Applications are invited for the post of ASSISTANT PROFESSOR on CLOCK HOURS BASIS

(C.H.B.) for various Schools (Campus School and Sub-Centre, Latur, Parbhani & Late Shri.
Uttamrao Rathod Tribal Development and Research Centre, Kinwat, Dist. Nanded)
Advt. No. SRTMUN/CHB-TP/02/2020, DATE 08.10.2020
Sr. Name of the School No. of Specialization
No. Posts
1 Life Sciences 14 Biotechnology/ Botany/ Microbiology/ Zoology
2 Physical Sciences 06 Physics
3 Chemical Sciences 03 Analytical/Industrial/ Medicinal/Organic/ Physical &
Polymer Chemistry
4 Earth Sciences 10 Geology/Geophysics/ Geography/ Environmental
Science
5 Mathematical Sciences 08 Math /Statistics
6 Social Sciences 12 Social Work/ Sociology/ Applied Economics/
Human Rights.
7 Media Studies 03 Electronic Media/Radio Journalism and Production.
8 Educational Sciences 00 Education & Physical Education
9 Language, Literature & Culture Studies 00 Marathi /English
10 Commerce and Management Sciences 03 Commerce/ Management HRM / Finance
11 Computational Sciences 06 Computer
12 Fine and Performing Arts 03 Music/Theatre
13 Social Sciences (Sub-Centre, Latur) 07 Social Work/Sociology
14 Management Sciences (Sub-Centre, Latur) 08 Management HRM / Finance
15 Technology (Sub-Centre, Latur) 03 Computer/ Bioinformatics
16 Sub-Centre, Parbhani 06 M.Com. (English Medium)
17 Late Shri. Uttamrao Rathod Tribal 02 Social Work/Sociology
Development and Research Centre, Kinwat,
Dist. Nanded
Note: The vacancies in each school subject to change.
Tenure of Post: Academic Year 2020-21
Period @ basis rates As per University / Government of Maharashtra norms.
 : EDUCATIONAL QUALIFICATION FOR TEACHING POSTS:
(Post no. 1 ,2,3,4,5,6,7,8,9,13 &17 accept Management)
Eligibility (A or B):
A.
i) A Master‘s degree with 55% marks (or an equivalent grade in a point-scale wherever the
grading system is followed) in a concerned/relevant/allied subject from an Indian University,
or an equivalent degree from an accredited foreign university.
ii) Besides fulfilling the above qualifications, the candidate must have cleared the National
Eligibility Test (NET) conducted by the UGC or the CSIR, or a similar test accredited by the
UGC, like SLET/SET or who are or have been awarded a Ph.D.Degree in accordance with the
University Grants Commission (Minimum Standards and Procedure for Award of
M.Phil./Ph.D. Degree) Regulations, 2009 or 2016 and their amendments from time to time as
the case may be exempted from NET/SLET/SET: Provided, the candidates registered for
the Ph.D. programme prior to July 11, 2009, shall be governed by the provisions of the then
existing Ordinances/Bye-laws/Regulations of the Institution awarding the degree and such
Ph.D. candidates shall be exempted from the requirement of NET/SLET/SET for recruitment
and appointment of Assistant Professor or equivalent positions in Universities
/Colleges/Institutions subject to the fulfilment of the following conditions :-
a) The Ph.D. degree of the candidate has been awarded in a regular mode;
b) The Ph.D. thesis has been evaluated by at least two external examiners;
c) An open Ph.D. viva voce of the candidate has been conducted;
d) The Candidate has published two research papers from his/her Ph.D. work, out of which at
least one is in a refereed journal;
e) The candidate has presented at least two papers based on his/her Ph.D.work in
conferences/seminars sponsored/funded/supported by the UGC/ICSSR/CSIR or any
similar agency.
Note: NET/SLET/SET shall also not be required for such Masters Programmes in disciplines for
which NET/SLET/SET is not conducted by the UGC,CSIR or similar test accredited by the
UGC, like SLET/SET
Or
B. The Ph.D degree has been obtained from a foreign university/institution with a ranking
among top 500 in the World University Ranking (at any time) by any one of the following:
(i) Quacquarelli Symonds (QS)
(ii) the Times Higher Education (THE) Or
(iii) the Academic Ranking of World Universities (ARWU) of the Shanghai Jiao Tong University
(Shanghai).
(Post no.10,14/16-MANAGEMENT)
i. Essential:
1. First Class Masters Degree in Business Management/Administration/ in a relevant management related discipline
or first class in two year full time PGDM declared equivalent by AIU/ accredited by the AICTE / UGC.
Or
2. First Class Graduate and Professionally Qualified Charted Accountant / Cost and Works Accountant/ Company
