foKkiu la[;k & 05@Mh0vkj0@ls

05@Mh0vkj0@lsok&02@2011&12

mkjk[k.M yksd lsok vk;ksx] gfj}kj

jktdh; ikWfyVsfDudksa esa izzoDrk ysDpjj Js.kh ^[k
^[k*
[k*] ds inksa ij p;u gsrq
vkosnu i= Lohdkj fd;s tkus dh vfUre frfFk& 23 vizSy] 2012
foKkiu izdkku dh frfFk& 22 ekpZ] 2012
2012
mkjk[k.M yksd lsok vk;ksx }kjk mkjk[k.M ds jktdh; ikWfyVsfDudksa esa IkzoDrkvksa ysDpjj ds fuEukuqlkj o.kr
fjDr inksa ds fy, foKkiu ds vUr esa ^ifjf'k"V&1* esa eqfr izk:i ij gh eksVs Qqy Ldsi dkxt ij vkosnu i= vkeaf=r fd;s
tkrs gSa ftldk foLr`r fooj.k vk;ksx dh osclkbZV www.ukpsc.gov.in ij miyC/k gSA inksa dh la[;k ?kV&c<+ ldrh gSA

01-

jktdh; ikWfyVsfDudksa esa IkzoDrkvks

Drkvksa ysDpjj ds fjDr in& 198

-la0
0102030405060708091011121314-

in dk uke

IkzoDrk eSdsfudy
IkzoDrk CE/CSE/PGDCA
IkzoDrk bySDVkfuDl
IkzoDrk fo|qr
IkzoDrk vkbZ0Vh0
IkzoDrk flfoy
IkzoDrk vkWVkseksckbZy
IkzoDrk dSfedy
IkzoDrk bUVhfj;j fMt+kbu ,.M MSdksjs'ku
deZ'kkyk v/kh{kd
IkzoDrk HkkSfrdh
IkzoDrk jlk;u
IkzoDrk xf.kr
IkzoDrk vaxzsth
dqy ;ksx

020304uksV %

vuqlwfpr tkfr
02
04
05
02
04
04
02
00
00
02
03
01
02
03
34

vuq0tutkfr
01
00
02
01
01
00
00
00
00
00
01
00
01
00
07

vU; fiNM+
fiNM+k oxZ
01
03
03
03
05
02
00
00
00
00
03
01
01
02
24

vukjf{kr
09
13
26
06
14
10
04
04
02
02
13
10
14
06
133

dqy in
13
20
36
12
24
16
06
04
02
04
20
12
18
11
198

osrueku %& ` 15600&39100] xzsM is ` 5400@&

in dk Lo:i %& jktif=r Js.kh ^[k*@vaa'knk;h isa'ku ;qDr@fujUrj pyrs jgus dh laHkkoukA
d vk;q lhek %&21 ls 40 o"kZA
vkjf{kr oxZ ds vH;fFkZ;ksa dks foKkiu ds fcUnq la[;k& 08 ds vuqlkj mPpre vk;q lhek esa NwV vuqeU; gSA

[k vk;q lhek dh x.kuk ds fy;s fu;r frfFk&

frfFk& 01 tqykbZ] 2012
2012

egoiw.kZ funsZk

vo; i<+s ,oa rn~uqlkj dk;Zokgh djs

djsa %&
1vH;FkhZ vius m/oZ@{kSfrt vkj{k.k ls lEcfU/kr Js.kh@mi Js.kh dk vadu ijEijkxr vkosnu i= ds
dkWye& 10 esa vo; djsaA vkosnu i= ij vkj{k.k dk nkok u fd;s tkus dh n'kk esa fjV ;kfpdk la[;k%
79@2010 jk/kk feRry cuke mRrjk[k.M yksd lsok vk;ksx esa ek0 mPp U;k;ky;]uSuhrky }kjk ikfjr vkns'k
fnukad 08-06-2010 rFkk ,l-,y-ih-flfoy ua0,l 19532@2010 esas ek0 mPpre U;k;ky; ds vkns'k fnukad 2007-2010 ds e esa vkj{k.k dk ykHk vuqeU; ugha gksxkA vkosnu i=ksa dh lfUujh{kk Scrutiny vk;ksx dh
lfUujh{kk fu;ekoyh ds vuq:i laikfnr dh tk;sxh] ftldk foLr`r fooj.k vk;ksx dh osclkbV ij miyC/k gSA
vH;FkhZ ;g lqfuf'pr dj ysa fd og vkosnu i= izkfIr dh
2dh vfUre frfFk vFkkZr~ fnukad 23 vizSy] 2012 rd
1

vfuok;Z kSf{kd vgZrk ,oa vuqHko ;fn ykxw gks vo'; /kkfjr djrs gksaA vH;FkhZ
vH;FkhZ vkosnu i= ds lkFk vkosfnr in
gsrq vfuok;Z U;wure 'kSf{kd vgZrk ,oa vuqHko ;fn ykxw gks ls lacfU/kr leLr lsesLVj@o"kks ds vad
i=@izek.k&i= vo; layXu djsa vU;Fkk vH;FkhZ dk vH;FkZu Lohdkj ugha fd;k tk;sxkA
3vH;FkhZ ijEijkxr vkosnu i= dh Nk;kizfr] Hkfo"; eas vk;skx ls fd;s tkus okys i=kpkj o vU; vko;d
iz;ksx@lk{; gsrq vius ikl lqjf{kr j[ksaA
vH;FkhZ dh in gsrq ik=rk@vgZrk ds lEcU/k esa vk;ksx dk fu.kZ; vafre gksxkA
45fu/kkZfjr kqYd@fu/kkZfjr kqYd ls de kqYd okys vkosnu i= vLohdkj dj fn;s tk;saxsA bl

lEcU/k esa vk;ksx dk fu.kZ; vfUre gksxkA

6vH;FkhZ foKkiu ds fcUnq la[;k&11 ,oa 13 esa mfYyf[kr funsZ'kksa dk ikyu vo'; djsaA
7vkosnu i= ds dkWye&15 esa vH;FkhZ }kjk ;fn izkIrkadksa dh x.kuk xzsM esa gks rks vadrkfydkvksa esa fn;s x;s
funsZkksa ds vuqlkj l{ke vadksa izfrkr dks nkkZuk vfuok;Z gS] xzsM x.kuk dks izfr'kr esa ifjorZu djus gsrq ykxw
QkWewZys dh izekf.kr izfr vFkok l{ke izkf/kdkjh }kjk fuxZr izek.k&i= vo'; layXu djsaA
8QthZ izek.k i=ksa 'kSf{kd ;ksX;rk@vuqHko@vkj{k.k laca/kh ds vk/kkj ij vkosnu i= izLrqr djus okys
vH;fFkZ;ksa dks vk;ksx dh leLr ijh{kkvksa ls vf/kdre 10 o"kksZ ds fy, izfrokfjr dj fn;k tk;sxkA
9vk;ksx esa vkosnu i= izLrqr dj fn;s tkus ds mijkUr vgZrk] vkj{k.k Js.kh@mi
kh@mi Js.kh o vk;q vkfn esa
fdlh Hkh izdkj dk la'kks/ku ;k ifjorZu dk vuqjks/k Lohdkj ugha fd;k tk;sxkA
10inksa ds fooj.k ls lacaf/kr dkWye ds ekad& 10 ij mfYyf[kr ^deZ'kkyk v/kh{kd*
v/kh{kd* in gsrq vkosnu djus
okys vH;FkhZ mDr in gsrq okafNr vuqHko ls lacaf/kr izek.k i= ifjf'k"V&
ifjf'k"V& 02 esa miyC/k izk:i ij gh izLrqr djsaA
mDr izk:i ls brj izk:i ij vuqHko izek.k i= Lohdkj ugha fd;k tk;sxkA
11vkosnu i= esa ;FkkLFkku vH;FkhZ gLrk{kj o vaxwBs dk fu'kku vo'; yxk;sa vU;Fkk vkosnu i= fujLr dj
fn;k tk;sxkA
05- vfuok;Z 'kSf{kd
{kd vgZrk &
05. (i) inks a ds fooj.k ls lEcfU/kr fcUnq la [ ;k&
;k & 01 ds eka d la 0 & 01 ls 09 rd mfYyf[kr inks a
gs r q vfuok;Z 'kS f {kd vgZ r k,a fuEuor gS a &
1- vfHk;a=.k@izkfof/kdh ds lEcfU/kr fo"k; esa 55 izfr'kr vadks ds lkFk mikf/k ;k ,0,e0vkbZ0bZ0 bf.M;kA
2- fgUnh dk KkuA
fVIi.kh % 1- tgka lEcfU/kr fo"k; esa ewy mikf/k ugha nh tkrh gS ;k tgka ,slh mikf/k j[kus okys vH;FkhZ miyC/k
u gks ogka oSdfYid ;k fo'ks"k fo"k; ds :i esa lacfU/kr fo"k; ds lkFk ewy Lukrd mikf/k ij fopkj fd;k
tk;sxkA
2- ljdkjh laLFkkuksa] lkoZtfud mieksa ;k fyfeVsM laxBuksa dk gh vuqHko Lohdkj fd;k tk;sxk vkSj mldh
x.kuk rHkh ls dh tk;sxh tc vH;FkhZ us fofgr 'kSf{kd vgZrk,a izkIr dj yh gksaA
vf/kekuh vgZ r k % &
1- lEcfU/kr fo"k; esa Lukrdkskj mikf/kA
2- ,d o"kZ dk vkS|ksfxd vuqHkoA
fVIi.kh % dsoy ljdkjh laLFkkuksa] lkoZtfud mieksa ;k fyfeVsM laxBuksa dk gh vuqHko Lohdkj fd;k tk;sxkA
05. (ii) inks a ds fooj.k ls lEcfU/kr fcUnq la [ ;k& 01 ds eka d la 0 & 10 ij mfYyf[kr deZ ' kkyk
v/kh{kd in gs r q vfuok;Z 'kS f {kd vgZ r k,a fuEuor gS a &
vfuok;Z 'kS f {kd vgZ r k,a &
1- eSdsfudy bathfu;fjax esa mikf/k ;k led{k vgZrk vkSj mRiknu ;k vuqj{k.k esa nks o"kZ dk vkS|ksfxd vuqHkoA
;k
eSdsfudy bathfu;fjax esa fMIyksek ;k led{k vgZrk vkSj mRiknu ;k vuqj{k.k esa vkB o"kZ dk vkS|ksfxd vuqHkoA
fVIi.kh % dsoy ljdkjh laLFkkvksa] lkoZtfud mieksa ;k fyfeVsM laxBuksa dk vkS|ksfxd vuqHko gh Lohdkj
fd;k tk;sxkA
vf/kekuh vgZ r k,a
k, a &
1- lEcfU/kr fo"k; esa Lukrdkskj mikf/k ,oa ,d o"kZ dk vkS|ksfxd vuqHko ,oa fgUnh dk KkuA
2

