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INFORMATION

BROCHURE&

APPLICATION FORM

Advt. No.17/2014-2015

N

I T T T

R

KO

LKA TA

NATIONAL INSTITUTE OF TECHNICAL TEACHERS

TRAINING AND RESEARCH,KOLKATA

(Formerly Technical Teachers Training Institute, Calcutta)

(Established by the MHRD, Government of India)

Block FCSector III

Salt Lake CityKolkata 700106

Tel. No.: +91 (033) 2337-0479/4125Fax No.: +91 (033) 2337-6331Website: www.nitttrkol.ac.in

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I. GENERAL INFORMATION:

National Institute of Technical Teachers Training and Research (NITTTR), Kolkata (formerlyTechnical Teachers Training Institute, Calcutta) is one of the four key Institutions set up by theGovernment of India, Ministry of Human Resource Development, New Delhi to pioneer thedevelopment of Technical Education System in India. This Institute is unique in the sense that itis the first such Institute established in South Asia for pre-service and in-service training of staff

of technical institutes. The major objective of the Institute is to take up various activities,including training, to serve as a catalyst for overall improvement of the quality of technicaleducation.

The raised status of the Institute is associated with a new mandate, which includes amongstothers:

Offering quality training programmes for teachers as per need of client systems, coveringthe entire gamut of technical education including polytechnics, engineering / technicalinstitutes / Universities, vocational and management education at regional as also atnational levels.

Undertaking systemic research and action research for development of innovative

methods, process and practices for improvement of teaching-learning environment intechnical and vocational education institutions.

Offering courses / programmes for technical and vocational teachers to suit overseasdemand especially in SAARC and ASEAN countries.

Collaborating with community and industry in organizing continuing and non-formalvocational education programmes and providing extension and consultancy services.

II. SERVICE CONDITIONS:

1 The Institute is an autonomous body registered under Societies Act and is fully funded bythe Ministry of Human Resource Development, Government of India. The serviceconditions will be governed by the Rules and Regulations of the Institute.

2 Appointment to all posts will be made on a temporary basis in the first instance. Higherinitial pay may be granted to specially qualified and experienced candidates. Pay,Dearness and other allowances will be admissible as per rules of the Institute in forcefrom time to time. Candidates not found adequately suitable for the prescribed pay scalecan be offered lower pay scale if found otherwise suitable.

3 Reservations will be applicable as per Government of India norms.

III. GENERAL INSTRUCTIONS:

1. Please read carefully all instructions before filling up the form.

2.

Applicants are advised to submit only self attested certificates.3. The selection process involves screening followed by presentation cum Interview.4.

Mere eligibility does not mean that a candidate will be called for interview.5. Applicants not found suitable for higher position may be considered for lower position in

the same area of specialization.6. Incomplete applications or applications received after the last date are liable to be

rejected summarily.7. Outstation candidates called for interview shall be paid AC II Tier to and fro Railway

fare by the shortest route, subject to production of proof of journey.8. A candidate who is found to have knowingly furnished particulars, which are false, or to

have suppressed information will be disqualified and if appointed, will be liable to

dismissal.9. Application Form may be downloaded from this website . While

submitting the duly filled in Application Form along with all the listed enclosures a sum

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of Rs.400/- (Rs.100/- for SC / ST / OBC(NCL) / PH(PWD)) through Bank draft payablein favour of the Director, NITTTR, Kolkata, payable at Kolkata should be remitted asapplication fee.

10. The envelope containing the filled up application form shall be superscripted as"Application for the post of __________________Against Advt. No. 17/2014-15.

IV. ADDITIONAL INFORMATION

1. Candidates applying for more than one position are required to use separate applicationforms including testimonials and application fees.

2.

The desired particulars are to be filled in the Application Form by the candidatesupported by certificates and documentary proofs (wherever necessary).

3. Separate sheet(s) used, if any, for a sub-heading should be referred in the columnprovided in the Application Form.

4. All pages including Application Form must bear full name and signature of the candidateat the bottom.

5. Besides pay, posts carry allowances according to the Institute rules which at presentcorrespond to those admissible to the Central Government employees.

6.

Higher initial pay/ upper age limit relaxation is admissible to exceptionally qualified anddeserving candidates.

7. Applicants who are employed in Government, Semi-Government Organizations orInstitutions should send their applications THROUGH PROPER CHANNEL;else theywill be required to produce a NO OBJECTION CERTIFICATEfrom their employer atthe time of interview.

8. No information will be sent to those candidates who are not short listed for interview. Itis expected that the entire selection process will be over within six months of the issue ofthe advertisement.

V. OTHER NOTES:

1. The Institute reserves the right to withdraw any advertised post(s) at any time withoutassigning any reason.

2. The Institute reserves the right to call only the requisite number of candidates forinterview after screening with reference to candidates' qualification, suitability,experience, etc.

3. The Institute reserves the right to set higher norms than the minimum while short-listing.The short-listing norms may not be uniform across the departments.

4. Any dispute with regard to any issue relating to the selection / recruitment process of theposts will be subject to the High Court of Kolkata.

5.

All recruitments will be done by the Institute only on the recommendations of dulyconstituted Selection Committee.

Application form, duly filled in and signed by the candidate, along with copies oftestimonials, certificates and application fee should reach the Director, NationalInstitute of Technical Teachers Training and Research, Kolkata, Block FC,

Sector III, Salt Lake City, Kolkata 700 106 on or before 19-12-2014.

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NATIONAL INSTITUTE OF TECHNICAL TEACHERS'TRAINING AND RESEARCH, KOLKATA

BLOCK FC, SECTOR III, SALT LAKE CITY, KOLKATA 700106

Applications are invited from Indian nationals for the posts of Assistant Professors/ AssociateProfessors/ Professors in the various departments including interdisciplinary ones of the

Institute. Appointments for these interdisciplinary departments are made in the relevantdepartments as mentioned in the following table,

Sl.No.

Department Inter-disciplinary, if any No.ofPost

Basic Qualification

1 MechanicalEngineering

1 BE/ B Tech and/ ME/M Tech inMechanical Engineering with FirstClass or equivalent either in BE/ BTech or ME/ M Tech

2. Education 1 B Sc/ M Sc with First class & M Edand PhD in appropriate discipline

3. ComputerScience &Engineering

Educational Technology 1 BE/ B Tech and ME/M Tech inComputer Science & Engineering /Electrical Engineering / ElectronicsEngineering or equivalent with FirstClass or equivalent either in BE/ BTech or ME/ M Tech

4. ComputerScience &Engineering

Continuing Education 1 BE/ B Tech and ME/M Tech inComputer Science &Engineering/Electrical Engineering /Electronics Engineering or equivalentwith First Class or equivalent either

in BE/ B Tech or ME/ M Tech5. Science Mathematics 1 M Sc in Mathematics / Statistics withFirst class and Ph D in Appropriatediscipline or BE/ B Tech and ME/MTech in any branch of engineeringwith First Class and having field ofresearch work in applied mathematics/ statistics

6. MechanicalEngineering

Industrial Consultancy &Entrepreneurship

1 BE/ B Tech and/ ME/M Tech in CivilEngineering/ Computer Science &Engineering / MechanicalEngineering with First Class or

equivalent either in BE/ B Tech orME/ M Tech

7. CivilEngineering

1* BE/ B Tech and/ ME/M Tech in CivilEngineering with First Class orequivalent either in BE/ B Tech orME/ M Tech

8. EducationalPlanning &Management

1* BE/ B Tech and/ ME/M Tech inComputer Science & Engineering /Electrical Engineering / ElectronicsEngineering or equivalent with FirstClass or equivalent either in BE/ BTech or ME/ M Tech and MBA orequivalent

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9. CommunityDevelopment& Rural Tech

1* BE/ B Tech and/ ME/M Tech in anyEngineering discipline with FirstClass or equivalent either in BE/ BTech or ME/ M Tech

10. EducationalPlanning &Management

1** BE/ B Tech and/ ME/M Tech in anyEngineering discipline or equivalentwith First Class or equivalent either

in BE/ B Tech or ME/ M Tech andMBA

OrBE/ B Tech in any Engineeringdiscipline and/ ME/M Tech inManagement or equivalent with FirstClass or equivalent either in BE/ BTech or ME/ M Tech

OrM Sc with First class, Ph D inScience and MBA/ M Ed

*Only for the post of Associate Professor/ Assistant Professor

** Only for the post of Assistant Professor

Desirable Qualification (for all faculty positions):

Ph.D. with first class or equivalent (in terms of grades, etc.) at the preceding degree inthe appropriate branch, with a very good academic record throughout.

Salary:

Pay Band (PB), Academic Grade Pay (AGP) of Professor/ Associate Professor/ AssistantProfessor are as follows:

Post AGP Pay Band(Rs.)

Professor Rs. 10000 PB-4 (37400-67000)

Associate Professor Rs. 9000 PB-4 (37400-67000)

Assistant Professor Rs. 6000 PB-3 (15600-39100)

The pay carries all other allowances as admissible to a Central Government employeestationed at Kolkata. The fringe benefits, such as HRA, LTC, medical re-imbursement,education allowance for children, contribution towards New Pension Scheme (NPS),financial support towards national and international conferences etc. shall be permitted as

per the Institute norms.

Higher start of pay is possible for deserving candidates.

Essential Experience:

Professor: Minimum of 10 years teaching with high quality research / industrialexperience of which at least 5 years at the level of Associate Professor or equivalent.

Associate Professor: Minimum of 5 years teaching out of which 3 years with AGP ofRs.8,000/- with high quality research / industrial experience and having at least 2 years

post Ph D experience.

Assistant Professor: For those with three or more years of teaching/research/industrialexperience, higher AGP can be offered.

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Additional Note:

Candidates should have interest to work in the fields like Education Technology,Curriculum Development, Community Development & Rural Technology etc. Toencourage the research in these fields, the Institute has the provision of providing theinitiation grant for three years to the newly recruited candidates subject to fulfilment oflaid down terms and conditions.

Period of Probation:

It is generally Two Years. However it may be extended by the Board of Governors onrecommendation of the Director.

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NATIONAL INSTITUTE OF TECHNICAL TEACHERS TRAINING

AND RESEARCH, KOLKATA(Formerly Technical Teachers Training Institute, Calcutta)

Block-FC, Sector-III, Salt Lake City, Kolkata 700 106

CHECK LIST

(Advt. No. 17 /2014 15)_____________________________________________________________________________

Ensure that

1. No column is either wrongly filled or kept blank. [Note that the information furnished by the

candidate will be used for determining the eligibility of candidates to be called for interviews].

2. Candidate has written his/ her name and signed at the bottom of each page.

3. Following self attested copies of certificates are enclosed in support of claims made

a)

Age proof,

b) documents/certificates along with mark sheets of all years in support of educational

qualifications,

c) Experience Certificate(s), if any.

d)

Order/ letter in respect of equivalence of the Educational Qualifications/Experience

claimed, if any.

e) Caste and Category certificates in prescribed Proforma, if any.

f)

Physically Handicapped certificate in prescribed Proforma, if any.

Signature

Name of the Candidate:

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NATIONAL INSTITUTE OF TECHNICAL TEACHERS TRAINING

AND RESEARCH, KOLKATABlock-FC, Sector-III, Salt Lake City, Kolkata 700 106

APPLICATION FORM(Advt. No. 17 /2014 15)

(to be filled by the applicant in black or blue ink only)Strike off the portion which does not apply in your case

FOR OFFICE USE ONLY

Receipt No.................... Date of Receipt: / /2014 Demand Draft attached: Yes/No

---------------------------------------------------------------------------------------------------------------

Demand Draft DetailsNo. .................Date : / / 2014Amount: `Rs. _______/-

Issuing Bank & Branch..........................................................................................

1. Application For

[a] Name of Department .....

[b] Post ..................................

[c] Interdisciplinary Department, if any ..

2. Personal Information

[a] Full Name of the Candidate .....

[in block letters]

[b] Fathers/ Husband's Name .....

[c] Date of Birth [d] Gender Male/ Female

[e] Nationality ____________ [f] Religion ___________

[g] Marital Status: Married/ Single

[h] Category [UR/OBC(Non-Creamy layer)/SC/ST]....[Enclose a self attested copy of the category certificate issued in the Central Govt. format]

[i] Person with Disabilities [PWD] Yes/No

If yes, form of Disability: OH/ HH/ VH DisabilityPercentage.%

[Enclose certified copy of document in support of your claim]

____________________________________________________________________________

Name: Signature

D D M M Y Y

Self attestedrecent passport

size photograph.

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3. Address

Correspondence Permanent

Name:......

Address:.....

........................................

.......................................................

PIN Code: ...........

Phone [R]: ...........

Phone [O]: .

Mobile:

Email :.............

Name: .

Address:...

........................................................

PIN Code: ......

Phone: ......

4. Educational Qualifications

[a] Details of Examinations passed

Examination

Passed

Year of

PassingBoard/ University

Discipline/

Specialization

Class/

Division

% ofmarks/

grades

\

[b] Title of Ph. D. Thesis:

[c]Any other earned academic degree .

[d] Upgradation of further knowledge

Title Duration Organized at

Short-term/Refresher course attended

Conferences/Seminar/Workshop attended

____________________________________________________________________________

Name: Signature

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5. Employment Record[Chronologically, starting from present employment]

[a]. Details of employment

Sl.

No.

Period Position

Held

Pay Scale, AGP &

last/present basic

Organization Nature of work

From To

1.

2.

3.

4.

5.

[b] Name and address of present employer ..

6. Teaching Experience [attach separate sheet, if required]

[a] Details of Theory Course[s] taught at Diploma/ Undergraduate (UG) level

Sl.No.

Name of the Course(Diploma/ UG/ PG)

Contact hours engaged perweek

No. ofyears

[b] Details of Practical class[es] engaged

Sl. No. Name of the Course Contact hours engaged per

week

No. of

years

[c] Details of experimental or computational projects added to teaching laboratory

Sl. No. Diploma/ Undergraduate Postgraduate

[d] Details of new courses developed/ existing courses revised

Sl. No. Diploma/ Undergraduate Postgraduate

____________________________________________________________________________

Name: Signature

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7. Thesis Supervision [attach separate sheet, if required]

[a] Details of Diploma/ Undergraduate Projects supervised

Sl.No.

Title of Project Institute Co-Supervisor[s], if

any

Year

[b] Details of PG Thesis supervised

Sl.No.

Title of Thesis Institute Co-Supervisor[s],if any

Year

[c] Details of Ph.D. Thesis supervised/on-going

Sl.

No.

Title of Ph.D.

Thesis

Institute Co-

Supervisor[s],if any

Year Status

[Complete/ongoing]

____________________________________________________________________________

Name: Signature

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8. Scholarly Contributions

[a] Publications [Enclose copy of best (according to your own assessment) two papers published

in SCI Journals] [Attach as separate annexure in the following format]

[i] Papers published/accepted in SCI Journals

Sl.No.

Author (s) Title of the paper Name ofJournal

Vol.No.

Page No.From To

Year

[ii] Papers published/accepted in Non-SCI Journals

Sl.No.

Author (s) Title of the paper Name ofJournal

Vol.No.

Page No.From To

Year

[iii] Papers published/accepted in Conference Proceedings [full papers only]

Sl.No.

Author(s) Title of the paper Name of Conference Year ISBN/ISSNNo.

____________________________________________________________________________

Name: Signature

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[b] [i]Text or Reference Books[s] published

Sl. No. Author(s) Year Book Title ISBN/ISSN

No.

Publisher

[ii] Book Chapters published/accepted in edited books

Sl.

No.

Author(s) Title of

Chapter

Title of

Book/Editedby

Year of

Publication

Page No. ISBN Publisher

From To

[c] Invited Lecture[s] delivered

Sl.

No.

Title of Lecture Short Term Course/

Conference/Organisation

Date Organisation

[d] Patent[s] held

Sl.No.

Name of Patent RegistrationNo.

Date ofAward/

Application

AwardingCountry

Co-Awardee[s],if any

____________________________________________________________________________

Name: Signature

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[e] Sponsored Research Project[s]

Sl.

No.

Title of Project Period Sponsoring

Organisation

Amount

[`in lakhs]

Co-Investigator[s],

if any

[f] Consultancy/Testing Project(s)

Sl.

No.

Details Period Organisation Amount

[`in lakhs]

Co-Investigator[s],

if any

9. Other Academic Activities [as Coordinator/Organising Secretary/General Chair]

[a] Short-term courses organised

Sl.

No.

In the

Capacityof

Title Duration Organised

at

Sponsors Amount

[`in lakhs]

Co-

Coordinator[s],if any

[b] Conference/Seminar/ Workshop organised

Sl.No.

In theCapacity of

Title Duration Organised at Sponsors Amount[`in lakhs]

10. Administrative Experience

Sl. No. Designation Period Nature ofResponsibility

Organisation

____________________________________________________________________________

Name: Signature

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11. Membership of Professional Bodies

Sl. No. Name of the Professional Bodies Period

12. Field of Research:-

13. Your Research Plan at NITTTR Kolkata [in 250 words]

14. Any other relevant information including interest / exposure in interdisciplinary

area(s): ....

