APPLICATION FORM FOR FACULTY / TRAINEES / CENTER MANAGER

DIVISION:
PREFERRED LOCATION:
Agra Gangapur City Mathura
Ahmedabad Guwahati Meerut
Aligarh Gwalior Nagpur
Aurangabad Haldwani Pune
Bareilly Jabalpur Rohtak
Bhilai Jammu Thane
Bhubaneswar Jhansi
ehradun !orba

ALL ENTRIES MUST BE IN CAPITAL LETTERS
Position Applied "or # Faculty / Trainees / Center Manager
$ub%e&t Applied "or # Physi&s'Mathemati&s'Biology'Chemistry (Physi&al) *rgani&) +norgani&,
Name #
Gender # Male ' "emale
ate o- Birth ('MM'...., #
"ather/s'Husband/s Name #
Marital $tatus # Married ' $ingle
Address #
City #
$tate #
P+N #
Residen&e Tel0 No (1ith $T,#
Mobile No0 (+- any, #
23mail #
Academic Perfrmance!
Name of
Institution
Year of
Passin
!ni"ersity#$oar%
Deree#Certificat
e
Disci&line 'ae C(PA
PG
4G
5++
Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA !"00# $Ra%.& IN'IA.
Te(.: $0)""& !"!10*), !"!"0*), !"!)+, !"!)* ,A-: $0)""& !".))*
Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj. !N"!A. Te#.: (0$44 2423245
%&ai#: ad&in'(an)a#.ac.in *e()i+e : ,,,.(an)a#.ac.in
Affix latest
Colored
Passport size
Photograph
It is Compulsory
IIT AIP)T
E"#erience $Starting frm Present %&'!
Name of Institution From
*))#YYYY+
To
*))#YYYY+
Post ,el% A"- $atc.
&er %ay
)e%ium Salary
Dra/n
Total 26perien&e (.ears,# 777777777777
$ignature# 7777777777777
Please bring a 8alid + proo- at the time o- +nter8iew0
+n &ase o- any work e6perien&e) bring e6perien&e &erti-i&ate and salary proo-0
Bring two passport si9e photographs0
Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA !"00# $Ra%.& IN'IA.
Te(.: $0)""& !"!10*), !"!"0*), !"!)+, !"!)* ,A-: $0)""& !".))*
Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj. !N"!A. Te#.: (0$44 2423245
%&ai#: ad&in'(an)a#.ac.in *e()i+e : ,,,.(an)a#.ac.in