inks a ds fooj.k ls lEcfU/kr fcUnq la [ ;k&

;k & 01 ds eka d la 0 & 11 ls 14 rd mfYyf[kr
inks a gs r q vfuok;Z 'kS f {kd vgZ r k,a fuEuor gS a &
vfuok;Z 'kS f {kd vgZ r k,a &
1- U;wure 55 izfr'kr vadksa ds lkFk f}rh; Js.kh esa Lukrdkskj mikf/kA
2- fgUnh dk KkuA
vf/kekuh vgZ r k& ch0,M0 ;k led{k vgZrkA
uks V % vU; ckrksa ds leku gksus ij ,sls vH;FkhZ dks lh/kh HkrhZ ds ekeys esa vf/keku fn;k tk;sxk ftlus %&
1- izknsf'kd lsuk esa 02 o"kZ dh U;wure vof/k rd lsok dh gks] ;k
2- jk"Vh; dSMsV dksj dk ^ch* izek.k&i= izkIr fd;k gksA
06- vH;Fk;ksa ds fy, lkekU; vuqnsk %&
11- vfUre frfFk ds ckn vkosnu i= fdlh Hkh nkk esa Lohdkj ugha fd;s tk;saxsA visf{kr lwpukvksa ls jfgr
viw.kZ vkosnu i= rFkk ,sls vkosnu i= ftl ij vH;fFkZ;ksa ds gLrk{kj@vaxwBs dk fu'kku ugha gS] le; ls izkIr
gksus ds ckotwn ljljh rkSj ij fujLr dj fn;s tk;saxsA
22- jkVh;rk& lsok esa fdlh in ij lh/kh HkrhZ ds fy, ;g vko;d gS fd vH;FkhZ&
d Hkkjrh; ukxfjd gks] ;k
[k frCcrh kj.kkFkhZ gks] tks Hkkjr esa LFkk;h fuokl ds vfHkizk; ls igyh tuojh] 1962 ds iwoZ Hkkjr vk;k gks]
;k
x Hkkjrh; mn~Hko dk ,slk O;fDr gks ftlus Hkkjr esa LFkk;h fuokl ds vfHkizk; ls ikfdLrku] cekZ] Jhyadk ;k
fdlh iwohZ vhdh nsk] dsU;k] ;qxk.Mk vkSj ;wukbVsM fjifCyd vkQ rUtkfu;k iwoZorhZ ratkfu;kWa vkSj tathckj
izotu fd;k gksA ijUrq mi;qZDr Js.kh [k ;k x ds vH;FkhZ dks ,slk O;fDr gksuk pkfg, ftlds i{k esa jkT;
ljdkj }kjk ik=rk izek.k i= tkjh fd;k x;k gks] ijUrq ;g vkSj fd Js.kh [k ds vH;FkhZ ls ;g Hkh vis{kk dh
tk;sxh fd og mi&egkfujh{kd] xqIrpj kk[kk mRrjk[k.M ls ik=rk izek.k i= izkIr dj ysA ijUrq ;g Hkh fd
;fn dksbZ vH;FkhZ mi;qZDr Js.kh x dk gks rks ik=rk dk izek.k i= ,d okZ ls vf/kd vof/k ds fy, tkjh ugha
fd;k tk;sxk vkSj ,sls vH;FkhZ dks ,d okZ dh vof/k ds vkxs lsok esa bl krZ ij jgus fn;k tk;sxk fd og
Hkkjr dh ukxfjdrk izkIr dj ysaA
fVIi.kh % ,sls vH;FkhZ dks ftlds ekeys esa ik=rk dk izek.k&i= vko';d gks fdUrq u rks og tkjh fd;k x;k
gks vkSj u nsus ls budkj fd;k x;k gks] fdlh ijh{kk ;k lk{kkRdkj esa lfEefyr fd;k tk ldrk gS vkSj bls
bl 'krZ ij vafre :i ls fu;qDr Hkh fd;k tk ldrk gS fd vko';d izek.k&i= mlds }kjk izkIr dj fy;k
tk; ;k mlds i{k esa tkjh dj fn;k tk;A
0707- OkSokfgd izkfLFkfr %&lsok esa fdlh in ij fu;qfDr ds fy, ,slk iq:"k vH;FkhZ ik= ugha gksxk ftldh ,d ls
vf/kd ifRu;ka thor gksa ;k ,slh efgyk vH;FkhZ ik= ugha gksxh] ftlus ,sls iq#"k ls fookg fd;k gks] ftldh igys
ls thfor iRuh gksA
ijUrq jkT;iky fdlh O;fDr dks bl fu;e ds izorZu ls NwV ns ldrs gSa] ;fn mudks ;g lek/kku gks tk;
fd ,slk djus ds fy, fo'ks"k dkj.k fo|eku gSaA
0808- mPpre vk;q lhek esa NwV %& fofHkUu Jsf.k;ksa@mi Jsf.k;ksa gsrq mPpre vk;q lhek esa NwV fuEuor~ gksxh%&
05. (iii)

