UNIVERSITY OF KERALA Application for selection as Instructor on Rs. 10790 - 18000 in the University Dept. of Music submitted in pursuance of Notification dated 1. Centre of Written Test preferred 2. Name of the candidate in full (IN BLOCK LETTERS) Sex 3. Age Place of birth Taluk and District 4. Date of Birth (In Christian Era) Address to which communication should be sent To be identified by Gazetted Officers/ Dated Signature of the Identifying Officer Principals of affiliated colleges/ Headmaster/ (To be signed on the Photograph) Headmistress of High Schools Name.................. 6. Name and Designation of the Identifying Designation................ Officer (Office Seal) 7. Whether the applicant is within the age in accordance with the Notification, if not, state whether he/she is exempted and if so, give grounds of exemption. 8. Whether a citizen of the Indian Union or one to whom certificate of eligibility has been awarded by the Ministry of Home Affairs, Government of India. 9. Name of Community/ Caste/ Tribe (Specify only if belonging to Backward Class/ Scheduled Caste/ Scheduled Tribe) (Where community claimed in the application is not proved by School records, Certificate issued by a competent authority will be accepted as proper proof of community) 10. Qualifications 11. Previous Experience, if any 12. If employed, full address of the present employer, State whether the consent of the employer has been obtained. 13. Whether dismissed from service from any other Institution/ Office or debarred by the Public Service Commission. 14. Particulars of Conduct Certificate produced 15. Particulars of documents submitted to prove payment of Registration fee. 16. Particulars of documents produced to prove age, qualification etc. I...........................do hereby declare that the information given in the application is correct to the best of my knowledge and belief. Signature of the Applicant Station: Date:
