Microsoft Word - APPLN (003).docx
INDIAN COUNCIL OF MEDICAL RESEARCH5721350112395Photo00Photo Ansari Nagar, New Delhi – 110 029Name of the Project:Applying for the Post of:Name of the Candidate: (In Block Letters)Father’s Name:Date of birth /: / Yrs. Age in completed yearsSex:Male / FemaleCategory:SC / ST / OBC / OthersAadhaar No. :9. Permanent Address:--------------------------------------------373380019685000373380045910500Present Address:--------------------------------------------36957001949450036957004584700010 Mobile Number and: E-mail ID: Educational QualificationEssential QualificationSl.NoExam passedYear ofpassingBoard /University% of MarksDesirable Qualification: Sl.NoExam passedYear ofpassingBoard /University% of Marks Work ExperienceSNName of the Employer (Name of the office/Institution)Period (Date/month/year)Post heldJob ResponsibilitiesFromToWhether any relative is employed in ICMR?Yes / No If yes give detailsPaper publications (if any):Any other information:DECLARATIONI hereby declare that the information furnished above is true, complete and correct to the best of my knowledge and belief. I understand that in the event of any of the information provided by me are found false or incorrect at any stage, my candidature / appointment shall be liable for cancellation / termination without notice or any compensation in lieu thereof.Place:Signature of the CandidateDate: ................
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