15. Referees

[Referees should be distinguished persons from appropriate fields and not related to the

candidate and at least one of them should be familiar with the work of the candidate]

1 2 3

Name:.

Address:

PIN Code: ..

Phone

Fax:

Email:

Name:

Address:

PIN Code: ..

Phone

Fax:

Email: .

Name:

Address:

PIN Code:

Phone ..

Fax:

Email: .

16. List of enclosures

____________________________________________________________________________

Name: Signature

Sr. No. Type of Certificate Annexure # Page #

1

2

3

4

5

6

7

8

9

10

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Declaration

I hereby declare that the information furnished above is true to the best of my knowledge and

belief. If at any time it is found that I have concealed any information or have given any

incorrect data, my candidature/ appointment, may be cancelled/terminated, without any notice orcompensation.

There are _____ number of enclosures with _____ pages attached alongwith this form.

Date: ..

Place: . [Signature of applicant with date]

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PRESCRIBED PROFORMA

Proforma-I

The form of certificate to be produced by Scheduled Castes and Scheduled

Tribes candidates applying for appointment to posts under the Government ofIndia

This is to certify that Shri/Shrimati* ________________________________ son/daughter* of

_____________________________ of village/town* ____________________ in District/

Division* _________________ of the State/Union Territory* __________________ belongs to

the caste/ tribe* which is recognized as a Scheduled Caste/Scheduled Tribe* under:

@ The Constitution (Scheduled Castes) Order, 1950

@ The Constitution (Scheduled Tribes) Order, 1950@ The Constitution (Scheduled Castes) Union Territories Order, 1951@ The Constitution (Scheduled Tribes) Union Territories Order, 1951[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order, 1956;The Bombay Reorganization Act, 1960, the Punjab Reorganization Act, 1966, the State ofHimachal Pradesh Act, 1970, the North Eastern Areas (Reorganization) Act, 1971, theScheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976., the State of MizoramAct, 1986, the State of Arunachal Pradesh Act, 1986 and the Goa, Daman and Diu(Reorganization) Act, 1987.]@ The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956@ The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended

by the Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976@ The Constitution (Dadar and Nagar Haveli) Scheduled Castes Order, 1962@ The Constitution (Dadar and Nagar Haveli) Scheduled Tribes Order, 1962@ The Constitution (Pondicherry) Scheduled Castes Order, 1964@ The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967@ The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968@ The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968@ The Constitution (Nagaland) Scheduled Tribes Order, 1970@ The Constitution (Sikkim) Scheduled Castes Order, 1978@ The Constitution (Sikkim) Scheduled Tribes Order, 1978

@ The Constitution (Jammu & Kashmir) Scheduled Tribes Order, 1989@ The Constitution (SC) Order (Amendment) Act, 1990@ The Constitution (ST) Order (Amendment) Act, 1991@ The Constitution (ST) Order (Second Amendment) Act, 1991@ The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act 2002@ The Constitution (Scheduled Castes) Order (Amendment) Act, 2002@ The Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act, 2002@ The Constitution (Scheduled Castes) Orders (Second Amendment) Act, 2002

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2. Applicable in the case of Scheduled Castes/Scheduled Tribes persons who have migratedfrom one State/Union Territory Administration to another.

This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes certificate issued

to Shri/Shrimati* ___________________________________ father/Mother of Shri/Shrimati

________ _______________ of village/town* _____________________ in ________________

District/Division ______________________ of the State/Union Territory* _________________

who belongs to the caste/tribe* which is recognized as a Scheduled Caste/Scheduled Tribe in the

State/Union Territory* of ______________________ issued by the _______________________

dated 24 09 2014.

3. Shri/Shrimati* ___________________________ and/or* his/her* family ordinarily resides in

________________________ village/town* ___________________ of ___________________

District/Division* of the State/Union Territory* of _________________

Date : Signature

Place : **Designation

(With Seal of Office) State/Union Territory*

*Please delete the words which are not applicable.

@Please quote specific Presidential Order.

% Delete the paragraph which is not applicable.

NOTE: The term ordinarily reside (s) used here will have the same meaning as in Section 20of the Representation of the People Act, 1950.