Secretary of the concerned statutory bodies.
Desirable
i. Teaching research, industrial and/ or professional experience in a reputed organization;
ii. Papers presented at Conference and /or published in referred journals.
(Post No.11/15 COMPUTER)
1. BE / B Tech and ME / M Tech in relevant subject with first class or equivalent either in BE B Tech or ME /
M Tech
Or
BE / B Tech and MCA with first class or equivalent either in BE / B Tech or MCA
Or
MCA with first class or equivalent either with two years relevant experience
(Post no.12 - Fine and Performing Arts)
Eligibility (A or B):
A.
i) Master‘s Degree with 55% marks (or an equivalent grade in a point scale wherever grading system is followed)
in the relevant subject or an equivalent degree from an Indian/foreign University.
ii) Besides fulfilling the above qualifications, the candidate must have cleared the National Eligibility Test (NET)
conducted by the UGC, CSIR or similar test accredited by the UGC like SLET/SET or who are or have been
awarded a Ph. D. Degree in accordance with the University Grants Commission (Minimum Standards and
Procedure for Award of M.Phil./Ph.D. Degree) Regulations, 2009 or 2016 and their amendments from time to
time as the case may be.
Provided further, candidates registered for the Ph.D. programme prior to July 11, 2009, shall be governed
by the provisions of the then existing Ordinances/ Bye-laws/Regulations of the Institutions awarding the
degree and such Ph.D. candidates shall be exempted from the requirement of NET/SLET/SET for recruitment
and appointment of Assistant Professor or equivalent positions in Universities/Colleges /Institutions subject to
the fulfilment of the following conditions:
a) Ph.D. degree has been awarded to the candidate in a regular mode
b) The Ph.D. thesis has been evaluated by at least two external examiners;
c) An open Ph.D. viva voce of the candidate had been conducted;
d) Candidate has published two research papers from his/her Ph.D. work, out of which, at least one is in a
refereed journal; and
e) The candidate has presented at least two research papers based on his/her Ph.D. work in conferences/
seminars supported/funded/sponsored by the UGC/AICTE/ICSSR or any other similar agency.
Note 1: The fulfilment of these conditions is to be certified by the Registrar or the Dean (Academic Affair) of the
University concerned.
Note 2: The clearance of NET/SLET/SET shall also not be required for such Masters Programmes in disciplines
for which NET/SLET/SET is not conducted by the UGC, CSIR or similar test accredited by the
UGC (like SLET/SET).
Or
B. A traditional or a professional artist with highly commendable professional achievement in the subject
concerned having a Bachelor’s degree, who has:
i) studied under a noted/reputed traditional Master(s)/Artist(s)
ii) Has been ‘A‘grade artist of AIR/Doordarshan;
iii) Has the ability to explain, with logical reasoning the subject concerned; and
iv) Has adequate knowledge to teach theory with illustrations in the discipline concerned.
 :Important instructions:
1. Reservation for Physically Handicapped person/s will be as per the State Government norms.
2. Reservation for Women will be as per the State Government norms.
3. A relaxation of 5% may be provided at the graduate and master’s level for the Scheduled Caste /
Scheduled Tribe / Differently-abled (Physically and visually differently-abled) categories for the purpose
of eligibility and for assessing good academic record during direct recruitment to teaching positions. The
eligibility marks of 55% marks (or an equivalent grade in a point scale wherever grading system is
followed) and the relaxation of 5% to the categories mentioned above are permissible, based on only the
qualifying marks without including any grace mark procedures.
4. A relaxation of 5% may be provided, from 55% to 50% of the marks to the Ph.D. Degree holders, who
have obtained their Master’s Degree prior to 19th Sept., 1991.
5. Relevant grade which is regarded as equivalent of 55% wherever the grading system is followed by a
recognized university shall also be considered eligible.
6. The period of time taken by candidates to acquire Ph.D. Degree shall not be considered as teaching /
research experience to be claimed for appointment to the teaching positions.
