Internet Edition No.

Vidyasagar University
Midnapore 721 102
Employment Application Form Attach Signed
Photograph

Candidate is requested to fill in the form. He/She may attach extra

sheets where necessary (incomplete and wrongly field in application
form will be rejected).

1. Employment Notification No.: Dated:

2. Post applied for (separate applications are to be submitted for different posts):

3. Bank Draft enclosed for Rs. ___________ No./Nos. __________________ Dated _____________
(to be made out in favour of ‘Vidyasagar University’ payable at Midnapore)

4. Personal Data

Name (in block letters):

Father’s/Mother’s/Spouse’s Name:

Date of birth: Age: Marital Status:

Address:
Permanent:

Mailing:

Whether SC/ST/OBC or Physically Handicapped:

(attach certificate from appropriate authority)

5. Academic Record

Examination Year Institute/ Subjects Special Division % Marks Rank or Remarks

Board/Council/ Paper, if or Class Medals if
University any any
 6. a) Employment Record

Institution/Organisation Post Date of Date of Scale of Pay Basic Pay Remarks if

Joining leaving any

6. b) Present Basic (where applicable): Rs.

c) Minimum Basic pay Expected: Rs.

7. a) Professional Experience:
(for candidates from outside the university system)

b) Administrative Experience:
(where applicable)

8. a) Research Degree / Degrees (if any)

(attach extra-sheet if necessary)
Title of Thesis:
Date of submission:
Date of award:
Institute / University:

b) Any other relevant information including UGC / CSIR NET or accredited State Level Test:

Year of qualification:

c) i) Research Experience
Predoctoral :
Postdoctoral :
Projects, etc. :
 ii) Publications (give list on a separate sheet)
Number : in professional :
in book form :
in edited books:
book chapters :

iii) Research Guidance

Number : at Master’s level:
M.Phil. level :
Ph.D. level :
In Projects :
d) Participation in Seminars and Conference (give list on a separate sheet)

Number : in Regional / National :

International :

9. Other relevant information

10. Names and Addresses of two Referees (not related to the candidate)

1.

2.

Declaration

I hereby declare that the information given above is true to the best of my knowledge and belief.

Date: Candidate’s Signature