Personal Details
3. Name of the candidate (As in Matriculation Certificate , initials must be at the end)
4. Email Address
5. Gender
Male
Female
6. Date of Birth
dd
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Month
January
February
March
April
May
June
July
August
September
October
November
December
yyyy
1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
7. Nationality
- - - Select - - -
Indian
8. State/UT
- - - Select - - -
Andaman and nicobar Andhra pradesh Arunachal pradesh Assam Bihar Chandigarh Chattisgarh Dadra and nagar Daman and diu Delhi Goa Gujarat Haryana Himachal pradesh Jammu and kashmir Jharkhand Karnataka Kerala Lakshdweep Madhya pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil nadu Telangana Tripura Uttar pradesh Uttarakhand West bengal Others
9. Religion
- - - Select - - -
Hindu Christian Muslim Sikh Buddh Jain Others No religion
10. Vacancy Category
- - - Select - - -
11. Are you claiming age relaxation (applicable to those other than SC/ST/OBC) ?(As per Govt. of India Orders)
Yes
No
a. If yes, enter details
12. Are you a Permanent Employee of this Institute (SCTIMST)
Yes
No
a. If yes, enter Employee Code
13. Address for Correspondence
House Name / No :
Place :
Post Office :
District / City :
State :
- - - Select - - -
Andaman and nicobar Andhra pradesh Arunachal pradesh Assam Bihar Chandigarh Chattisgarh Dadra and nagar Daman and diu Delhi Goa Gujarat Haryana Himachal pradesh Jammu and kashmir Jharkhand Karnataka Kerala Lakshdweep Madhya pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil nadu Telangana Tripura Uttar pradesh Uttarakhand West bengal Others
Pincode :
14. Permanent Address(Same as above - Change to √ )
House Name / No :
Place :
Post Office :
District / City :
State :
- - - Select - - -
Andaman and nicobar Andhra pradesh Arunachal pradesh Assam Bihar Chandigarh Chattisgarh Dadra and nagar Daman and diu Delhi Goa Gujarat Haryana Himachal pradesh Jammu and kashmir Jharkhand Karnataka Kerala Lakshdweep Madhya pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil nadu Telangana Tripura Uttar pradesh Uttarakhand West bengal Others
Pincode :
15. Contact Number( With STD code )
a. Landline :
b. Mobile :
16. Father's
a. Name :
b. Occupation :
c. Address :
17. Are you Married?
Yes
No
If yes, enter Name of your Spouse
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Details of Educational Qualification/Experience
18. Are you a Professional Certificate Holder (Medical Graduate/Nurse/Pharmacist etc.)?
Yes
No
Reg.No.
Date
State
- - - Select - - -
Andaman and nicobar Andhra pradesh Arunachal pradesh Assam Bihar Chandigarh Chattisgarh Dadra and nagar Daman and diu Delhi Goa Gujarat Haryana Himachal pradesh Jammu and kashmir Jharkhand Karnataka Kerala Lakshdweep Madhya pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil nadu Telangana Tripura Uttar pradesh Uttarakhand West bengal
19. Select your Educational Qualification/Experience for the post
16. Minimum Educational Qualification/Experience for the post
[ Enter the details of educational qualification from Std. X ]
20. Select educational qualifications from standard X onwards
Add Row (click 'Add Row' button to enter more qualification details).
21. Enter additional educational qualifications not included in Sl. No. 19, if any.
Add Row (click 'Add Row' button to enter more qualification details other than above).
Details of Academic Work
Research - Publications (excluding Review Articles, Conference Abstracts and Book Chapters), Teaching, Service, Leadership/ Organizational Qualities, National/International Awards/Recognitions, Fellowships, Presentations, etc. may be submitted in separate sheets along with Hard Copy of the application.
22. Select whether the required experience is obtained AFTER acquiring essential qualifications (as applicable)
Yes
Not Applicable
23. Details of Experience
Add Row (You can add or remove the rows while entering your experience details by clicking 'Add Row'/'Delete Last Row'(as required) buttons. Click 'Next' button to go to STEP - 5).
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