7. Applicants for Assistant Professors are to provide documentary evidence to the effect that the Ph.D. was
awarded as per UGC Regulation, 2009.
8. Candidates applying for more than one post should submit separate application for each post.
9. University reserves the rights to reduce or increase the number of posts & to fill up or not to fill up any of
the advertised posts, without assigning any reasons.
10. University reserves the rights to decide criteria / procedure for short listing of the candidates.
11. Candidates belonging to reserved categories, as notified by the State Government of Maharashtra and also
belonging to specific reserved category from Maharashtra State will alone be considered for reserved
posts.
12. As per G.R. dated 29-03-1997 the reservation in favour of VJ (A), NT (1), NT (2) & NT(3) will be
interchangeable if the candidate/s not available from required category, Hence, candidate belongs to all
categories (i.e VJ(a), NT(1), NT(2) & NT(3) ) can apply for the concerned reserved post.
13. Preference will be given to Sports person as per provision under Maharashtra State Govt. Resolution No.
jkØh/kks&2002@iz-Ø-68@Øh;qls&2]fn- 30 ,fizy] 2005-
14. As regards instructions Women and Sports candidates from the Open, OBC, NT-2 & NT-3 category must
submit Non-Creamy layer Certificate for getting the benefit of Horizontal Reservation in the said
category as per Government norms.
15. As per provision laid down in State Govt. Notification No. SRV.2000/CR(17/ 2000)/XII dated 28th
March, 2005 issued by General Administration Department, Mantralaya, Mumbai, candidates must
submit the prescribed declaration of the small family as one of the essential qualifications for recruitment,
in the prescribed proforma with Application Form, as Declaration FORM-A.
16. A candidate must fill all the columns in the application form.
17. A candidate furnishing incorrect or false information shall stand disqualified at any stage.
18. Interview of candidates found eligible will be preceded for oral interview.
19. No application shall be entertained if it is incomplete.
20. Those who are already in service should submit the application through proper channel & also submit No
Objection Certificate from previous employer at the time of interview.
21. Mere possession of minimum qualifications does not confer any right to be appeared for interview and /
or selection.
22. No queries or correspondence regarding selection of candidates will be entertained at any stage.
23. The University will not be responsible for any postal lapses or delay.
24. No TA/DA will be paid either for attending the interview or for joining the post.
25. The University shall not be held responsible for postponement or cancellation of scheduled interviews for
any unforeseen / unavoidable reasons.
26. Canvassing in any form, directly or indirectly, will disqualify the candidate immediately.
27. Candidate should enclose attested or self attested copies of all the following documents/certificates with
each application.
(i) Degree/Diploma, Statement of Marks and other certificates of the educational qualifications and
experience.
(ii) Caste Certificate from Competent Authority, if candidate belong to Scheduled Caste / Scheduled Tribe /
Nomadic Tribe and Vimukta Jati/OBC. It is compulsory to attach the Non Creamy Layer Certificate
(current year) with application form to the candidates who belongs to the VJ-A, NT-B, NT-C, NT-D and
OBC categories vide Government of Maharashtra’s Circular No. CBC 10/2006/Pra.Kra.15/MAVAK 5
dated 5th June, 2006.
(iii) Caste validity certificate (for reserved posts).
(iv) SSC certificate or other equivalent certificate in support of age. The original certificates would be
required at the time of interview only and
a. All other relevant documents / certificates.
28. The last date for submitting application in prescribed form, duly completed One copy Date23/10/2020,
05.40 p.m
29. The Actual date of interview will be informed to the concerned qualified candidate and published on
the University web-site.www.srtmun.ac.in
30. The Government Resolutions / Circulars issued by the Government of Maharashtra and the Provisions
of Maharashtra Public Universities Act, 2016 will be applicable.
31. The Vacancies in each school Subject to Change.

