APPLICATION FORM FOR JOB OPENINGS AT IBSD, IMPHAL

1. Post applied for: (Please tick √ any one)

i) SRF ii) JRF iii) Traineeship iv) Studentship Paste a recent
passport size
2. Project applied for (Please tick √ any one) photograph
a) Identification and Screening for Potential Biodiesel Yielding micro algae from North East India.

b) Biodiversity, Characterization and Conservation of Cyanobacteria of Indo-Burma Biodiversity Hotspots for Harnessing of Value
Added Products.

c) Prospecting Zingiber Zerumbet for Molecular Resources.

d) Distributed Information Sub-Centre (DISC)

3. Name of the applicant (as per matriculation certificate in capital letters):

……………………………………………………………………………………………………………………………………………………………………………………………………
4. Name of Father/Husband: ……………………………………………………………………………………………………………….…………………………………………
5. Date of Birth (as per matriculation certificate): ………………………………………………………………………………………………………………………….
6. Nationality: ………………………………………………………………………………………………………………………………………………………………………………..
7. Permanent Address with pin- code (In capital letters): ………………………………..………..……..…………………….........................................
……………………………………………………………………..……….………………………………………………………………………………….…………………………………
8. Address for correspondence with pin- code (In capital letters): …………………………………………………………….………..............................
………………………………………...………………………………………………………………………………………………..…….………………………….…………………….
9. (i) Telephone number: ……………………………... (ii) Telefax……………………… (iii) E-mail address: …….……………………………………..…………
10. Academic record: For each of the following examinations, Starting from Matriculation to the highest qualification:
Sl. No. Degree Name of the College/ Year of Specialization % of Marks*
University Passing

In case of CGPA/ CPI, Please give marks in percentage with conversion formula.
11. Experience in years if any: (Please enclose all testimonials in support) ……………………………………………………………….……………………
…………………………………………………………………………………………………………………………………………………………………..……………….………………
12. Any other relevant information: (Please attach separate sheet if required)……………………………………………………….……………………..
……………………………………………………………………………………………………………………………………………..…………………………………………………….
13. Declaration: I declare that the information furnished above is true and correct to the best of my knowledge and belief, and
that no related information is concealed. If any discrepancy is observed at any stage, IBSD will be free to cancel my
selection/candidature.

Date: Candidate’s signature

Place:

INSTRUCTIONS FOR FILLING UP THE APPLICATION FORM (Applications not submitted in proper format is likely to be rejected):
1. Application form should be neatly typed or handwritten in CAPITAL LETTERS.
2. Enclose attested photocopies of relevant certificates.
3. Duly filled Application should be submitted in 28x12 cm envelop mentioning the ‘Post Applied for’ on the top of envelop.
4. The competent authority of the Institute reserves all right to cancel/modify any of the above posts.