UTTAR BANGA KRISHI VISWAVIDYALAYA Pundibari, Cooch Behar, Pin , West Bengal

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1 UTTAR BANGA KRISHI VISWAVIDYALAYA Pundibari, Cooch Behar, Pin , West Bengal 1. The Candidate must be a citizen of India. 2. A separate application form must be submitted for each post/item in the advertisement. 3. Persons in service may submit an advance copy of the application along with the application fee (as applicable) direct to the Registrar (Recruitment Section), Uttar Banga Krishi Viswavidyalaya, P.O. Pundibari, Dist. Cooch Behar, Pin , West Bengal so as to reach on or before the closing date. The application duly forwarded by the employer must reach the University within 30 days of the closing date. 4. The candidates should attach documents as specified in the application form. 5. With the application, a crossed Demand Draft of any nationalized bank of Rs.... (valid for three months, with name, address of the candidate and post applied for on its back) should be submitted drawn in favour of the "Uttar Banga Krishi Viswavidyalaya" payable at Cooch Behar. 6. SC/ST/OBC-A/OBC-B/PWD candidates must attach attested copy of relevant certificate issued by the competent authority. 7. Incomplete applications and applications not accompanied with the prescribed fee are liable to be rejected. 8. Candidates apply from outside India should arrange to send international Crossed Demand Draft for US $ 50 drawn on or before the closing date for receipt of applications. 9. Original documents in support of various claims should be produced at the time of interview. 10. No TA/DA will be paid to candidates. Instruction 11. A candidate must be in sound health. He/She must be prepared to undergo such medical examination and satisfy such medical authority as required. 12. The candidate may submit only the front page of the published paper/book/journals along with the application form. 13. The decision of the University with regard to eligibility or otherwise of any candidate based upon evaluation of the application and particulars/ records submitted with the application by the candidate shall be final and the University will not enter into any correspondence in this regard with the unsuccessfully candidates. 14. Canvassing in any manner shall lead to disqualification. 15. Any other information: included any significant contribution relevant to the post applied for and not covered elsewhere. In case of candidates dealing with work related to coordination/ facilitation, significant contributions can be given here. 16. Giving of any false information or claim may render the candidate liable to such action as the University may deed fit and appropriate apart from disqualification of candidature.

2 Serial No: UTTAR BANGA KRISHI VISWAVIDYALAYA Pundibari, Cooch Behar, Pin , West Bengal APPLICATION FORM FOR RECRUITEMENT OF TEACHER / OFFICER (The Viswavidyalaya reserves the right to reject/not to accept any form without adducing reasons) By cash To be filled by the candidate Demand Draft No. & Date Name of Issuing Bank Amount of fee remitted For Official Use Only Checked by Dealing Assistant Section Office / In-charge Remarks, if any (TO BE FILLED IN BY THE CANDIDATE IN HIS/HER OWN HAND WRITING) To The Vice-Chancellor Uttar Banga Krishi Viswavidyalaya P.O.- Pundibari, Dist.- Cooch Behar West Bengal, Space for Candidate s Photograph (Passport size) Sir, In response to your advertisement No. dated.. I wish to apply for the post of My particulars are given below. Signature of Candidate in full 1. Post Applied for Post - Discipline - 2. Name of the Applicant in full (in Block letter) 3. i) Candidate s address in full where correspondence is to be made ii) Candidate s permanent address Surname Name Pin Code: Pin Code: [ 1 ]

3 4. Contact details Mobile No.: Tel. No. : Fax No. : 5. i) Date of birth (According to Christian era) ii) Place of birth iii) Dist. and State of which he belongs (iv) Whether an Indian Citizen (v) Citizenship by birth / domicile. 6. Age on date mentioned in the notification (YY-MM-DD) 7. Sex (Male/ Female) 8. Father s name, address and occupation (if dead, state his last address & occupation before death) 9. i) Marital status ii) Name of husband/wife as applicable, occupation & address ID : i) ii) iii) iv) v) i) Married / Unmarried / Widow / Divorced ii) 10. Candidate s mother tongue. 11. a. Category b. Whether belong to Scheduled Caste or Tribe/ OBC-A/ OBC-B, If yes. Give details with attested copy of the certificate document in support. General SC ST OBC-A OBC-B PWD Sub-caste : Issuing authority: 12. Give particulars of all examinations passed and degree and Technical qualifications obtained at the University or other places of higher education or instruction (commencing with the Matriculation or equivalent examination including professional / technical). Examination or Degree or Diploma Matriculation or equivalent Higher Secondary or equivalent Graduate Masters' Degree Doctoral Degree NET /SLET/ SET/ GATE Post Doctoral Others ( Use additional sheet if required) 13. Reasons of gap, if any: Board / University Year of % of Admission Passing out marks Obtained Class/ Division Subject with Specialization at Master degree level and onward Academic Distinctions If any [ 2 ]