Date: 08-10-2020
Registrar
 APPLICATION
Post Applied for :
School Name : Please attached
Recent Pass
Advt.No & Date : Port size photo
Applied Category : (SC / ST / VJ(A) / NT-1 / NT-2 / NT-3 / SBC / OBC /SEBC/EWS/OPEN )
First Name Middle Name Last Name
Name of the
1. applicant

2. Date of Birth

3. Nationality

4. Male or Female

Marital Status
5. (Married / Unmarried) (It is mandatory to fill up the Family Declaration form for all applicants)

6. Correspondence address: ___________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Tel/Mobile.No:___________________________________________________________________________________________________________
Email.Id.:__________________________________________________________________________________________________________________
7. Whether from backward class : ____________________________________________________________________________________________________
Or open category, if backward, mention Category & Caste

8. Whether Physically Handicapped, : ______________________________________________________________________________________________

if yes, please specify details (attach supporting document)
9. Academic Vitae (attach documents) : (Appendix-I)
Passing Class/
Exam Name of University/Board Subject % Obtained
Year Grade
S.S.C.
H.S.C.
Graduation
Post Graduation.
M.Phil.
Ph.D
NET
SET
MS-CIT or Equivalent
Other if any
10. Field of Specialization :
 11. University Approved Teaching Experience: Total No. of Years......................................................................................................................
Sr. Name of the Institution Post held Period Present Basic Reason for Leaving
No R/T/C &
Pay Scale pay Full Time Services, If any
From to /Part Time

(R-Regular, T-Temporary, C-Contractual)

12. Administrative Experience : Total No. of years---------------------------------------------------

Sr. Name of the Post held Period Pay Scale. Reason for Leaving
No
Institution Basic pay Services, If any
From to

13. Reference-give names of two eminent persons with postal address email Id & mobile number not
related to you who can provide authentic information about you.
1. 2.

14. Demand Draft / University Receipt, Details:

University /Bank Name Receipt / DD.No & Date Amount
 CATEGORY – II
PROFESSIONAL DEVELOPMENT, CO-CURRICULAR AND EXTENSION ACTIVITIES
II (A) STUDENT RELATED CO-CURRICULAR, EXTENSION AND FIELD BASED ACTIVITIES.
(i) Discipline related co-curricular activities (e.g. remedial classes, career counselling, study visit,
student seminar and other events.
Actual Hours spent per academic year / 10
Academic Field Study Student Career Other Score
Year Work Visits Seminar Couns Events
elling

Total Scores
(ii) Other co-curricular activities (Cultural, Sports, NSS, NCC etc.)
Actual Hours spent per academic year / 10
Academic NSS / Student PG/Research Other Score
Cultural Sports
Year NCC Welfare activity Scholar forum Events

Total Scores
(iii) Extension and dissemination activities (Public /popular lectures/ Talks / seminars etc.)
Actual Hours spent per academic year / 10
Academic Public/Popular Public/Popular Public/Popular Others activities Score
Year Lectures Talks Seminars of such nature

Total Scores
(GRAND TOTAL {II (a)(i)+II(a)(ii)+II(a)(iii))
Maximum API score 15

II (B) CONTRIBUTION TO CORPORATE LIFE AND MANAGEMENT OF THE DEPARTMENT AND

INSTITUTION THROUGH PARTICIPATION IN ACADEMIC AND ADMINISTRATIVE COMMITTEES AND
RESPONSIBILITIES $
(i) Administrative Responsibilities (including as Dean/Principal / Chairperson/ convener/ Teacher-in-charge/ similar other
duties that require regular office hrs for its discharge)

Actual Hours spent per academic year / 10

Academic Dean HOD Chairperson Convener Admission Faculty Coordinator Any other activity of
Year work Advisor of Refresher similar nature that
require regular
Courses office hrs for its
discharge

Scores
Grand Total
 (ii) Participation in Board of Studies, Academic and Administrative Committees
Actual Hours spent per academic year / 10
Academic Board of Academic Administrative Any other activity of
Year Studies Committees Committees similar nature that
require regular office
hrs for its discharge

Scores
Total Scores
$ GRAND TOTAL {II
$ Maximum API score 15 (b)(i)+II(b)(ii)}

II (C) Professional Development Activities ( such as participation in seminars, conferences, short term
training courses, industrial experience, talks, lectures in refresher/ faculty development courses, dissemination
and general articles and any other contribution) $
Actual Hours spent per academic year / 10
Organizer and Place Period / Scores
Event Duration
Participation in Conferences / Seminars / Workshops / Summer
and Winter Schools
Refresher Courses / Training programmes
Short term Courses
Methodology workshop
Industrial Experience – Study / Consultancy
Invited Talks
Lectures in Refresher Courses / Faculty Development Courses
Membership in Professional Bodies
Dissemination of Academic / Research Knowledge / General Articles
Any other contribution of similar nature (Please specify)
$ Total Scores
$ Maximum API score 15
SUMMARY OF API SCORES CLAIMED UNDER CATEGORY II
Category Scores
II (a)
II (b)
II (c)
Total Scores (Maximum API score 45)
CATEGORYIII.RESEARCH/ACADEMIC CONTRIBUTIONS
(A): DETAILS OF RESEARCH PAPERS PUBLISHED
(i): Refereed Journals as notified by the UGC#
Sr. Title of the Article Name of the journal Whether you are No. of Co- Impact Claimed Annexure
No. Vol. No. & PP / Month the main Author Authors Factor Score No.
&Year

Note: 25 points per publication..

