Name : ___________________________________________________________________________
Post applied for: __________________________________________________________________
Advertisement No. and Date: ________________________________________________________
Information to the Candidates
1. Please answer each question clearly and completely, fill all the blank spaces, if not applicable
2. Candidate has to paste stamp size / passport size photo in the place specified in the application form. 3. The eligibility and suitability of a candidate shall be considered based on the information provided in the application. 4. All claims mentioned in the application should be supported by relevant and authenticated documents. 5. Certificates for prescribed qualifications must have been obtained from Competent Authority on or before the last date of submission of application. 6. Applications should be complete in all respect as on the date of submission. 7. For Sl. No 11, Photo copies of all relevant mark sheets should be furnished. Any additional documents / certificates / records / photo copies provided after the last date for submission of filled-in application will not be considered. 8. For Sl. No. 12, Photo copies of relevant experience should be furnished, without which experience will not be considered. Any additional documents / certificates / records / photo copies provided after the last date for submission of filled-in application will not be considered. 9. 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. 10. Proficiency of Kannada eligibility is subject to fulfillment of kannada language proficiency in the written test.
Page 1 of 9 11. Incomplete applications will to be rejected. 12. The selection procedure will be in accordance with the norms laid out for the qualification / experience and others for the relevant posts and are as per the Advertisement published in News Papers and available in the website: www.nijalingappasugar.com 13. For the post of Technical Adviser: Sugar Technology GM / DGM / AGM [Section Head] is considered as higher level, Assistant Manager / Manager / Senior Manager is considered as middle level and Officer / Junior Officer / Assistants / Instructor/Trainee is considered as lower level. 14. For the post of Technical Adviser: Sugar Engineering & Co-Generation GM / DGM / AGM [Section Head] is considered as higher level, Assistant Manager / Manager / Senior Manager is considered as middle level and Officer / Junior Officer / Assistants / Instructor/Trainee is considered as lower level. 15. For the post of Technical Adviser: Alcohol Technology GM / DGM / AGM [Section Head] is considered as higher level, Assistant Manager / Manager / Senior Manager is considered as middle level and Officer / Junior Officer / Assistants / Instructor/Trainee is considered as lower level. 16. For the post of Sugar Technologist the experiences in the post of Shift-Chemist / Chemist / Deputy Chief-Chemist / Chief Chemist is considered as middle & above level and Trainee- Chemist / Junior-Chemist / Assistant-Chemist / Instructor is considered as lower level. 17. For the post of Sugar-Engineer the experiences in the post of Assistant Engineer / Senior Engineer / Deputy Chief Engineer / Chief Engineer and above is considered as middle & above level and Officer / Junior Engineer / Trainees / Assistants / Instructor is considered as lower level. 18. For the post of Alcohol Technologist experiences in the post of Shift Chemist / Chemist / Dy. Chief Chemist / Chief Chemist and above is considered as middle and above level and Trainee Chemist / Jr. Chemist / Assistant Chemist/ Instructor is considered as lower level,. 19. Working sugar factories experience shall be provided with the performance of the sugar factory as mentioned in Sl. No. 13A. For the post of Distillery Chemist the performance of the distillery to be furnished in the Sl. No.13B.
Page 2 of 9 APPLICATION FORM
1 Name of the post applied for
2 Name of the candidate in full :
(in capital letters as appearing in the degree
certificate)
3 Address for communications to be sent
with pin-code No. and State.
Telephone No. with STD Code:
Mobile No. :
E-mail ID: (if any)
4 a) Are you an Indian Citizen?
(Please tick) Yes No b) Religion
5 a) Sex Male Female (Please tick )
b) Date of Birth Day Month Year (to be supported by a copy of the valid certificate / SSLC Marks card)
c) Age as on the date of Year Month
advertisement
6 Marital status : (Please tick )
Single Married
7 Place of birth and district / state to
which he / she belongs to
Page 3 of 9 8 i) Do you belong to Scheduled Caste or
Scheduled Tribe? Yes No
If yes, please indicate the category and
enclose a certificate in the prescribed format from the competent authority
a) Caste SC ST b) Sub-Caste
ii) Do you belong to any Backward
Class (Cat. I, II (A), II(B), III (A) & III (B))? Yes No If yes, please indicate the category and enclose a certificate in the prescribed format from the competent authority?
a) Caste Cat-1 IIA II B IIIA IIIB
b) Sub-Caste
iii) Do you belongs to any Horizontal
Reservation category [Women (W), Rural Candidates (RC), Ex-Serviceman Yes No (Ex-Ser), Kannada Medium (Kan.), etc.]?
If yes, please indicate the category and
enclose the relevant certificate in the W RC Ex. Ser. Kan. Others prescribed format from the competent authority. (Please tick )
iv) Do you belongs to Hyderabad Yes No
Karnataka Region (HKR) Reservation (Please tick ) If yes, please indicate the Cat-1 IIA II B IIIA IIIB category and enclose the relevant certificates issued by the Competent Authority as required under the Government Notification-II No. DPAR W RC Ex. Ser. Kan. Others 43 HKC 2013 dated: 29-01-2014
Page 4 of 9 Note: 1. Claims under item 8 to be supported with valid certificates issued by competent authorities.
2. Claims without required certificates will be treated under GM Category
9 a) occupation b) Income per annum Rs.
10. Languages known
Language Speak Read Write Read and write Examination
11. Academic Qualification:
Examination Passed (enclose marks Examining Subject Year of Marks obtained Percentage card / certificates) body/University studied Passing out of total marks of Marks**
SSLC
PUC
Ph.D Degree
M. Phil (Not less than 10 months)
Additional qualification if any *
Page 5 of 9 *Additional qualification means masters degree of minimum of two years duration.
**In case of CGPA / any other grade point system, the candidates are required to furnish the formula to convert to percentage from the concerned institute /university from where they have obtained the degree.
11A. Whether passed UGC-NET (National Eligibility Test) / SET (State Eligibility Test): Yes / No
__________________________
12. Relevant Industrial Experience details
Emolument Reporting Date of Date of Gross pay Reasons for Leaving Name of the Employer Designation / Cadre Authority Joining Leaving (Rs. per month)
Lower Level *
Middle Level *
Higher Level *
Page 6 of 9 Note: * It should be as per the sl. No. 13,14,15,16,17&18 of the instruction sheet. Use separate sheet if necessary. Enclose certificate issued from competent authority.
13. A) Performance of the working sugar factory details where the candidate has served:
Sl. No Name of the factory Year Cane crushed Sugar bagged Recovery % (M.T) (Qtl)
13. B) Performance of the working distillery / ethanol plant details where the candidate has served:
Sl. No Name of the factory / distillery / ethanol Year Production Yield
plant (%)
Page 7 of 9 14. Publications Note: Should be supported by duly attested copy of documents. Any additional documents / certificates / records / photo copies provided after the last date for submission of filled-in application will not be considered for award of marks.
Number of publications Sl. No. Particulars / Article
i) Local Publication
ii) National Level
iii) International level
iv) Books in English / Kannada
15. Others: A. Foreign exposure:
Sl. No Name of country visited Purpose of visit Year
4 5
Note: Candidate has to provide passport endorsements as proof of foreign visit along with the application. Any proof of photo copies provided after the last date for submission of filled-in application will not be considered for award of marks.
B. Awards:
Sl. Name of the award Award issuing authority / Year
No organization
Page 8 of 9 5
Note: Candidate has to provide copy /proof of the awards along with the application. Any proof of photo copies provided after the last date for submission of filled-in application will not be considered for award of marks.
Declaration by the candidate
Sl.No Name of the document enclosed Page No. 1
10
I hereby declare that information furnished in this Application Form is true to the best of my knowledge and belief. In case, if the information provided by me is proved to be false, I shall undertake that I may be punished in accordance with law.
