ANNEXURE -I : I N D I A N I N S T I T U T E O F I N T E G R A T I V E M E D I C I N E , J A M M U : APPLICATION OF RECRUITMENT TO THE POST OF ______________________________ 1. Name ( in Capital Letters) : 2. Father's Name : Affixed Passport 3. Date & Place of birth : Size photograph 4. Address for Correspondence : 5. Permanent Home Address : 6. Post for which applied : 7. Whether SC/ST/OBC ( Certificate in the : prescribed proforma to be attached ) If SC/ST/OBC status is claimed) 8. Date of joining on Temporary Casual : Daily Wage Worker 9. Date from which Temporary status : (O.M. to be attached) 10. Section/Division and name of lab./Instt. in : which working 11. Details of qualifications indicating %age : of marks 12. Experience, if any : 13. Language Option for taking Written Examination and Typewriting : Hindi or English 14. Typewriting speed : Hindi _________ English _________ 15. Any other relevant information : I declare that the particulars furnished above are true to the best of my knowledge and belief. Date : _______________ Signature of the candidate Place _______________ Certified that Shri/Ms ................. is working in Lab./Instt. w.e.f ....... as .......... He/She has been identified for absorption under Casual Workers Absorption Scheme of CSIR vide O.M. No. ............ dated ........ Above information is correct. There is no vigilance case is pending/contemplated against him/her. Signature of COA/AO