Refer Note (I & II) in the end of the form.
 (ii): Other reputed Journals as notified by the UGC#
Sr. No Title of the Author Co-Author(s) Name of the journal Total
Impact Annexure
Article Vol. No. & PP / Month &Year
Factor No.

Note: 10 points per publication.

Refer Note (I & II) in the end of the form.
III (B): PUBLICATIONS OTHER THAN JOURNAL ARTICLES (Books, Chapters in Books)
(i) : Text / reference books by International Publishers, with ISBN/ISSN number.
Sr. Title of the Book Author Co-Author(s) Name of the Publisher / Total Annexure
No. Month, Year Points No.

Note: 30 points per book for single author. Refer Note (II) in the end of form.

(ii): Title of the Book Author Co-Author(s) Name of the Total Points Annexure
Subjec Publisher No.
/ Month, Year

Note: 20 points per book for single author. Refer Note (II) in the end of form.
(iii): Subject books, published by other local Publishers, with ISBN/ISSN number as approved by the
University and posted on its website. The list will be intimated to UGC.
Sr. No. Title of the Book Author Co-Author(s) Name of the Total Points Annexure
Publisher No.

Note: 15 points per book for single author. Refer Note (II) in the end of form.
(iv): Chapters in Books published by National & International level Publishers, with ISBN.ISSN number as
approved by the University and posted on its website. The List will be intimate to UGC.
Sr. No Title of the Book Number of Title of the Author Name of the Total Annexure
Chapters Chapter Publisher of the Points No.
contributed Book/ Month, Year

Note: International: 10 points per chapter. National: 5 points per chapter. Refer Note (II) in the end of form.
III (C): RESEARCH PROJECTS
(i): Details of Sponsored Projects
Title of Funding Grant Project Status Project Type: Policy Total Annexure
the Agency sanctioned Duration completed / Research/ Document points No.
Project on-going Consultancy/
Action
Research
From To

Note: (i) Major projects of over 30 lakhs in Science / Engineering/ Agriculture/Medical/Veterinary Sciences and grants above 5
lakhs in Languages /Humanities/arts/Social Sciences/Library/Physical education/Management will get 20points per project.
 (ii)Projects of 5-30 lakhs in Science / Engineering/ Agriculture/Medical/Veterinary Sciences and grants above 3-5 lakhs in Languages
/Humanities/arts/Social Sciences/Library/Physical education/Management, etc. will get 15 points per project.
(iii) Minor projects of 1 lakh – Rs. 5 lakhs in Science / Engineering Agriculture/Medical/Veterinary Sciences and grants Rs.1 lakh –
3 lakhs in Languages /Humanities/arts/Social Sciences/Library/Physical education/Management, etc, will get 10 points per project.
(ii): Details of Consultancy Projects
Title of Funding Grant Duration Project Status Project Type: Policy Total Annexure
the Agency sanctioned completed / Consultancy/ Document points No.
Project on-going Action Research

From To

Note: Consultancy mobilized for more than 10 lakhs in Science and Engineering and 2 lakhs in Social Science, etc. will get 10
Points for every Rs.10 lakhs and Rs. 2 Lakhs respectively.
(iii): Projects Outcome / Output
Title of the Funding National Project Outcome/Outputs Total Annexure
Project Agency /International Details of Patents / Major Policy points No.
Technology Transfer Documents of Central
/ Product / Process / State Govt./
(Science &Engineering)* WHO/ UNO/
UNESCO / UNICEF
etc. Bodies prepared
(Humanities &
Management)**

* Faculties of Science /Engineering / Agriculture / Medical / Veterinary Sciences

** Faculties of Languages / Humanities / Arts / Social Sciences / Library / Physical Education / Management.
Note: 30 points for each International or patent / 20 points for each National level output or major policy document /
State Government 10 points and for Local bodies 5 points.
III (D): RESEARCH GUIDANCE
(i): Details of M.Phil. Awarded
Total Annexure No.
Name of the Scholar Title of the Name of the Month and Year
Points
Dissertation University

Note: 5 points per candidate.

