APPLICATION FOR THE POST OF LECTURER IN MATHEMATICS Name of the Candidate (in Block Letters) Affix Passport size photo 2. Father’s/Husband’s Name attested bya Gazetted 3. Residential Address with Phone No. Rae 4. Date of Birth/Age as on 30.07.2011 5. Sex 6. Employment Registration Details:- 6.1 Registration Number 6.2 Date of Registration 7. Community (SC/MBC/OBC/GEN) (enclose attested copy of the certificates issued on or after 30.07.2011) 8. Category (PH/XSM/MSP) 9. Whether Native of UT of Puducherry 10. Educational & Professional Qualifications SLNo | Qualification | Subjects | Year of | Marks secured | % of | Name of the Passing | with maximum | Marks | University marks 11. Languages studies upto Secondary Level (X std.) (Specify Tamil / Telungu or any other Language)Experience, if any 12, Details of Attested Certificates enclosed 13. Any other Information I hereby certify that the information furnished by me is true and | understand that my application liable for rejection at any stage, if any information furnished given is found to be false. Place: Puducherry Date: 14.07.2011 SIGNATURE OF THE CANDIDATE