**List of authorities empowered to issue Scheduled Caste/Scheduled Tribe Certificate.

a. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Deputy Collector/First Class Stipendiary Magistrate/Sub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant

Commissioner. (not below of the rank of 1st Class Stipendiary Magistrate).b. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency

Magistrate.c. Revenue Officers not below the rank of Tehsildar.d. Sub Divisional Officer of the area where the candidate and/or his/her family normally

resides.e. Administrator/Secretary to Administrator/Development Officer (Lakshadweep)

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Proforma-II

The form of certificate to be produced by Other Backward Classes candidatesapplying for appointment to posts under the Government of India (NOT more thanONE years old).

This is to certify that Shri/Shrimati ____________________________ son/daughter* of Shri

__________________________________of village/town* _____________ in District/

Division* ______________ of the State/Union Territory* ____________________ belongs to

the Community ___________ which is recognised as a backward class under:

@ Government of India, Ministry of Welfare Resolution No. 1201i/68/93-BCC (C) dated10 September, 1993 published in the Gazette of India Extraordinary Part-I, Section-i, No.186 dated 13 September, 1993.

@ Government of India, Ministry of Welfare Resolution No. 12011/9/94-BCC dated 19-10-94, published in the Gazette of India Extraordinary Part-I, Section-i, No. 163 dated20-10-1994.

@ Government of India, Ministry of Welfare Resolution No. 12011/7/95-BCC dated 24-5-95, published in the Gazette of India Extraordinary Part-I, Section-i, No. 88 dated 25-5-1995.

@ Government of India, Ministry of Welfare Resolution No. 12011/96/94-BCC dated 9March, 1996 published in the Gazette of India Extraordinary Part-I, Section-i, No.60dated 11 March, 1996.

@ Government of India, Ministry of Welfare Resolution No. i2011/44/96-BCC dated 6December, 1996 published in the Gazette of India Extraordinary Part-I, Section-i, No.210 dated 11 December, 1996.

@ Government of India, Ministry of Welfare Resolution No. i2oii/99/94-BCC dated 11December, 1997 published in the Gazette of India Extraordinary Part-I, Section-I, No.236 dated 12 December, 1997.

@ Government of India, Ministry of Welfare Resolution No. 12011/i3/97-BCC dated 3December, 1997 published in the Gazette of India Extraordinary Part-I, Section-i, No.

239 dated 17 December, 1997.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.i2011/68/98-BCC dated the 27 October, 1999 published in the Gazette of IndiaExtraordinary Part-I, Section-i, No. 241 dated the 27 October, 1999.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.i2011/88/98-BCCdated 6 December, 1999 published in the Gazette of IndiaExtraordinary Part-I, Section-i, No. 270 dated 6 December, 1999.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.i2011/36/99-BCC dated 4 April, 2000 published in the Gazette of India ExtraordinaryPart-I, Section-i, No. 71dated 4 April, 2000.

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@ Government of India, Ministry of Social Justice and Empowerment Resolution No.i2011/44/99-BCC dated the 21 September, 2000 published in the Gazette of IndiaExtraordinary Part-I, Section-i, No. 210 dated the 21 September, 2000.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.120i5/ 9/ 2000-BCC dated 6 September, 2001 published in the Gazette of IndiaExtraordinary Part-I, Section-i, No. 246 dated 6 September, 2001.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.1201i/1 /200i-BCC dated 19 June, 2003 published in the Gazette of India ExtraordinaryPart-I, Section, 1 No. 151dated 20 June, 2003.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.12011/4/2002-BCC dated 13 January, 2004 published in the Gazette of IndiaExtraordinary, Part-I Section-i, No. 9 dated 13 January, 2004.

@ Government of India, Ministry of Social Justice and Empowerment Resolution No.

12011/i4/2004-BCC dated 12 March, 2007 published in the Gazette of IndiaExtraordinary, Part-I, Section-i, No. 67 dated 12 March, 2007.

Shri/Shrimati/Kumari* _________________________ and/or* his/her* family ordinarily resides

in village/town* ___________________ of District/Division* _______________ of the State/

Union Territory* of ______________________.

This is also to certify that he/she* does not belong to the persons/sections* (Creamy Layer)

mentioned in column 3 of the Schedule to the Government of India, Department of Personnel &

Training O.M. No. 36012/22/93-Estt. (SCT) dated 8-9-1993 O.M. No. 36033/3/2004-Estt. (Res.)

dated 9 March, 2004 and O.M. No. 36033/3/2004-Estt. (Res.) dated 14 October, 2008.

Signature

**Designation

Place

Date

*Please delete the words which are not applicable.

@ Strike out whichever is not applicable.