4 14. Scholarships and fellowships enjoyed / awards obtained: 15. In which language (including Indian language) you can read, write or speak. Read only Speak only Read and Speak Read, Write and Speak 16. a) Are you free from debt? b) If you are under liability to repay money advanced by any institution or party for your education or for any other purposes: State the particulars. Answer Yes or No to question (a) If the answer is No answer question (b) clearly. 17. Present and previous employment (Give particulars below) Name of Employer Status of the Organisation (Govt./Govt. aided/ Govt. undertaking/ private/ corporate/ others) Designation of post Pay Scale and Salary (Basic+ Grade Pay) Date of Joining Leaving Actual Duration (years & months) Nature of Work Perm. Or Temp Reasons of leaving 18. Teaching experience (use additional sheet if required): UG level Item Details Year(s) Individual/Collaborative M.Sc. Level Ph.D level Designing of course curriculum M.Sc./Ph.D students guided as Major/ Coguide Innovation of teaching methods [ 3 ]

5 19. Research experience (use additional sheet if required): Project handled (mention the type of projects such as "Institutional", "Sponsored", "Contractual" and "Consultancy") Title of the Project Whether PI/Co-PI/ Associate Duration Category Major Accomplishments 20. Extension experience (use additional sheet if required): a) Popularization of new technologies: Title of Technology Methods adopted Impact assessment Individual/ Collaborative b) Innovation of new extension technologies: Title of Technology Methods adopted Impact assessment Individual/ Collaborative c) Collaborative extension programmes: Title of Technology Methods adopted Impact assessment Individual/ Collaborative d) Training Courses Programmes Organisation Title Year Duration No. of beneficiaries Co-ordinator/ Associated e) Organisation of Krishi Melas, Exhibitions etc. Title & Location Year Duration No. of beneficiaries Co-ordinator/ Associated f) Radio Talks/TV shows Title Date 21. Administrative/ Management experience (use additional sheet if required): Name of the Post Nature of Work Duration Status of the Organisation (Govt./Govt. aided/ Govt. undetaken/ private/ corporate/ others) Remarks 22. Co-curricular activities (please furnish testimonials in support ) 23. Recognitions / Awards/ Scholarship/ Fellowship/ Special Attainments & Achievements (please furnish testimonials in support ): [ 4 ]

6 24. Are you prepared to accept the minimum initial pay offered? If not, state what is the lowest initial pay that you would accept in the prescribed scale: 25. Particulars of place (with periods & residence) where you have resided for more than one year at a time during the preceding five years. From To Residential address in full (i.e. Village, Thana and Dist. House No. Lane/Street/Road and Town) Name of the District headquarters of the place mentioned in the preceding column 26. a) Have you ever been arrested, prosecuted, kept under detention or bound down / fined convicted by court of law of any offence or debarred disqualified by any selection / examination or rusticated by any University or any other educational authority / institution for reasons other than traffic offence: (if Yes give the details) b) Is any case pending against you in any court of law, University or any educational authority/ institution at the time of filling up this form? If the answer to (a) or (b) is Yes give full particulars. 27. If selected, what notice you would require before joining. 28. (a) Research publication. Give details of papers here and attach with application (use additional sheet if required). Sl. No. Name of the Journal with volume & page number Title of the Publication Author Year of Publication NAAS Rating/ Impact Factor (b) Other Publications (i) Book Published: Item Year Details Publisher Pages Books Authored Book Edited [ 5 ]

7 (i) Book Chapters/ Manuals: Item Year Details Publisher Pages (c) Seminar / Symposium / Workshop attended. Give details with date(s), duration and place. (use additional sheet if required) i) National: Sl. No. Seminar/ Symposium/ Workshop/ Training (Mention category) Year Organizing Institute Title of the Seminar/ Symposium/ Workshop/ Training Duration Remarks ii) International: Sl. Seminar/ No. Symposium/ Workshop/ Training (Mention category) Year Organizing Institute Title of the Seminar/ Symposium/ Workshop/ Training Duration Remarks 29. Special qualification or experience, if any (provide documentary evidences): 30. Name, designation, address and contact numbers of two reference must not be related to the candidate. 31. List of documents attached to the application (all documents are to be attested and to be produced in original at the time of interview/ joining, if selected).: [ 6 ]

8 D E C L A R A T I O N I here by declare that the statements in this application form are true to the best of my knowledge. Date: Candidate s full signature CANDIDATE ALREADY EMPLOYED SHOULD GET FOLLOWING ENDORSEMENT SIGNED BY HIS/HER PRESENT EMPLOYER. No.. Date.. i) The entries relating to details of service mentioned by... Sir/Sm. are correct. ii) There are no circumstances rendering him/ her unsuitable for appointment to the post applied for iii) His/ Her confidential dossiers / Service Book are to be provided if selected. iv) There is no vigilance / disciplinary case pending against him / her. (Official Seal) Signature Date: Designation Deptt./ Office [ 7 ]

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