Affix your

ITER-INDIA recent
INSTITUTE FOR PLASMA RESEARCH passport size
colour
Plot No. A/29, GIDC Electronics Estate, Sector-25, photograph
Gandhinagar-382 025, Gujarat (INDIA)
here
Phone: 079-23269500/23269589/90 Fax : 079-23269501/9591

APPLICATION FORM
1. Advt. No. & Sl. No.:
2. 2a) Post Applied for :
2b) I am also applying for (Write appropriate Sr. No. of post)
another post * I II III IV V VI VII VIII
3. Name : First/Given name :
(in capital letters)
Family name/Surname:
4. Father’s/Husband’s Name:
5. Date of Birth (DD/MM/YYYY) : 6. Category :(Attach attested copy of proof except for General)
General SC ST OBC PH Ex-S
7. Nationality :
8. Permanent Address :

9. Address for Correspondence :

10. Nearest Railway Station :

11. Phone No.: Mobile No. :
Email ID :

12. References: (Names, addresses and 1)

contact numbers of two senior
responsible persons, who are familiar
with your professional work, whom
we can contact)
2)

1
 13. Educational & Professional Qualifications (SSC onwards)
Level Exam Passed Board / Year of Class / Main Subjects
(specify BA, University Passing Percentage of
B.Com, Marks
MBA, etc.)
Class X

Class XII

Pre-
graduation
Dipl.
Graduation
(Bachelors
degree)
PG Diploma

Post
Graduation
(Masters
degree)
Any other

14. Experience (start with present position and proceed backwards)

Name of the Post held Period Total Monthly Nature of work in brief
Employer with period Salary (Give details in separate
Address From To (years & sheet**)
Months)
1)

2)

3)

4)

I affirm that the information given in this application is true and correct. I also fully understand that if at any stage it
is discovered that an attempt has been made by me to willfully conceal or misrepresent the facts, my candidature
may be summarily rejected or my employment terminated.

Date: Signature of the Candidate

Place:

* Mandatory: If applying for more than one post, do so on separate application forms.
** Mandatory: On a separate sheet describe in your own words, details of your experience and responsibilities in
recent years.