(ii): Details of Ph. D Awarded / submitted
Name of the Scholar Submitted Awarded Name of the Month Total Annexure
Title of the
University and Points No.
Thesis
Year

Note: 15 points per candidate for degree awarded and 10 points per candidate for thesis submitted
 III (E): FELLOWSHIPS, AWARDS AND INVITED LECTURES DELIVERED IN CONFERENCES /
SEMINARS
(i): Details of Fellowships/ Awards
Name of the Award / Sponsoring Agency International/ Date Total Annexure
Fellowship National/State/University level Points No.

Note: 15 points for International level, 10 points for National level and 5 for State/University level per award/fellowship
(ii): Details of invited lectures / papers presented in Conferences / Seminars, etc.
Name of the Name of Organising International/ National/ The Paper / Talk Duration Total Annexure
Programme Agency State/University level (Dates of Event) Points No.

Note: 7 points per lecture and 5 points per paper presented for International level, 5 points per lecture and 3 points per
paper Presented for National level and 3 points per lecture and 2 points per paper presented for state/University level.
[For Professor and Associate Professor:-The score under this sub-category (III (E) (ii)) shall be restricted to 20 % of the
minimum score fixed for category III for any assessment period]
III (F): DEVELOPMENT OF E-LEARNING DELIVERY PROCESS/MATERIAL
Name of the Name of the Subject / Level of Details of the Number Total Annexure
subject/discipline for course for which e-learning Course URL/website of Points No.
which e-learning resource resource is developed Material (Eg. where available Modules
is developed (Eg: B.E, M.E, M.Sc., B.Sc., UG/PG) or
(Eg. Science: Physics)
MA, BA, B.Com, M.Com) if CD/DVD
enclose a copy

Note : 10 points per module. 70% to the first author and remaining 30% to be shared equally by all the other authors.

SUMMARY OF API SCORES CLAIMED UNDER CATEGORY III

Category Scores
III (A)
III (B)
III (C)
III (D)
III (E)
III (F)
Total Scores
 SUMMARY OF API SCORES CLAIMED UNDER CATEGORY II & CATEGORY III
(Cumulative)
Category Scores

II

III

Total Scores
# UGC has notified the List of Journals vide Notification F.No. 1-2/2016(PS) dated 10th January, 2017 which is available on
UGC website i.e. www.ugc.ac.in for the perusal of all stakeholders. Any addition/deletion made by UGC in the list of Journals
shall also be applicable.
NOTES:

(I) Wherever relevant to any specific discipline, the API score for papers in refereed journal would be augmented as
follows: (i) Papers with impact factor less than 1 by 5 points (ii) Papers with impact factor between 1 and 2 by 10 points
(iii) Papers with impact factor between 2 and 5 by 15 (iv) papers with impact factor between 5 and 10 by 20 points (v)
papers with impact factor above 10 by 25 points.
(II) The API for Joint Publications shall be calculated in the following manner: of the total score for the relevant category
of publications by the concerned teacher, the first and principal/corresponding author/supervisor/mentor would share
equally 70 % of the total points and the remaining 30% would be shared equally by all other authors.
(III) Attach the self-attested proofs of all the self-assessment claims made in category II and III.

DECLARATION
I , hereby declare that the particulars furnished above
are true to my knowledge.

Place: -------------------------------------------- SIGNATURE OF THE APPLICANT

Date: / /2020
 CERTIFICATE

1. The above information furnished by me is correct.

2. I am neither convicted nor any criminal case, departmental enquiry or disciplinary
action is pending against me.
3. In case any false information is detected, I understand that my application is liable
to be rejected or the appointment made would stand terminated.

Signature of applicant

Place : ………………………

Date : ………………………
_______________________________________________________________________________
If employed, the application should be forwarded through proper channel.
Recommendation of forwarding authority _______________________________________
_________________________________________________________________________________

Place : ………………………

Date : ………………………

Name & Signature

Seal of the Department / Institute

 Declaration FORM "A"
(See Rule - 04)
I Shri./ Smt. / Sow. __________________________________________________________________

Son / Daughter / Husband / Wife of Shri. ____________________________________________________

aged _______________ years, resident at _______________________________________________________

_____________________________________________do hereby declare as follows:

1. That I have filled my application for the post of _____________________________.

2. I have ____________ (Number) living children as on today, out of which number of children
th
born after 28 March 2005 is _________ (mention dates of Birth, if any).
3. I am aware that, if any total number(s) of living children are more than two due to the children
th
born after 28 March 2005, I am liable to be disqualified for the same post.

Signature of Applicant

Place :

Date :