and Research Mohali (MGSIPAP Complex, Sector-26,
Chandigarh 160 019).

Date: Signature of the Head of the Institution with Seal