UNIVERSITY OF AGRICULTURAL SCIENCES, BANGALORE

APPLICATION FORM FOR RECRUITMENT OF

Programme Assistant (Computer) Posts (T-4 SERIES)

To be filled in by the applicant’s own handwriting

Name : ___________________________________________________

Post applied for : ___________________________________________

Advertisement No. and Date : _________________________________

DD No. with Date and Name of the Bank : ________________________

Note: 1. Please answer each column clearly and completely.

2. Eligibility and suitability of a candidate shall be considered based on the

information provided in the filled application with attested copies of
certificates from competent authority.

3. All claims mentioned in the application should be supported by relevant

and authorized documents.

4. Certificates for prescribed qualifications must have been obtained from

the competent authorities and its attested copies are submitted on or
before the last date prescribed for submission of application.

5. Application should be complete in all respects as on the date of

submission. Any additional documents / certificates / records provided
after the last date for submission of filled-in application will not be
considered for award of marks.

6. If a candidate has submitted more than one application for the same
post, the latest application submitted within the prescribed last date
shall be considered as valid for the purpose of recruitment process.

7. Separate sheets may be attached wherever necessary.

8. Incomplete applications shall be rejected.

9. The selection procedure shall be in accordance with the Statutes and

Cadre & Recruitment Regulations of the University and the score card
published in Karnataka gazette dated: 31-01-2008 under No. AO / RSP
/ C & RR / T-Series / 2007-08, dated 16-01-2008 and also available
on website www.uas bangalore.edu.in
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APPLICATION FORM

1. Name of the post

2. Name of the candidate in full

(in capital letters as appearing in the
degree certificate)

3. Address
(to which all communications to be
sent) Telephone No. with STD code .,
e-mail : Mobile number:

4. Are you an Indian Citizen? Yes No

5. a) Sex
Male Female Others
b) Marital Status

b) Date of Birth Day Month Year

(to be supported by a copy of the valid
certificate / SSLC marks card)

6. Place of Birth , District and State to

Which it belongs

7. a) Do you belong to Scheduled Yes No

Caste or Scheduled Tribe?
If yes, please indicate the SC ST
category and enclose a certificate
in the prescribed format from the Name of the
competent authority. Sub Caste

b) Do you belong to any

Backward Class [Cat. I, II (A), Yes No
II (B), III (A) & III (B)] ?
If yes, please indicate the Cat-I IIA IIB IIIA IIIB
category and enclose a certificate
in the prescribed format from the Name of the
competent authority. Sub Caste
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c) Do you belong to any

Horizontal Reservation
category [Women (W),
Rural Candidates (RC), Ex-
serviceman (Ex-ser), Kannada Yes No
Medium (Kan.),Physically
challenged, PDP etc]? EX- PDP PC
W RC Kan Others
If yes, please indicate the ser
category and enclose a certificate
in the prescribed format from the
competent authorities.

Note: Claims under item 7 to be supported with valid certificate issued by the
competent authorities.

8. a) Father’s Name, Address and

occupation
b) Income per annum.

c) Aadhar Card details(enclose copy)

9. Languages Known

Mention the
Languages Read Write Speak
Examination Passed

Kannada

English

Hindhi

10. Particulars of School Education (upto 10th Standard)

Name of the School and Place Date of Entry Date of leaving

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11(a) Academic Qualifications: Particulars of examination passed i.e SSLC / PUC /

Degree / PG Degree obtained; including post graduate training, if any.

Marks College /
Examination / Year of
Subject Studied obtained University /
Degree passed completion
(%) Institution

SSLC

PUC

Bachelor’s Degree

Master’s Degree

PG diploma of not
less than one year
duration

Ph.D Degree

Any Training
Programmes
For less than
one month

One month to three

months duration

More than three

months duration)

Note: 1. Field of specialization should be indicated clearly at the Master’s, Ph.D and
Post Graduate Diploma level.
2. The candidate shall furnish attested copy of the certificate of equivalent
percentage of marks in the case of award of marks other than 10 point scale.

11(b) Medals / Awards / Recognitions obtained at Bachelor’s /

Master’s / Doctoral Degree for academic excellence.

International

National / Jawaharlal Nehru / Rajyothsava

UAS Gold Medal

Private Gold Medal instituted through University

State Award

Professional Society
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Others

Note: If candidate has secured more than one Award / Medal / Recognition for the
same degree and or achievement, the highest award will be considered for
allotting marks.

12. Experience in the concerned field and pay scale

Name of the Designation Date of Date of Emoluments Reasons for

Employer / Cadre Joining Leaving (Basic pay) Leaving
(Rs.)

Note: Use separate sheet, if necessary. Enclose certificate issued by the competent
authorities.

13. Publications

Number of Publications
Particulars of Publication Name within Above three
three authors authors
a) Research papers published in standard
scientific journals
b) Research notes / short communications
published in standard journals or periodicals
like Current Research
c) Papers presented and documented in
Seminars / Symposia / Conferences at
International level
d) Popular article published in leading Dailies /
Institutional / Govt. Departments Periodicals
e) Paper presented and documented in National
conferences / Symposia / Seminars and also
articles published in sourvenirs
f) Research bulletins / Extension bulletins /
Extension folders / Chapters in books
published by Universities / National
institutes / Standard commercial publishers

g) Books published by individuals

Note: a) All the publications mentioned above should have been published as on
the last date prescribed for submission of filledin application.
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b) The first three authors in all the above cases will get full marks, while the
rest of the authors will get 50 % of the marks allotted to each item.
c) The candidates should furnish the list of publications in chronological
order of year of publication grouping them into name appearing within
three authors and name appearing after 3rd author under each group by
enclosing the copy of the publications in the same order.

14. Reference(furnish Name, Mobile no and Address of three persons not related to the
applicant) :

1.

2.

3.

15. Additional Remarks, if any:

16. Did you reject the employment

offered by UAS, Bangalore in
the past? Yes No
If yes, indicate full particulars
of post with date of offer.

17. a) Was there any criminal

case against you in the
past? Yes No
If yes, give details.

b) Is there any criminal case

pending against you? Yes No
If yes, give details.

I hereby declare that the information furnished in this Application Form and the additional
information furnished above are true to the best of my knowledge and belief. In case, the
information furnished is proved to be false, I shall undertake that I may be punished in
accordance with law.

Place:
Date: Signature of the applicant
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FORWARDAL CERTIFICATE FROM THE EMPLOYER

Certified that Smt. / Sri. ___________________________________________

is working in this Department / Institution / Organization as

_____________________________ w.e.f. ______________________ in the scale of

Rs. ________________. He / She is at present drawing a basic pay of

Rs. _________________ besides DA and other allowances amounting to

Rs. _____________________ .

We have no objection in forwarding his / her application for a post in University

of Agricultural Sciences, Bangalore. The Confidential Reports of the employee for the

past five years are *Satisfactory / Not Satisfactory. Attested confidential reports will

be mailed within 15 days.

*Strike off whichever is not applicable.

Date :

Office Seal : Signature and Designation

FORWARDAL CERTIFICATE
(Applicable only to UAS(B) Employees)

Certified that Smt. / Sri. ___________________________________________

is working in this Office / College / Research Station as

_______________________________ w.e.f. _____________ in the scale of

Rs. _______________________ . His /Her present basic pay is

Rs. _____________________.

Date :

Place : Signature and Designation