APPLICATION FORM FOR FACULTY DIVISION: IIT AIPMT

PREFERRED LOCATION: [ MARK 1, 2, 3 ] JAMMU DEHRADUN NAGPUR MEERUT AHEMEDABAD PUNE THANE AURANGABAD

BHILAI GANGAPUR CITY HALDWANI KOTA

Affix latest Colored Passport size Photograph It is Compulsory

ALL ENTRIES MUST BE IN CAPITAL LETTERS Position Applied For : Faculty Subject Applied For : Name : Gender : Male / Female Date of Birth (DD/MM/YYYY) : Fathers/Husbands Name : Marital Status : Married / Single Address : City : State : PIN : Residence Tel. No (With STD): Mobile No. (If any) : E-mail : Academic Performance: Name of Institution PG UG XII Year of Passing University/Board Degree/Certificat Discipline e %age CGPA Physics/Mathematics/Biology/Chemistry (Physical, Organic, Inorganic)

Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2421097, 2424097, 2423738, 2423739 FAX: (0744) 2436779 Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2423245 Email: admin@bansaliitjee.com Website : www.bansaliitjee.com

Teaching Experience (Starting from Present Job): Name of Institution From

(MM/YYYY)

To
(MM/YYYY)

Post Held

Avg. Batch per day

Medium

Salary Drawn

Total Experience (Years): ____________ Signature: _____________ Please bring a valid ID proof at the time of Interview. In case of any work experience, bring experience certificate and salary proof.

Bring two passport size photographs.

Corporate Office: A-10 Gaurav Tower, Road No. 1, IPIA, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2421097, 2424097, 2423738, 2423739 FAX: (0744) 2436779 Regd. Office : 2-K-15, Vigyan Nagar, KOTA 324005 (Raj.) INDIA. Tel.: (0744) 2423245 Email: admin@bansaliitjee.com Website : www.bansaliitjee.com