Js.kh@miJs.kh
m0 vuqlwfpr tkfr
m0 vuqlwfpr
tutkfr
m0 v0fi0o0
m0 kkjhfjd :i ls
fu%kDr
m0 Mh0,Q0,Q0
m0 HkwriwoZ lSfud
m0 dq'ky f[kykM+h
m0 jkT;

kkluknsk la[;k o fnukad

1399@XXX2@2005] fnukad 21 ebZ] 2005
1399@XXX2@2005] fnukad 21 ebZ] 2005
1399@XXX2@2005] fnukad 21 ebZ] 2005
1244@XXX2@2005] fnukad 21 ebZ] 2005
1244@XXX2@2005] fnukad 21 ebZ] 2005
17@2@1981&dkfeZd&2] fn0 28 Qjojh] 1985
22@21@1983&dkfeZd&2] fnukad 28-11-1985
1270@rhl&2@2004] fnukad 11 vxLr] 2004]
3

vf/kdre vk;q essa NwV

05 okZ
05 okZ
05 okZ
05 okZ
05 okZ
05 okZ
05 okZ
vf/kdre vk;q

vkUnksyudkjh

776@XX426@m0vkUnks0@2006&08] fnukad 22-10-2008]

637@XX 4&26@m0vk0@2006@09 fnukad 13-08-2010]
1739@chl&4@2011&26@m0vk0@2006] fnukad 05-08-2011]
rFkk 2963@XX 4&326@2006] fnukad 13 fnlEcj] 2011

