(An Autonomous Research Institution of Department of Biotechnology,
Ministry of Science and Technology, Govt. of India)

Aruna Asaf Ali Marg, New Delhi - 110067
Affix self attested photograph

1. Name (in Block letters) :*
    A) Office Address (with Tel No.) :
    B) Residential Address :*
    C) Telophone/ Cell No. :*  
    D) Email ID :*  
2. Father's/Husband's Name :*  
3. Date of Birth (in Christian era) :*       Age:  
4. Date of retirement under Central Government Rule:  
5. Educational Qualifications : (Start from Matriculation onwards)*    
Examination passed
& subjects taken
Name of the College/
Year in which
% age of marks
with division
6. Whether Educational and other qualifications required for the post are satisfied. (If any qualification has been treated as equivalent to the one prescribed in the Rules, state the authority for the same)* -
    Qualification / Experience required Qualification / Experience possessed
Essential (1)
Desirable (1)
7. Please state clearly whether in the light of entries made by you above, you meet the requirement of the post :*

8. Additional details about employment - (Please state whether working under (a) Central Government (b) State Government (c) Autonomous Organization (d) Government Undertaking (e) Universities (f) Others) (indicate the Name of your employer against the relevant column) [Enter Current employment onwards].
Name of Organisation Post held Nature of Employment From To Scale of pay and basic pay Nature of duties (In detail)
Total Work Experience

9. Total emoluments per month now being drawn :

10. Details of referees :*

11. Additional information, if any, which you would like to mention in support of your suitability for the post. (This among other things may provide information with regard to (i) additional academic qualification (ii) professional training (iii) work experience over and above prescribed in the Vacancy Circular / Advertisement).

12. Whether belongs to SC/ST/OBC/Gen. :*

13. Any other information :

I have carefully gone through the circular / advertisement and I am well aware that the Curriculum Vitae duly supported by documents submitted by me will also be assessed by the Selection Committee at the time of selection for the post.


Date : ....................
Place : .......................
Signature of the candidate


(To be filled in by the Parent office / Department)
(In case of candidates working in Government Departments on regular basis)

  1. Certified that the particulars furnished by the applicant have been checked from available records and found correct.

  2. Certified that the candidate is eligible for the post as per conditions mentioned in the advertisement.

  3. Certified that no vigilance case is either pending or being contemplated against the applicant. Integrity of the applicant is also certified.

  4. Copies of complete and up to date APARs of the officer for the last five years, duly attested, on each page are enclosed.

  5. No major/minor penalty has been imposed on the concerned officer during the preceding ten years.

Signature Name & Designation of the
Head of the Department / Authorized
Signatory with seal & Telephone Number

(*) Marked Fields are mandatory.