Application for Senior Research Fellowship

Name in Block Letters: _______________________________________

Marital Status: Married/Single: ____________ Category: SC/ST/OBC/PH/Gen
Date of Birth: ____________ Age: Yrs. __________ Months: __________
Days: __________ as on 01.01.2017
Address for Communication:
__________________________________________________________
________________________________________________________________
Contact details: Phone: ________________Mobile No.: __________________
E-mail ID: ________________
Educational Qualifications ((from SSC/Matric onwards)
SN Exam Passed

University
/Board

Year of Passing GATE GATE

Passing Division score Qualified
Year

Experience Details:
SN

Post
held

Name of
Employer

Period
From

Nature of duty
To

Willingness to register for Ph.D. in the same department:

Describe the work done by you after post graduation (maximum five
sentences)
Any Other Information:
DECLARATION: I hereby declare that, the above furnished particulars are
correct and no information is suppressed.
Place: _____________ Date: ______________ Signature of the Candidate