lhek 50 okZ

fVIi.kh %&
1-& fodykax vkj{k.k ds ykHk gsrq fodykaxrk dh rhuksa Jsf.k;ksa esa ls fdlh ,d Js.kh esa de ls de 40 izfr'kr
dh fodykaxrk gksuk vfuok;Z gSA foHkkx esa ftl&ftl fodykaxrk gsrq in vkjf{kr gksasxs mlh fodykaxrk Js.kh
gsrq vkj{k.k iznku fd;k tk;sxkA
2-& vkj{k.k ds ykHk dk nkok djus okys vH;fFkZ;ksa ds ikl viuh Js.kh ds leFkZu esa fu/kkZfjr izk:i ij l{ke
izkf/kdkjh }kjk fuxZr izek.k i= gksuk vko;d gSA
09- vkj{k.k %&
11- vkj{k.k dk ykHk 'kklu }kjk fuxZr v|ru 'kklukns'kksa ds vuqlkj vuqeU; gksxk rFkk /okZ/kj vkj{k.k ,oa
{kSfrt vkj{k.k dk ykHk dsoy mRrjk[k.M jkT; ds vf/koklh vH;fFkZ;ksa dks gh vuqeU; gSgSA vkj{k.k laca/kh lHkh
kkluknskksa ,oa vkj{k.k lEcU/kh izek.k i=ksa ds izk#i dk voyksdu mkjk[k.M yksd lsok vk;ksx dh osclkbV
www.ukpsc.gov.in ij fd;k tk ldrk gS rFkk mlh vk/kkj ij vkj{k.k dk nkok ,oa vuqeU;rk ns; gksxhA
22- ;fn vH;FkhZ ,d ls vf/kd miJs.kh esa vkj{k.k dk nkok djrk gS rks og dsoy ,d Js.kh] tks mlds fy,
vf/kd ykHknk;d gksxh] dk ykHk ikus dk ik= gksxkA
3- vkj{k.k ds ykHk dk nkok djus okys vH;fFkZ;ksa ds ikl viuh Js.kh ds leFkZu esa fu/kkZfjr izk:i ij l{ke
vf/kdkjh }kjk fuxZr izek.k i= gksuk vko';d gS] ftls mUgsa vkosnu i= ds lkFk layXu djuk gksxkA
1010- vkos
vkosnu dSls djsa %&
vH;FkhZ bl foKkiu ds ^ifjfkV&1^ esa fufnZV ijEijkxr vkosnu i= dks Vafdr vFkok eqfnzr djkdj vkosnu
i= ds fu/kkZfjr LrEHkksa dks iw.kZ djrs gq, leLr okafNr layXudksa lfgr ^^lfpo] mRrjk[k.M yksd lsok vk;ksx]
xq#dqy dkaxM+h] gfj}kj 249404^^ dks fdlh Hkh ek/;e ls cSjax ek/;e dks NksM+dj izsfkr dj ldrs gSa vFkok
vk;ksx dk;kZy; ds Mkd dkmUVj ij Lo;a Hkh tek dj ldrs gSaA ijUrq izR;sd vH;FkhZ dk vkosnu i= fu/kkZfjr
vfUre frfFk fnukad 23 vizSy] 2012 dks lk;a 06%00 cts rd vk;ksx dk;kZy; esa vo;
vo; igqp tkuk pkfg,A Mkd
foHkkx }kjk fd;s x;s fdlh foyEc ds fy, vk;ksx dk;kZy; mRrjnk;h ugha gksxkA QSDl }kjk izsfkr vkosnu&i=
fdlh Hkh nkk esa Lohdkj ugha fd;k tk;sxkA
1111- vkosnu i= ds lkFk fuEufyf[kr vfHkys[k vo; gksus pkfg;s vU;Fkk vuqeU; ykHk@vH;FkZ
ykHk@vH;FkZu fujLr dj fn;k
tk;sxk %&
fuEufyf[kr vfHkys[kksa dh Loizekf.kr QksVks LVsV izfr;kW %&
1- gk;j lsds.Mjh@gkbZLdwy ,oa b.VjehfM,V ds vadi=@izek.k i=A
2- Lukrd@Lukrdkskj ds lHkh o"kks@lsesLVjksa dh vad&rkfydk ,oa fMxzhA
3- d vkosfnr in gsrq U;wure vfuok;Z 'kSf{kd vgZrkvksa ,oa okafNr vuqHko ;fn ykxw gks dh iqfV gsrq
leLr vadi= ,oa fMxzh@izek.k i=A
[k fu/kkZfjr kqYd ds Hkqxrku dh iqfV gsrq ewy cSad MkVA
x QkesZV ij fpidk gqvk ,d LolR;kfir ikliksVZ vkdkj dk QksVksxzkQA
?k vkosnu i= ds dkWye 10 esa nkfor fdlh Hkh vkjf{kr Js.kh@Jsf.k;ksa ds vUrxZr vkj{k.k ds
nkos
dh iqfV esa ftykf/kdkjh@vfrfjDr ftyk eftLVsV@uxj eftLVsV@,l0Mh0,e0@ rglhynkj }kjk
fu/kkZfjr izi= ij tkjh izek.k i=A
1212- kqYd % izR;sd vH;FkhZ ls vkosnu&i= ds lkFk ijh{kk kqYd fy;k tk;sxkA lkekU;@vU; fiNM+k oxZ@Lora=rk
laxzke lsukuh ds vkfJr vH;Fk;ksa ds fy, ijh{kk 'kqYd `130@& ` 100@& ijh{kk kqYd $ ` 30@& Mkd
kqYd gSA fdUrq mRrjk[k.M ds vuqlwfpr tkfr] vuqlwfpr tutkfr rFkk lekt ds fodykax vH;fFkZ;ksa ds fy;s `
90@& ` 60@& ijh{kk kqYd $ `30@& Mkd kqYd gSA mRrjk[k.M iwoZ lSfud] dqky f[kykM+h] efgyk o
mRrjk[k.M jkT; vkUnksyudkjh rFkk mRrjk[k.M jkT; vkUnksyudkjh ds vkfJr miJs.kh ds vH;fFkZ;ksa ds fy;s 'kqYd
mudh Js.kh ds vkjf{kr oxZ ds lerqY; gSA 'kqYd fdlh Hkh jk"Vh;d`r cSad }kjk
}kjk vkgfjr ,oa fuxZr ,dkm.V is;h
cSad MkV@Hkkjrh; iksLVy vkMZj }kjk izsf"kr tks ^^lfpo] mRrjk[k.M yksd lsok vk;ksx] gfj}kj dks gfj}kj esa ns;
gks^^ Lohdkj fd;k tk;sxkA vH;FkhZ cSad MkV ds ihNs viuk uke] rFkk irk vo'; fy[ksaA vU; fdlh izdkj ls
4

