APPLICATION FOR STAFF SELECTION
NAME IN CAPITAL LETTERS [as in the SSLC certificate]
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SEX
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-- Select Sex--
MALE
FEMALE
THIRD GENDER
DATE OF BIRTH
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AGE
PLACE OF BIRTH
DISTRICT
RELIGION
CASTE CATEGORY
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GENERAL
SCHEDULED CASTES (SC)
SCHEDULED TRIBES (ST)
OTHER BACKWARD CLASSES (OBC)
OTHER ELIGIBLE COMMUNITIES (OEC)
COMMUNITY
DIOCESE
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PARISH
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PARISH PRIEST NAME
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PARISH PRIEST PHONE NUMBER
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PHYSICAL DISABILITY :
Yes
No
PHYSICAL DISABILITY CERTIFICATE
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DISABILITY DETAILS
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PERMANENT ADDRESS
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CONTACT ADDRESS
EMAIL
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PHONE NUMBER (LANDLINE)
MOBILE NUMBER
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WHATSAPP NUMBER
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POSITION APPLIED FOR
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-- Select Applied Post --
Guest Lecturer
DEPARTMENT
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-- Select Department --
DD Reg. No
PLEASE ENTER THE POSITION SOUGHT FOR
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DEPARTMENT
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Select
Reg. No. from Ernakulam DY. DCE
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PARENT DETAILS
PARENTS
NAME
EDUCATION
OCCUPATION
REMARKS
MARTIAL STATUS
SINGLE
MARRIED
DIVORCE/SEPARATED
NAME OF SPOUSE
HOUSE NAME OF SPOUSE
IF MARRIED,EDUCATIONAL QUALIFICATION OF SPOUSE
OCCUPATION OF SPOUSE
HAVE YOU APPLIED FOR ANY OTHER JOB?
Yes
No
IF YES, DETAILS
IF APPOINTED,MINIMUM PERIOD OF ASSURED SERVICE
IF YOU ARE APPOINTED , WHAT IS YOUR INSPIRATION FROM OUR VISION AND MISSION STATEMENTS AND WHAT COULD YOU CONTRIBUTE TOWARDS ACHIEVING THEM
LANGUAGES KNOWN:
LANGUAGES KNOWN:
READ
WRITE
SPEAK
EDUCATIONAL QUALIFICATIONS (ENCLOSE ATTESTED COPIES OF CERTIFICATES):
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QUALIFICATION
INSTITUTION
/
COLLEGE
BOARD
/
UNIVERSITY
SUBJECT
YEAR OF PASSING
No. OF ATTEMPTS
CLASS/GRADE
% OF MARKS
EMPLOYMENT HISTORY (BEGINNING WITH THE LATEST):
ORGANISATION
DESIGNATION
FULL TIME/PART TIME
PAID/HONORARY
IF PAID,SCALE OF PAY
PERIOD
NAME & PH. NO.OF SUPERVISOR
RESEARCH PUBLICATIONS(Peer-reviewed or UGC care listed Journals):
INTERNATIONAL
NATIONAL (Nos.)
REGIONAL
PROCEEDINGS WITH ISSN
ANY OTHER
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Research Score:
REFERENCES (NAME & PHONE NUMBER):
NAME
PHONE NUMBER
DETAILS OF EXTRACURRICULAR ACTIVITIES :
REFERENCES (NAME & PHONE NUMBER):
NAME
PHONE NUMBER
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2.Image should be in jpg format
3.Size of Image should be between 60kb and 100kb
I hereby declare that the information furnished above is true to the best of my knowledge.
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