CSIR-CENTRAL INSTITUTE OF MINING AND FUEL RESEARCH

(Council of Scientific & Industrial Research)

Barwa Road, Dhanbad-826015
Website: www.cimfr.nic.in
Notification No:
Affix recent
Position applied for: .. Passport size
Photograph
1. Name of Applicant (In Block letters) : . here duly
signed
2. Fathers Name:

3. Date of Birth: .. Sex (M/F):

4. Age as on date of Interview/Closing date of application: Year______ Month_______ Days____

5. Category: SC______ ST______OBC______PH_______ General ________

6. Communication Address: .

7. Permanent Address: .

8. Phone No./Mobile No.

9. Email, if any:

10. Qualifications (Attach self attested copies of certificates)

Educational Discipline/Subject University/ Year of Percentage of
Qualifications Board passing Marks/CGPA
(10th onwards)

11. Experience, if any (Attach certificates): ...

12. Name of the close relatives } Name ...

in CIMFR/CSIR or its Labs/Instts (if any) } Relationship ..

I declare that the above particulars are correct to the best of my knowledge and belief. I understand that action can be
taken against me if these are found to be incorrect and my candidature may be cancelled.

Place:______________
Dated:_______________ SIGNATURE OF CANDIDATE