tek fd;k x;k 'kqYd Lohdkj ugha fd;k tk;sxk vkSj ,sls vH;FkhZ dk vkosnu i= vLohd`r dj fn;k tk;sxk rFkk
ijh{kk 'kqYd fdlh Hkh nkk esa okil ugha fd;k tk;sxkA
1313- vH;Fk;ksa ds fy, lkekU; vuqnsk %&
1- vkosnu i= ds lkFk 23x10 lsa0eh0 vkdkj ds nks fyQkQs ftl ij in dk uke fo"k; lfgr rFkk foKkiu
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ifjf'k"V 02
Experience Certificate

Logo of
Officer
(If available)

Name of Deptt./Officer :..........................................................................................................

Address of Dept./Officer:........................................................................................................
Date of Reg. of Company/Firm/Society/Institution/Trust :....................................................
Telephone No. :......................................................................................................................
Website :.................................................................................................................................

Ref. No. :This is certify that Shri/Smt./Km. ....................................................................... Son/Daughter/Wife of

shri.................................................................. is an employee of this Department/Organization/Company/Firm/ Society
/Institution/Trust and duties performed by him during the period (s) are as under :
Name
of post
held

From
dd/mm/yy

To
dd/mm/yy

Total
Period
dd/mm/yy

Nature of appointment
(Permanent
Regular/Temporary/Parttime/contract/Visiting
faculty/Daily
wages/Honorary,etc.

Nature of Experience:
Specialty/Field of
Research/Technical/
Administration/
Academic or any other
experience.

Pay scale
and last
salary
drawn

Duties
performed/experien
ce gained in brief in
each post (Please
give details, if
need be, in attached
sheet)

Place of
posting

Worked at
supervisory
level/middle
management
level/head of
branch or
other

01

02

03

04

05

06

07

08

09

10

It is also certify that above facts and figures are

Department/Organization/Company/Firm/Society/Institution/Trust.

true

and

based

on

service

records

available

in

our

Sign...............................................
(Name & Signature of Authorized
Signatory in Capital letters)

Date :
Place :
Name & Signature of Candidate :

Designation with seal

9

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10

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11

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12

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,p&lquus@cksyus ds tfj, dk;Z dj ldrs@ldrh gSaA
gk@ugha
(xi)
vkj MCyw&i<+us vkSj fy[kus ds tfj, dk;Z dj ldrs@ldrh gSaA
gk@ugha

