Central University of Kerala

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Application Format (For Non-Teaching positions other than Assistant

Librarian)

Application for the post of

1. Advertisement No. & date

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2. Name of the Applicant (in block letters) :

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3. Name of the Father /Husband/Wife

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4. Telephone/Mobile number

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5. E-mail I D

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6. *Date of Birth & Age

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7. Present address for correspondence

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...........................................................
...........................................................

8. Permanent Home Address

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...........................................................
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9. Place of birth

........................... District: ..................

State :..................

10. **Academic/Professional qualifications (Please attach copies of certificates)

Sl.
No.

Examination
Passed

Division
With % of
Marks

Subject

Specialization

Year of
Passing

**suppression of qualifications will lead to cancellation of the candidature.

*Age will be reckoned as on 01.01.2013

Board/
University

11. Work Experience

Sl.
No.

Post held

Employer

Last pay
Drawn
with Pay
Band &
Grade Pay

12. Whether belongs to

a) Scheduled Caste
b) Scheduled Tribe
c) Other Backward Class

:
:
:

Nature of
assignment

Period with dates

Yes/No
Yes/No
Yes/No

(Please attach a copy of the certificate in the prescribed format appended)

13. Particulars of Demand Draft

14. Technical qualification if any

15. Details of enclosures sent with the

Application

No & Date
:
Amount
:
Name of the Bank :
:
...........................................................
..........................................................
..........................................................
:

16. Have you ever been dismissed from service :

Yes/No

17. Additional information if any may please be provided in an additional sheet.

I certify that the foregoing information is correct and complete to the best of my knowledge
and belief. I am not aware of any circumstances which may impair my fitness for
employment in Central University of Kerala, Kasaragod. I further certify that if any
information furnished by me is subsequently found to be false, I am liable for disciplinary
action as per rules and regulation of Central University of Kerala

Date:

Signature of the Applicant