Form No.

Ph. D Programme in Management/Engineering

Application Form
Instructions

1. This form is an integral part of the admission process. Please provide correct information. Admission
granted on incorrect information will be ipso facto null and void.
2. Fill in the application form legibly. Incomplete forms shall not be considered.
3. Please attach true copies of certificates and mark sheets to this form.
4. In all matters regarding admission to the programme, the decision of the University will be final and
binding on the applicant. No correspondence from the applicant with respect to his/her non-selection will be
entertained. The admission process at the University shall be subject to the Jurisdiction of the courts of
Jaipur.
5. Enclose a demand draft for Rs. 500/- drawn in favour of "JK Lakshmipat University” payable at Jaipur. The
Application fee is non-refundable.

DD Details:
DD No.: Bank: Date:

A. Personal Details

Name (Block Letters): ______________________________________________________________________

First Name Middle Name Last Name

Address _________________________________________________
(For Correspondence):
_________________________________________________ PHOTO

_________________________________________________

____________________________ Pin _________________

Telephone (with STD Code): ____________________ Fax: ________________

Mobile:……………………………………………………………………...

E-mail:…………………………….…………………………………………

Gender: Male  Female  Blood Group: ______________

Date of Birth: Date ________ Month ________ Year ________

Age (as on 1.6.2017): __________ years

Nationality: ___________________________________________________________

Father’s /Guardian’s Name: ____________________________________________________

B. Education

Have you completed your Master’s Degree? Yes  No 

Class/
Marks Division
Name of Examination Max.
Obtained Awarded
(mention degree) University Year Major Subjects Marks for the
Total %
Degree
Master’s Degree

Bachelor’s Degree

Other Degree/
Examination

C. Work Experience (Only Full-Time Job)

Period
Sr.
Position Organisation From To Total No. of
No.
(month/year) (Month/year) Months
D. Research Experience
(List scholarly presentations, publications, studies etc.)

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(You may enclose extra sheets, if needed)

E. Scholastic Achievements

1. Prizes, distinctions, medals etc.

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F. Other Significant Achievements

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G. Future Plans

1. What are your future career plans? Why would you like to join the Ph. D. Programme?

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2. Do you have any tentative idea/s on the theme that you would like to explore for your Ph.D. Thesis?

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H. Any other information that you may wish to provide in support of your candidature?

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I. Declaration

I have carefully read the instructions and agree to abide by the decision of the Institute regarding my selection
to the programme. I certify that the information furnished in this application form is correct to the best of my
knowledge and belief.

Place: ________________________ __________________________

Signature of the Applicant

Date: ________________________