jehL ma bjhEg ika (jHf murh WtglJ )

fhklg rhiy

brid - 600 025.

Tamilnadu Science and Technology Centre (Established by the Government of Tamilnadu) Gandhi Mandapam Road, Chennai-600 025.

bjhiyng / Phone No. : + 91 - 44 24410025

(Reference to the advertisement published in the Newspapers Indian Express and Dinamani Dt:23.02.2015)

zF gj bga :

APPLICATION FOR THE POST OF :

1. zgjhu bga : (jiybgGJf W tuntL)

NAME OF THE CANDIDATE : (initials at the End)

2. jij / fzt bga ( $ /U / Kidt nghwtiw vGjh )

FATHERS / HUSBANDS NAME : (Do not write Shri / Mr / Dr etc.)

3. wj nj / DATE OF BIRTH :

4. ehod / NATIONALITY :

5. brhj l / NATIVITY : ------------------

a / Indian w / Others

Affix

a recent

passport size

photo

2

6. jhbkh / MOTHER TONGUE

7. mj bkhf ngr vGj gof

LANGUAGES KNOWN To Speak Write Read 1.

2. 3. M iy

8. khW wdhah? / Differently Abled ? (M v, tu izf)

(If Yes, Please enclose the details)

9. ghd / SEX :

10 Ukzkhdtuh / MARITAL STATUS :

11. tF / COMMUNITY : OC / BC / MBC / DNC / SC / SC(A) /ST

(Ra rhbwhglgl efiy izf) (Please enclose self Attested Photocopy) 12. a) bjhl bfhtjfhd Kft : (jf bga kW jij bga F Fl ntlh)

ADDRESS FOR CORRESPONDENCE : (Do not write your name or fathers name)

mr FpL

Pin Code

Ukzkhfhjt

UNMARRIED

M/ Male bg / Female

Ukzkhdt

MARRIED

3

12 b) bjhiyng v / ifng v mr Kft :

TELEPHONE NUMBER / MOBILE NUMBER E.Mail Address [[

13. f jF / EDUCATIONAL QUALIFICATION :

m) f / ACADEMIC :

t

v.

Sl.No.

nj nj tu

Examination Passed

tUl

Year

kbg /

ju tF /

ju tir

Marks / Grade Class/ Rank

f iya / gfiy fHf

Institution / University

siy KJiy

13 (M) jlR iy / Typing Grade Lower Higher

(thf g zgjhufSF kL)

j

Tamil My

English 13 () f fa / mDgt :

Computer Knowledge / Experience -------------------

4

14 (m) bjh Eg / TECHNICAL :

t

v.

Sl.No.

nj nj tu /

Examination Passed

tUl

Year

kbg /

ju tF /

ju tir

Marks / Grade Class /

Rank

f iya / FG

Institution / Board

14 (M) mDgt / EXPERIENCE :

t

v.

Sl.No.

gahW myJ gaha Wtd bgaU gj bgaU.

jfhf / uju

Name of the post holding / held with name of the

Institution. Temporary / Permanent

g a ga

tuf

Nature of Duties

fhy ms

Duration

bkhj tUlf

Total No. of Years

Kj

From tiu

To

5

15. w jftf / ANY OTHER INFORMATION :

16. izfgLs rhjf goa : ( tir r vw F Lf)

CHECK-LIST OF ENCLOSURE : ( Tick in the Appropriate Column)

t.

v.

Sl.No.

iz

(Ra rhbwhgl eff kL)

Enclosure ( Self-attested photocopies only)

izfgLsJ

Attached

1. taJ rhW w rhj / Age Proof Birth

Certificate

2. gf rhj Kj gf / SSLC First

page

3. rh rhj / Community Certificate

4. caiy g / nkiy g / gla/

sfiy/

KJfiy rhjf / siy MtP / Kidt

SSLC / +2 / Diploma / UG / PG Degree Certificates / M.Phil / Ph.D

5. jil ik rhW ( g U)

No Objection Certificate if already employed

6

6. Wahf bgw Ca rhW ( g U)

Last Pay Drawn Certificate if already employed

7. Ul rhW / Proof of Address

8. edlij rhW / Conduct Certificate

9. ntiy th mYtyf g mil

Employment Registration Card

10 jlR, f f rhjf

Typewriting , Computer Education Certificates

cW bkh / DECLARATION

nkny bfhLfgLs midJ gufS rahdit kW cikahdit vd rhwnw.

I declare that all the information given above are true and correct to the best of my knowledge. eh / DATE : zgjhu ifbahg SIGNATURE OF THE CANDIDATE

7

mYtyf cgnahfF kL : FOR OFFICE USE ONLY

zgjhu mr (cik) rhjf neKf nj nghJ rghfglJ

ORIGINAL CERTIFICATES SUBMITTED BY THE CANDIDATE AT THE TIME OF

INTERVIEW WERE VERIFIED

bra aFe

8

GENERAL CONDITIONS :

1. Employees of Government Departments / Government Undertakings should

send their application through proper channel (OR) they should produce No

Objection Certificate from their employers at the time of interview. No

Travelling Allowance / Daily Allowance will be paid for attending the interview.

2. The envelope containing application should be superscribed Application for

the post of --------------------------------------------.

3. The Department reserves the right to fill or not to fill any of the post(s) without

giving any reason whatsoever therefor.

4. The filled-in applications should be addressed to The Executive Director,

Tamilnadu Science and Technology Centre, Gandhimandapam Road,

Chennai 600 025 and sent under Registered Post. Application should

reach the addressee on or before 18.03.2015 before 5.45. p.m.

5. The last date is extended to 31.3.2015. i.e. the filled-in applications

should be sent under Registered Post and the applications should reach the

above address on or before 31.03.2015 before 5.45. p.m.

6. Age - Relaxable in deserving cases by the Chairman, on the recommendation

of the Executive Director.

7. Age is relaxable in the case of BC, MBC, SC / ST as per the existing order of

the Government.

8. Applications with incomplete details and not made in the required manner are

liable to be rejected.

9. No correspondence of any kind will be entertained.

10. Applications will not be received at the office in person.

11. Before the interview, trade test / written test as the case may be will be

conducted and candidates selected accordingly.

EXECUTIVE DIRECTOR