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Non-Teaching Appln Form (1)

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  NATIONAL INSTITUTE OF TECHNOLOGYROURKELA-769 008 APPLICATION FOR A NON-TEACHING POSITION (Please Fill in BLOCK LETTERS)Advertisement No.Post Applied for epartment!.Name in F ll (First S rname) ( Please ti#$)%. Address& PresentPermanentFA'EmailTeleponeOffi#e& Residen#e&*. ate of Birt+. Nationalit,& a, -ont ear  /. Present Emplo,ment&esi0nationOr0ani1ationate of 2oinin0S#ale of Pa, (Rs).Basi# Pa, (Rs.)Total Emol ments (per mont)(Rs.)3. Basi# Pa, e4pe#ted (Rs.)555555555555555555555555555  03 / 2011 Affi4 ere re#ent passport si1e  poto0rap-arriedSinle-aleFemale  6.(a) Ti#$mar$ te appropriate 7o4 if ,o 7elon0s to te parti# lar #ate0or, 8EN SC ST OBC (7) O## pation of fater and -oter&555555555555555555555555555555555555555  (#) earl, in#ome of parents (Rs.) 555555555555555555555555555555555555555 9. Total ,ears of te e4perien#e after attainin0 essential : alifi#ation ;. Areas of Spe#ialisation !<. A#ademi# Re#ord startin0 =it se#ondar, ed #ation  ( Please atta# 4ero4 #opies of all Certifi#ate > mar$seet) E4aminationBran#?Spe#ialisationColle0e?@niversit,?nstit teearPer#enta0eof mar$ Class?ivision?8rade !!. Emplo,ment&   parti# lar of ,o r past position (s) Name of te Emplo,er Post eldPeriod of Emplo,mentBasi# Pa, =it S#ale of pa, Nat re of  t,FromTo  !%. Dave ,o ever 7een dis#ar0ed?s spended from an, position f ,es  state reasons&!*. Spe#ial A#ievements or A=ards?Dono rs re#eived if an,&earName of A=ard?Dono r?A#ievement!+. Names and addresses of three Referees   (at least one of tem so ld 7e familiar =it ,o r re#ent =or$s) (!) (%) (*)  NameO## pation or  positionAddressFa4EmailPone No.!/. An, oter point tat te Board so ld #onsider for sele#tion& 5555555555555555555555555555555555555555555555555555555555555555555555555  555555555555555555555555555555555555555555555555555555555555555555555555  555555555555555555555555555555555555555555555555555555555555555555555555  555555555555555555555555555555555555555555555555555555555555555555555555  555555555555555555555555555555555555555555555555555555555555555555555555   !3.  ere7, de#lare tat  ave #aref ll, read and nderstood te instr #tions and parti# lars s ppliedto me and tat all entries in tis form as =ell as atta#ed seets are tr e to te 7est of m,$no=led0e and 7elief. There are attached sheets along with this form.Date:___________________ Place:__________________  ( Si0nat re of Appli#ant )  Note& @se separate seet if ne#essar, for an, of te a7ove items.  List of Attachments: !.%.*.+./.
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