Form - A

CASH COUPON NO.

FOR Rs.

DATE

VISVA-BHARATI

D. D. No. ____________
Name of Bank.

for Rs. _______

Photograph

____________________

APPLICATION FORM FOR EMPLOYMENT

(For posts other than Associate Professor & Professor)
1. _____________________________
Advertisement No.

2. _____________________________________
Post (Name and Serial No.)

3. _____________________________
Scale of pay

4. _______________________________________________________
Applicants Name (in block letters) with contact phone number(s)

5. ____________________
Date of birth

6. _______________________________________________________________________________________________
Present address (in full) with e-mail I.D.
7. ___________________________
Nationality

8. _______________________________________________________
Whether belonging to SC / ST / O.B.C. /PH /Ex-Servicemen / Meritorious
Sports Persons ; (Copies of evidence to be enclosed )

9. ___________________________
Religion
10. ______________________________________________________________________________________________
Mothers and Fathers / Husbands Name, Address and Occupation (if dead, state last address and occupation before
death)
11. ______________________________________________________________________________________________
Permanent address (in full) with nearest Railway Station
________________________________________________________________________________________
12. Educational qualifications :
Name of the School
with Board / Council,
College and University

Examination
passed

Full
Marks

Marks
Obtained

Class or
Division

Marks
obtained in
percentage

Year

Subjects of
studies

Contd. Page 2

13. Details of publication

Date of
Publication

Title

Name of the Coauthors, if any

Name of the
Journal

Volume and
Pages

Remarks

14. Particulars of experience in reverse chronological order (starting from present employment).
Name of
Organisation/Institution

Position Held

Scale of pay &

other allowances

Duration
From
(Date)

Nature of
work

Reason for
leaving

To
(Date)

15. Specify additional qualifications / experience

( Sports, Music, Literary and Social Activities etc. )
_________________________________________________________________________________________________

Contd. Page 3

3
16. Special interest or hobbies, if any
_____________________________________________________________________________________________
17. Give names of two referees, not related to you, with full address.
Name

Name

Occupation :

Occupation :

Address :

Address :

Phone No. :

Phone No. :

Fax

Fax

e-mail

e-mail

________________________________________________________________________________________
18. Are you a past student / worker of the Visva-Bharati? (pl. indicate dates and other details)
________________________________________________________________________________________
19. Have you any relations already serving in Visva-Bharati?
________________________________________________________________________________________
20. Would you be prepared to live with the students in their dormitories?
( Only in case of an applicant for a teaching post )
________________________________________________________________________________________
21. What other voluntary work may be expected from you, if appointed?
________________________________________________________________________________________
22. Are you married? If so, have you any children? Give details.
________________________________________________________________________________________
23. Are you free from debt?
________________________________________________________________________________________
24. Are you willing to accept the minimum initial
pay, if offered ? If no, state what is the lowest
initial pay that you would accept.
In case of pay protection submit L.P.C.
________________________________________________________________________________________
25. If appointed what notice period you require for joining the post. ?
26. I declare that the above particulars are true and correct. Should any of the informations / documents / statements
turn out to be incorrect or false, the appointment is liable to be terminated.

Date
Note:
1.
2.
3.

4.
5.

_____________________________________________
Signature of the Applicant

Where space provided in the form is found to be inadequate, annexures may be given quoting serial numbers
under which additional information is supplied.
Visva-Bharati does not hold itself responsible to fill up the post advertised if the post advertised is not filled up.
One set of attested true copies of academic certificates, mark-sheets, caste certificate , froof of birth and other
testimonials and two copies of recent photographs (passport size ) should accompany the application, in all
cases. (No certificates, testimonials are required to be given with the12 photo copies of application forms.
The University may raise the standard of qualification, experience etc. at its discretion.
Attestation can be done by Dean/Registrar/Finance Officer/Proctor/Principal/Professor/Associate Professor
/Assistant Professor/Group-A officer of a University; Gazetted /Group-A officer of Govt; Principal of a college;
Principal/Headmaster of a recognized and affiliated High School.