Tamil Nadu Veterinary and Animal Sciences University: Application Form
Tamil Nadu Veterinary and Animal Sciences University: Application Form
Tamil Nadu Veterinary and Animal Sciences University: Application Form
APPLICATION FORM
(For Technical Posts Only)
Application Number
(For Office Use Only)
Advertisement Number
Date
Date
Bank
Amount (Rs.)
Fathers Name
Mothers Name
Spouse Name
Date of Birth
D
Years
Y
Months
Gender ( mark)
Male
Female
1
Transgender
Y
Days
Nationality
Community ( mark)
OC
BC
BCM
MBC
DNC
SC
SCA
ST
Caste
8
Permanent Address
(Door No., Street Name,
Village / Town, District,
State, Pin Code)
10
Married
Single
E-mail Address
Mobile Number
11
Mother Tongue
12
Vernacular Language in
School/College
Other Languages Known
13
To Read
To Write
To Speak
14
Part
Time /
Full time
Degree/
Diploma
Received
OGPA/
Marks/
Percent
XII or HSC
UG Degree
PG Degree
Ph.D. Degree
Note: Attach attested copies of certificates in support of each degree or diploma received.
2
Specialization
15
16
Subject
Membership in Veterinary
Council
(Attach Evidence)
Year of Pass
Registration No.
Valid up to
17
Details of previous and present employment
If employed,
a. Present designation
b. Name and designation of the present employer
Employer
Post Held
Pay Drawn
Period
From
To
Duration
M
D
Note: Period spent on study for Masters / Ph.D. degree should not be included except the part time study period. Use
a separate sheet if required
18
Experience regarding Teaching / Research / Extension / Administration
Period
Duration
Place of
Experience in
Post Held
Work
From
To
Y
M
D
Teaching
Research
Extension
Administration
Note: Use a separate sheet if required
19
Publication Details
a
Research Paper
First Author
Co-Author
Thesis
Foreign
Journal Research Report / Lab / Field Research
Indian
journal
Thesis
Research Report / Lab / Field Research
Abstracts
Research
Clinical
3
Author
Co-Author
Publisher
Note: Furnish only the number published for a to d, Enclose the list of publications with Author(s) / Year / Title / Journal
separately and Use a separate sheet if required.
20
Workshop/Seminar/Symposia/Summer Institute/Refresher Course Attended and Conducted
Title
Attended
From
Conducted
To
From
To
National
International
Note: Use a separate sheet if required
21
Attended
From
Conducted
To
From
To
National
International
Note: Use a separate sheet if required
22
Guidance of research scholars as Chairman of the Advisory Committee (Enclose Certificate page of Thesis)
Degree
Awarded
Submitted
In-progress
Ph.D.
Masters (M.V.Sc., M.F.Sc.,
M.Sc., M.Tech., M.Phil)
Others
23
Medals/Awards won
Name of the award (Indicate)
Award given by
(Organization)
Year
International
National
State
University
Society
Others
Note: Use a separate sheet if required
24
Funds mobilized
Name of the
Position
Research Scheme
Funding agency
Duration
Amount
PI
Co-PI
Others
25
Patent / Innovation / Technology Transferred
Name of the patent / innovation /
Year
technology
26
Beneficiary
Utility
Level
29
30
31
32
Yes / No
Purpose of visit
33
List three referees known to you who can certify your professional competency
Name
Address with Phone number
List of Professional Societies in which you are member and position, if any
Professional Society
Position
I solemnly and sincerely affirm that all information furnished in the application are true and correct to
the best of my knowledge and belief.
Should there be any incorrect or false information having been furnished that may come to light in
due course, I bind myself for such action as the University may decide.
I understand that I am liable for criminal prosecution and the University has the right to cancel my
candidature/selection as the case may be and I would forego my selection and the application fee.
I further undertake to submit all the required originals at the time of interview process, as per the
Tamil Nadu Veterinary and Animal Sciences University rules, failing which I would forego my
interview.
Place:
Date: