U. S.

OSTWAL GROUP OF COLLEGES, MANGALWAD

(A UNIT OF U. S. OSTWAL EDUCATION SOCIETY)
APPLICATION FORM FOR THE TEACHING POST
(Please fill up separate form for each post)

Advt. No.: _______________________ Post No.: ______________________Post applied for:

___________________________

(A) PERSONAL INFORMATION:

1. Name (in block letters) Dr./Mr./Ms.____________________________:

2. Date of Birth : ________________________________
3. Father's Name : ________________________________
4. Husband Name : ________________________________ PASTE
5. Gender : ________________________________ COLOUR
6. Mobile No. : ________________________________ PHOTOGR
7. Alternate Contact Number : ________________________________ APH
8. Email Address : ________________________________
9. Marital Status : ________________________________ Signature
10. State of Domicile_______________:
11. Nationality______________________:
12. Religion_________________________:
13. Permanent Address____________:
________________________________
________________________________
Pincode: _____________________
(B) EDUCATION QUALIFICATION: (Starting with highest degree obtained)

Examination/Deg Board/Universi Year of

Subject(s) Percentage
ree ty Passing

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(1)Title of Ph.D. Thesis and year of submission/award:

_________________________________________________

_____________________________________________________________________________________
_____________________________

_____________________________________________________________________________________
_____________________________
(2)Whether qualified UGC/CSIR/JRF Test/SLET
___________________________________________________________ (If Yes, indicate the
year and attach a photocopy of NET/SLET Certificate)

(3)Details of Employment: (in Chronological order starting with the most

recent)

Basic
Salary last
Designatio Period Nature of drawn and
Institution To
n From Duties pay scale
(Attach
Certificate)

Note: Please attach self attested photocopies of degrees, diploma and

other documents relevant to experience.

(4)Experience : Teaching ________ Years, Research (excluding M.Phil./Ph.D.

research) _______ Years

Total: ______ Years (Note: Please ensure that the periods of teaching and
research experiences claimed do not overlap)

(5)Please indicate how you satisfy the essential qualifications prescribed for
the post:

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(6)Publications : (Give details of each publication)

Books Accepted for

Published Communicated
Publication
 Research
Paper/Articles

N.B. Please attach a separate sheet listing Books/Articles under each of

the above mentioned categories. In those cases where they have been
published, please mention the title, name of the publisher/name of the
journal, year of publication, whether written in collaboration (Submit first
page as proof) etc. In the absence of these details, the information
furnished under this column will not be given any consideration.

(7)Mention briefly your experience/activities under the following heads,

including the positions held, any:

(a)Administration

(b)Extra-curricular activities

(8)(a) Have you been punished during your studies at College/University. If

so, give details:

______________________________________________________________________________________

______________________________________________________________________________________

(b) Have you been punished during your service, if any, on Gender
related/Caste discrimination issues etc. or convicted by a Court of Law. If
so, give details.

______________________________________________________________________________________

______________________________________________________________________________________

(c) Do you have any case pending against you in any Court of Law? If yes,
give details:

______________________________________________________________________________________
______________________________________________________________________________________

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(C) MISCELLANEOUS DATA:

(1)Write minimum acceptable pay.

__________________________________________________________________________________
 (2)If selected for appointment, what notice period would you require for
joining the post?
__________________________________________________________________________________

(3)Name and Address of two Referees:

(i) (ii)

Two references, not related to the applicant.

Date: _____________ (Signature of the Applicant)

Note: In case there is any subsequent change in the contact

address/telephone number etc., please inform the Director General, U. S.
Ostwal Group of Colleges, indicating the advertisements No. & the post
applied for.

DECLARATION:
I hereby declare that the information given by me in the Application is true,
complete and correct to the best of my knowledge and belief and that
nothing has been concealed or distorted. If at any time, I am found to have
concealed/distorted any information or given any false statement, my
application/appointment shall liable to be summarily rejected/terminated
without notice or compensation.

Date: ______________ (Signature of the applicant)