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On Deputation Basis / On Contract Basis

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Application for the post of ……………………………….. (Post No…...

) in

INDIAN NATIONAL SPACE PROMOTION AND AUTHORIZATION CENTRE


(IN-SPACe)
[On Deputation basis / on Contract basis]
(strike out whichever is not applicable) Recent
Color
Passport
Size PHOTO

1. Name & Address


(in BLOCK LETTERS)
Mobile No.
Email id.
2. Date of Birth (in Christian era) / Age
3. Gender
4. Whether belong to SC/ST/OBC/PWD/
Ex-Servicemen? If yes, specify
5. Type of present employment (State
Govt./UT/PSU/etc.) pls. specify
6. Date of entry into service
7. Educational Qualification
Degree/Diploma/ University/Board Main Month & % Marks/CGPA
Certificate Sub. Year of
Passing
i.
ii.
iii.
8. Whether satisfying Qualification/ Experience Qualification/experience possessed by
required as mentioned in the Advertisement the applicant
i. Essential Qualification
Desirable Qualification
ii. Holding analogous posts/comparable level on Pay Level: Since date:
regular basis in the parent cadre or department
iii. Relevant experience as per the advertisement, if
so number of years of experience.

9. Details of Employment, in chronological order:


Sl. Office/ Post held on Whether From To Pay Matrix/Pay Nature of
No. Institution regular regular/ level/ Duties
basis/Name of Deputation/ Annual Highlighting
Employer Contract Remuneration experience
required for
the post

10. Additional information, if any, relevant to the post


you applied for in support of your suitability of the
post

*Separate sheets in support of qualification, experience, etc. can be attached as an


annexure
I have carefully gone through the vacancy circular/advertisement and I am
well aware that the information furnished in the application duly supported by the
documents in respect of Essential Qualification/ Work Experience submitted by me
will also be assessed by the Selection Committee at the time of selection for the
post. The information/ details provided by me are correct and true to the best of my
knowledge and no material fact having bearing on my selection has been
suppressed/ withheld.

(SIGNATURE OF THE APPLICANT)

Place: Correspondence Address:


Date:

Certification by the Employer/Cadre Controlling Authority


(for Deputation cases)

1. The information/details provided in the above application by the applicant are true
and correct as per the facts available on records. He/She possesses educational
qualifications and experiences mentioned in the vacancy Circular. If selected,
he/she will be relieved immediately.

2. Also certified that;


i) There is no vigilance or disciplinary case pending/contemplated against
Shri/Smt./Ms.
ii) His/ Her integrity is certified.
iii) His/ Her ACR/APAR Dossier/ Yearly Performance Report is enclosed/
photocopies of the APARs for the last 5 years duly attested are enclosed
iv) No major/minor penalties imposed on him/her during the last 10 years
enclosed (as the case may be).

Date:

Countersigned_____________________

Name & Designation_________________

(Employer/Cadre Controlling Authority with Seal)

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