22542122 PBX 22542824 (Council of Scientific and Industrial Research) Unit : 22544523 Taramani, Chennai 600 113 COA CSIR-CECRI 22541271 Notification No. EC/01/2015 Fax 22541973 APPLICATION FOR ENGAGEMENT TO THE POSITION OF CECRI UNIT” ………………………. – 1 Name : 2 Father’s / Husband’s Name : 3 Date of Birth and Age : 4 Address for Communication : Permanent Present Affix a Recent Passport Size Photo Telephone No(s) Nationality / Religion : 5 Whether belongs to : YES / NO SC / ST / OBC / PH (Please strike out which ever is not applicable. If Yes please attach copy of the community certificate) : (*) 6 Details of Qualifications Examination Passed Year of Class & % of Sl. Name of the Board / University Passing No. (Main Subject) Marks 1 2 3 4 7 Whether possessing Experience : YES / NO (If yes, mention the following particulars) Period of Engagement Name & Address of the S.No. Designation Nature of Work From To Company / Institution 1 2 3 8 Whether you have any blood relative working in : YES / NO CECRI Unit, Chennai. (If yes, give his/her complete details) 9 Name & Address of Two Referees : (1) (2) 10 Any other relevant information : DECLARATION I hereby declare that all statements made in this application are true and complete to the best of my knowledge and belief and nothing has been concealed / distorted. If, at any time I am found to have concealed / distorted any material / information, my engagement is liable to be terminated without notice. Place : Date : SIGNATURE OF THE CANDIDATE (*) Attach separate sheet if required.
(Council of Scientific and Industrial Research) Taramani, Chennai 600 113 Notification No. EC/01/2015 PBX COA 22542122 22542824 Unit : CSIR-CECRI 22544523 22541271 Fax 22541973 APPLICATION FOR ENGAGEMENT TO THE POSITION OF ………………………. – CECRI UNIT” 1 Name : Affix a Recent Passport Size Photo 2 Father’s / Husband’s Name : 3 Date of Birth and Age : 4 Address for Communication : Permanent Present Telephone No(s) Nationality / Religion : 5 Whether belongs to : SC / ST / OBC / PH YES / NO (Please strike out which ever is not applicable. If Yes please attach copy of the community certificate) 6 Details of Qualifications : (*) Sl. No. Examination Passed (Main Subject) Name of the Board / University Year of Passing Class & % of Marks 1 2 3 4 7 Whether possessing Experience : YES / NO (If yes, mention the following particulars) S.No. Name & Address of the Company / Institution Designation Period of Engagement From To Nature of Work 1 2 3 8 Whether you have any blood relative working in CECRI Unit, Chennai. : YES / NO (If yes, give his/her complete details) 9 Name & Address of Two Referees : (1) (2) 10 Any other relevant information : DECLARATION I hereby declare that all statements made in this application are true and complete to the best of my knowledge and belief and nothing has been concealed / distorted. If, at any time I am found to have concealed / distorted any material / information, my engagement is liable to be terminated without notice. Place : Date : SIGNATURE OF THE CANDIDATE (*) Attach separate sheet if required.
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