Mk0---------------------------------------
lnL;
fpfdRlk cksMZ

Mk0---------------------------------------
lnL;
fpfdRlk cksMZ

Mk0---------------------------------------
v/;{k
fpfdRlk cksMZ

fpfdRlk v/kh{kd@eq[; fpfdRlk vf/kdkjh@

vLirky ds eqf[k;k }kjk izfrgLrk{kfjr
eqgj lfgr

* tks ykxw u gks dkV nsaA

13

mkjk[k.M ds Lora=rk laxzke lsukfu;ksa ds vkfJrksa ds fy, izek.k&i=

kkluknsk la[;k 4@23@1982&2@1997] fnukad 26 fnlEcj]1997
tSlk fd m0iz0 iquxZBu vf/kfu;e]2000 ds vUrxZr mkjk[k.M esa ykxw gS
izek.k&i=
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------------------------------------------------------------------------------lqiq=@iRuh@ lqiq=h ------------------------------------------------------------------------------ fuoklh xzke -------------------------------------------------rglhy --------------------------------------------- uxj ----------------------------------------------- ftyk ---------------------------------------------mRrj iznsk yksd lsok kkjhfjd :i ls fodykax] Lora=rk
laxzke lsukfu;ksa ds vkfJr vkSj HkwriwoZ lSfud ds fy, vkj{k.k vf/kfu;e]1993 tSlk fd mkjk[k.M jkT; esa ykxw gS]
ds vuqlkj Lora=rk laxzke lsukuh gS vkSj Jh@Jherh@dqekjhvkfJr ---------------------------------------------------------------------------------------------------- iq=@iq=h@ikS=@ vfookfgr ikS=h mi;afdr vf/kfu;e]1993 ds gh izko/kkuksa ds vuqlkj mDr
Jh@Jherh@Lora=rk laxzke lsukuh ds vkfJr gSA
LFkku %
gLrk{kj -----------------------------------fnukad %
iwjk uke------------------------------------inuke ------------------------------------eqgj -----------------------------------------ftykf/kdkjh --------------------------lhy ---------------------------------------

14

dqky f[kykfM+;ksa ds fy, izek.k&i=

kkluknsk la[;k&22@21@1983&dkfeZd&2 fnukad 28 uoEcj]1986
tSlk fd m0iz0 iquxZBu vf/kfu;e]2000 ds vUrxZr mkjk[k.M esa ykxw gS
izek.k&i= ds QkeZ&1 ls 4
QkeZ&1

ekU;rk izkIr dhM+k@[ksy esa vius nsk dh vksj ls vUrjkZVh; izfr;ksfxrk esa Hkkx ysus okys f[kykM+h ds fy;s
lEcfU/kr [ksy dh jkV
jkVh; QsMjsku@jkVh; ,lksfl,ku dk uke ----------------------------------------------------------------jkT;
----------------------------------------------------------------jkT; ljdkj dh
lsokvksa@inksa ij fu;qfDr ds fy, dqky f[kykfM+;ksa ds fy;s izek.k&i=A

izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ----------------------------------------------------------------------------vkRet@iRuh@vkRet Jh

----------------------------------------------------------------------------------- ls fnukad --------------------------------------- LFkku dk uke esa vk;ksftr -------------------------------------------------------------------------dzhM+k@ [ksydwn dk uke dh izfr;ksfxrk@VwukZesUV esa nsk dh vksj ls Hkkx fy;kA
muds Vhe ds }kjk mDr izfr;ksfxrk@VwukesUV esa -------------------------------------------------------------------------LFkku izkIr fd;k x;kA ;g
izek.k&i= jkVh; QsMjsku@jkVh; ,lksfl,ku@;gk laLFkk dk uke fn;k tk;sLFkku %
gLrk{kj -----------------------------------fnukad %
in -------------------------------------------laLFkk dk uke -------------------------------------------------------------------------eqgj -----------------------------------------uksV %& ;g izek.k&i= uskuy QsMjsku@uskuy ,lksfl,ku ds lfpo }kjk O;fDrxr :i ls fd;s x;s gLrk{kj gksus
ij gh ekU; gksxkA
QkeZ&2
ekU;rk izkIr dzhM+k@[ksy esa vius iznsk dh vksj ls jkVh; izfr;ksfxrk esa Hkkx ysus okys f[kykM+h ds fy;s
lEcfU/kr [ksy dh iznskh; ,lksfl,ku dk uke ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- jkT; ljdkj dh
lsokvksa ij fu;qfDr ds fy;s dqky f[kykfM+;ksa ds fy, izek.k&i=A
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------------------------------------------------------------------------vkRet@iRuh@vkRet
Jh ---------------------------------------------------------------------------------------- fuoklh -------------------------------------iwjk irk----------------------------------------------------------------------------------------------------------------------us fnukad---------------------------------------- ls fnukad ----------------------------------------- rd ------------------------------------------------------------------------------------------ dzhM+k@[ksydwn dk uke dh izfr;ksfxrk VwukZesUV dk LFkku----------------------------------------------------------------------------------vk;ksftr jkVh; -------------------------------------------------------------esa dzhM+k@[ksydwn dk uke dh izfr;ksfxrk@VwukZesUV
esa iznsk dh vksj ls Hkkx fy;kA
muds Vhe ds }kjk mDr izfr;ksfxrk@VwukZesUV esa ------------------------------------------------------- LFkku izkIr fd;k x;kA ;g
izek.k&i= ----------------------------------------------------------------------------------iznskh; la?k dk uke esa miyC/k fjdkMZ ds vk/kkj ij fn;k x;k
gSA
LFkku %
gLrk{kj -----------------------------------fnukad %
in --------------------------------------------laLFkk dk uke --------------------------------------------------------------------------eqgj ------------------------------------------uksV%& ;g izek.k&i= iznskh; [ksydwn la?k ds lfpo }kjk O;fDrxr :i ls fd;s x;s gLrk{kj gksus ij gh ekU; gksxkA

