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IISERBhopalIndianInstituteofScienceEducationandResearchBhopalApplicationfortheNon-TeahchingPositionRegistrationNo:IISERB/2012/1983Advt.No:PostAppliedForModeNT-01/12AssistantRegistrar(Academic&StudentsAffairs)RegularDDNoDDDATEBANK0

I.PersonalProfile:FirstNameMiddleNameSurnamePastePassportSizePhotographPreetiDubeyDateofBirthGenderMaritalStatus25-May-1982FMarriedNationalityReligionCategoryIndianHinduGENAreyouanEx-ServicemanAreyouGovernmentServentNoNo

II.FamillyDetails:Father'sNameMother'sNameFather'sOccupationFather'sGrossAnualIncomeLekhramDubeySarojDubeyGovernmentServent300000PANNoPassportNoIssuedAtValidTillALWPD5962DH7350936H7350936

III.ContactDetails:AddressforcorrespondencePermanentaddressContactDetailsC/oRavibhushnDubey,Q.No.PE-4/1,VidhyutViharColny,DeepnagarBhusawal,JalgaonMaharashtraIndia425307C/oShriLekhramDubey,H.No.P-453,,ShinagarColony,DamohnakaJabalpurMadhyaPradeshIndia482002Phone(O)91---Phone(R)91-02582-250014Mobile91-9370550873

Email(O)preetydubey2007@gmail.comEmail(R)rbdubey2020@gmail.comNAMESIGNATURE

IV.AcademicQualification(inchronolgicalorder):DegreeNameoftheUniversityPeriodofstudyGrade/DivMaxmarksmarkssecured%SubjectsFromToXMadhyaPradeshBoardofSecondaryEducation01-07-199530-06-1996I50032865.6Hindi,English,Sanskrit,Math,

Science,SocialScienceXIIMadhyaPradeshBoardofSecondaryEducation01-07-199730-06-1998I45027460.89Physics,Chemistry,Mathematics,Hindi&EnglishB.ScRaniDurgavatiVishwavidyalaya01-07-199830-06-2001I1800119166.17Mathematics,Physics,Electronics&FoundationCourseM.ScRajivGandhiProdoyogikiVishwavidyalaya01-07-200230-06-2004I2000156578.25AppliedPhysicsV.Qualification/ExperiecneinComputerApplications:

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DegreeNameoftheUniversityPeriodofstudyGrade/DivMaxmarksmarkssecured%SubjectsFromToAdvancedDiplomainComputerApplication(ADCA)DeviAhilyaVishwavidyalaya,Indore01-07-200230-03-2003A75051969.2NAMESIGNATURE

VI.ProfessionalExperiencefromcurrentpositiononwards(Enclosedseperatesheetforadditionaldescriptivedata):A.CurrentPositionPositionNameoftheorganizationOrganizationTypePeriodofworkYearMonthBasic/ConsolidatedPayPayBandCodeAreaofworkFromToHeadofDepartmentSantGadgeBabaEngineeringCollege,Bhusawal.Non-Government17-08-201111-04-20120718000--TeachingandAdministrationA.PreviousExperiencesPositionNameoftheorganizationNameoftheorganizationPeriodofworkYearMonthBasic/ConsolidatedPayPayBandCodeAreaofworkFromToHeadofPhysicsDepartmentRadharamanEngineeringCollege,

BhopalNon-Government01-07-200813-04-20090916600HAGAdminiatrationandTeachingSr.LecturerRadharamanEngineeringCollege,BhopalNon-Government09-04-200730-06-20081212000HAGTeachingLecturerJabalpurEngineeringCollege,JabalpurGovernment01-07-200407-04-20072912000HAGTeaching(Contract)VII.Awards&DistinctionsNameoftheAward/FellowshipNameoftheorganizationValueoftheawardUniversitytopperRajivGandhiPraudyogikiVishwavidyalaya,BhopalGoldMedalNAME

SIGNATURE

VIII.AntecedentsA)DetailsofanyjudicalproceedingsinthepastorpresentNoB)AnyhealthproblemsNoVII.ReferenceReference1Reference2NameMr.S.K.TiwariMr.A.R.SiddiquiDesignationDean,Research&Development,Director,AddressJabalpurEngineeringCollege,JabalpurRadharamanEngineeringCollege,BhopalPhone0761233285507552896660

Fax0761233285507552896661Emailprincipal_jec_jabalpur@yahoo.co.inadmin@radharamanbhopal.comItem/certifictaeattachedwiththeprintedapplicationwithAnnexureNumber1.CastecertificateAnnexure-INo2.AnualIncomeincaseofNon-creamylayerAnnexure-IINo3.PWD/PHAnnexure-IIINo4.Ex-ServicemanAnnexure-IVNo5.GovernmentServent/NOCAnnexure-VNo6.10thAnnexure-VIYes

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7.12thAnnexure-VIIYes8.DegreeAnnexure-VIIIYes9.PostGraduationAnnexure-IXYes10.previousExperiencecertificatesAnnexure-XYes

Declaration:Theabovefurnishedinformationiscorrectandtotruetothebestofmyknowledge.Station:Signature:Date:Place: