VCRC

VECTOR CONTROL RESEARCH CENTRE

ICMR-VECTOR CONTROL RESEARCH CENTRE

Note: This application form should be filled in by candidate's own handwriting. Affix a recent
All informations must be given in words and not by dashes and dots. passport size
Please strike out whichever is not applicable. Incomplete application will be photograph
rejected.
(3.5cm x 4.5cm)

Application for the post of _________________________________

Demand Draft No: _________________________ Date: ________________________

Name of Bank: _______________________________________ Amount (`): __________

01. Name in Full: Shri./Smt./Kum. : __________________________________________________

02. Present / Communication Address : __________________________________________________

: __________________________________________________

: __________________________________________________

: ___________________________________________________

(B) Permanent address : ___________________________________________________

: ___________________________________________________

: ___________________________________________________

(C) Telephone /Mobile No : __________________________________________________

(D) E-mail : __________________________________________________

03. Date of Birth* (DD/MM/YYYY)_________________________ 04. Nationality _______________________

05. Gender: Male Female (Please  the appropriate box)

06. Marital status: Unmarried Married (Please  the appropriate box)

07. Community/Category* : SC ST OBC EWS UR PwD XSM

......2
 -:2:-
08. Educational Qualification: (Attach Self attested copies of all certificates)

Class/
Sl. Examination Year of Name of the Board/ Percentage
Subjects taken
No passed passing University of marks
obtained

1. SSLC/Matric

2. HSC / 12th

3. Degree

Post Graduation
4.
(PG Degree)

Diploma / PG
5.
Diploma

Other
6. qualifications,
if any

09. Languages known:

Read Only Speak Only Read and Speak Examination Passed

10. Previous Service Details: (Chronologically starting from the present employer)
Date of Name of the post
Number of Scale of Pay
Name of the with status Nature of
years of & Gross Pay
Employer Joining Leaving (whether Regular work
experience drawn
/ Contractual)

.....3
 -:3:-

11. If selected, what notice period would you require :

12. Any other information, you wish to add :

DECLARATION

I, ______________________________ hereby declare that the information furnished above is true to the
best of my knowledge and belief and no related information has been concealed. I am aware that if any of
the above statements are found to be incorrect or false or any material information or particulars have been
misstated, suppressed or omitted, I am liable to be disqualified for appointment and if appointed, my
appointment will liable to be terminated without any notice.

Signature of the candidate

Date:

Place:

CHECK LIST

Tick () whether the self-attested copies of the certificate and other documents in support of the
application are enclosed, as given under;

1. Certificate for proof of age :

2. Community certificate, if claim is under OBC/SC/ST :

3. Income & Asset certificate, if claim is under EWS :

4. Disability certificate, if claim is under PwD :

5. Discharge certificate, if claim is under XSM :

6. Certificates in support of Educational Qualifications :

7. Certificate for proof of Experience, if any :

8. Demand Draft (if applicable) :