(With seal of Office) State/Union Territory

NOTE: The term ordinarily reside (s) used here will have the same meaning as in Section 20of the Representation of the People Act, 1950.

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**List of authorities empowered to issue OBC Certificate

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Deputy Collector/First Class Stipendiary Magistrate/fSub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra AssistantCommissioner.-I-(not below of the rank of 1st Class Stipendiary Magistrate).(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/PresidencyMagistrate.(iii) Revenue Officers not below the rank of Tehsildar.(iv) Sub Divisional Officer of the area where the candidate and/or his/her familynormally resides.(v) Administrator/Secretary to Administrator/Development Officer (Lakshadweep)

Note 1: Candidates claiming to belong to OBCs should note that the name of their caste(including its spellings) as indicated in their certificates, should be exactly the same as publishedin the lists notified by the Central Government from time to time. A certificate containing anyvariation in the caste name will not be accepted.

Note 2: The OBC claim of a candidate will be determined in relation to the State (or part of theState) to which his/her father originally belongs. A candidate who has migrated from one State(or part of the State) to another should, therefore, produce an OBC certificate which should have

been issued to him/her based on his/her fathers OBC certificate from the State to which he(father) originally belongs.

Note 3: No change in the community status already indicated by a candidate in his/her simplifiedapplication form for this examination will ordinarily be allowed by the Commission.

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Proforma-III

Form of declaration to be submitted by the OBC (Non-Creamy Layer) candidate(in addition to the communi ty certificate)

I ______________________________ Son/daughter of Shri _________________________

resident of village/town/city ____________________ District ____________________ state

__________________________ hereby declare that I belong to the community which is

recognized as a backward class by the Government of India for the purpose of reservation in

services as per orders contained in Department of Personnel and Training Office Memorandum

No 36102/22/93-Estt. (SCT) dated 8-9-1993. It is also declared that I do not belong to

persons/sections/sections (Creamy Layer) mentioned in column 3 of the Schedule to the above

referred Office Memorandum dated 8-9-1993, O.M. No. 3603313/2004-Estt. (Res.) dated 9

March, 2004 and O.M. No. 36033/3/2004-Estt. (Res.) dated 14 October, 2008.

Signature

Full Name

Address

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Proforma-IV

The form of certificate to be produced by Physically Handicapped candidatesapplying for appointment to posts under the Government of India

NAME & ADDRESS OF THE INSTITUTE/HOSPITAL _______________________________

This is certified that Shri/Smt. ________________________________ son/wife/daughter of Shri

___________________________ Age ___ Yrs, sex Male/ Female having identification mark(s)

___________________________________________ is suffering from permanent disability of following

category: Strike out whichever is not applicable.

A. Locomotor or Cerebral Palsy (OH):i.

Both legs affected but not arms

ii.

Both arms affected

(a) Impaired reach (b) Weakness of gripiii. Both legs and both arms affected

iv.

One leg affected (right or left)(a) Impaired reach; (b) Weakness of grip; (c) Ataxic

v. One arm affected (right or left)

(a) Impaired reach (b) Weakness of grip (c) Ataxicvi. Stiff back and hips (cannot sit or stoop)

vii. Muscular weakness and limited physical endurance.

B. Blindness or Low Vision (Visual Impairment):(a) Blind (b) Partially blind

C. Hearing Impairment:(a) Deaf (b) Partially deaf

(Delete the category whichever is not applicable)

2. This condition is progressive/non-progressive/likely to improve/not likely to improve. Reassessment ofthis case is not recommended/is recommended after a period of ____ months.

3. Percentage of disability in his/her case is _______ Percent.

4. Shri/Smt._________________________________ meets the following physical requirements for

discharge of his/her duties:

i.by manipulating with fingers. Yes/No

ii.by pulling and pushing. Yes/No

iii.

by lifting. Yes/Noiv.by kneeling Yes/No

v.bybending. Yes/No

vi.by sitting. Yes/No

vii.by standing. Yes/No

viii.by walking. Yes/No

ix.

by seeing. Yes/Nox.by hearing/speaking. Yes/No

xi.by reading and writing. Yes/No

(Dr ) (Dr ) (Dr )Member Member ChairmanMedical Board Medical Board Medical Board

Countersigned by the Medical Superintendent/CMO/Head of Hospital (With seal)

Candidate'sRecent

Photograph

duly attestedby Chairperson of

the MedicalBoard