15

QkeZ&3
ekU;rk izkIr hM+k@[ksy esa vius foofo|ky; dh vkSj ls vf[ky Hkkjrh; vUrfoZofo|ky; izfr;ksfxrk esa Hkkx ysus
okys f[kykM+h ds fy;s
foofo|ky; dk uke---------------------------------------------------------------------------------------uke----------------------------------------------------------------------------------------jkT;
----------------------------------------------------------------------------------------jkT; Lrj dh lsokvksa@inksa ij fu;qfDr ds dqky
f[kykfM+;ksa ds fy;s izek.k&i=A
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh-------------------------------------------------------------------------------vkRet@iRuh@vkRetk
Jh-----------------------------------------------------------------fuoklh iwjk irk-----------------------------------------------foofo|ky; dh d{kk ---------------LFkku dk
uke esa vk;ksftr vf[ky Hkkjrh; vUrfoZofo|ky; ------------------------------------hM+k@[ksydwn dk uke izfr;ksfxrk@VwukZesUV
esa foofo|ky; dh vksj ls Hkkx fy;kA muds Vhe ds }kjk mDr izfr;ksfxrk@VwukZesUV esa ------------------------------------------LFkku@esMy izkIr fd;k x;kA ;g izek.k i= Mhu vkWQ LiksV~Zl vFkok bapktZ [kssydwn --------------------------------------------------------------------foofo|ky; esa miyC/k fjdkMZ ds vk/kkj ij fn;k x;kA
LFkku-----------------------------------------gLrk{kj------------------------------------------------------------fnukad ------------------------------------uke-------------------------------------------------------------------in uke ----------------------------------------------------------laLFkk dk uke------------------------------------------------eqgj ----------------------------------------------------------------uksV %& ;g izek.k&i= foofo|ky; ds Mhu vkQ LiksV~Zl ;k bapktZ [ksydwn }kjk O;fDrxr :i ls gLrk{kj gksus ij
gh ekU; gksxkA

QkeZ&4
ekU;rk izkIr hM+k@[ksy esa vius Ldwy dh vksj ls jkVh; [ksydwn esa Hkkx ysus okys f[kykM+h ds fy;s
MkbjsDVsV vkWQ ifCyd bULVDku@funskd] fk{kk mkjk[k.M -------------------------------------------------------------------------------------------------------jkT;
----------------------------------jkT; Lrj dh lsokvksa ij
fu;qfDr ds fy;s dqky f[kykfM+;ksa ds fy;s izek.k i=A
izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh ------------------------------------------------------------------------vkRet@iRuh@vkRetk Jh ----------------------------------------------------------------fuoklh iwjk irk---------------------------------------------esa ---------------------------------------------------------------------------------------Ldwy esa d{kk----------------------------------------LFkku dk uke esa vk;ksftr Ldwyksa ds uskuy xsEl dh ------------------------------------------------hM+k@[ksydwn dk uke izfr;ksfxrk@VwukZesUV esa ------------------------------------------------------------------------------Ldwy dh vksj ls Hkkx
fy;kA
muds Vhe ds }kjk mDr izfr;ksfxrk@VwukZesUV eas ------------------------------------------LFkku izkIr fd;kA ;g izek.k i= MkbjsDVsV
vkWQ ifCyd bULVDku@fk{kk esa miyC/k fjdkMZ ds vk/kkj ij fn;k x;k gSA
LFkku-----------------------------------------gLrk{kj------------------------------------------------------------fnukad ------------------------------------uke-------------------------------------------------------------------in uke ----------------------------------------------------------laLFkk dk uke------------------------------------------------eqgj ----------------------------------------------------------------uksV%& ;g izek.k i= funskd@;k vfrfjDr@la;qDr ;k mi funskd MkbZjsDVsV vkWQ ifCyd bULVDku@fk{kk }kjk
O;fDrxr :i ls gLrk{kj gksus ij ekU; gksxkA

16