INDIAN INSTITUTE OF SCIENCE EDUCATION AND RESEARCH MOHALI

(Established by the Ministry of Human Resource Development, Govt. of India) Sector 81, Knowledge City, P. O. Manauli, S.A.S. Nagar, Mohali, Punjab-140306

APPLICATION FOR THE POST OF ________________________

1.

Advt. No. & Date

Recent Passport size photograph (5 cm X 4.5 cm) to be affixed.

2.

Name in Full (Capital Letters)

3. Date of Birth (enclose copy of 10th Class/ Matriculation Certificate) 4. Citizenship Status (tick the appropriate box)

Day

Month

Year

Citizen of India by Birth by Domicile

5. Member of Scheduled Caste/ Scheduled Tribe/OBC/PD

Write SC or ST/OBC (Attach Certificate) 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 9. Details of Educational Qualifications starting from 10 th Standard/ Matriculation Name of the Examination/ Board/College/University Degree Subjects (Class / Division/ Percentage) Year of Passing

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 (In the scale of )

Minimum Basic Pay expected (in the present scale offered)

Time required to join if offered the post

12. Names of Referees (for Group A Posts only) Name and Designation (a) Current Address

(b) (c)
In the case of Group A Posts, Referees' reports have to be sent to the Registrar by email : registrar@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 canceled/terminated. Place : Date : 16. Endorsement of the Present Employer : Signature of the Applicant

The application of Shri / Ms. __________________________________(Name and Designation of the applicant) for the post of ________________________________, at IISER Mohali is forwarded to the Registrar, Indian Institute of Science Education and Research Mohali, Sector 81, Knowledge City, P. O. Manauli, S.A.S. Nagar, Mohali, Punjab-140306
Date: Signature of the Head of the Institution with Seal