jehL ma bjhEg ika(jHf murh WtglJ )

fhklg rhiybrid - 600 025.

Tamilnadu Science and Technology Centre(Established by the Government of Tamilnadu)Gandhi Mandapam Road, Chennai-600 025.

bjhiyng / Phone No. : + 91 - 44 24410025

(Reference to the advertisement published in the Newspapers Indian Express and Dinamani Dt:23.02.2015)

zF gj bga :APPLICATION FOR THE POST OF :

1. zgjhu bga : (jiybgGJf W tuntL)

NAME OF THE CANDIDATE : (initials at the End)

2. jij / fzt bga ( $ /U / Kidt nghwtiw vGjh )FATHERS / HUSBANDS NAME : (Do not write Shri / Mr / Dr etc.)

3. wj nj / DATE OF BIRTH :

4. ehod / NATIONALITY :

5. brhj l / NATIVITY : ------------------

a / Indian w / Others

Affixa recent

passport sizephoto

2

6. jhbkh / MOTHER TONGUE

7. mj bkhf ngr vGj gof LANGUAGES KNOWN To Speak Write Read

1.

2.

3.

M iy8. khW wdhah? / Differently Abled ?

(M v, tu izf)(If Yes, Please enclose the details)

9. ghd / SEX :

10 Ukzkhdtuh / MARITAL STATUS :

11. tF / COMMUNITY : OC / BC / MBC / DNC / SC / SC(A) /ST

(Ra rhbwhglgl efiy izf) (Please enclose self Attested Photocopy)

12. a) bjhl bfhtjfhd Kft : (jf bga kW jij bga F Fl ntlh)

ADDRESS FOR CORRESPONDENCE : (Do not write your name or fathers name)

mr FpLPin Code

UkzkhfhjtUNMARRIED

M/ Male bg / Female

UkzkhdtMARRIED

3

12 b) bjhiyng v / ifng v mr Kft :

TELEPHONE NUMBER / MOBILE NUMBER E.Mail Address[[

13. f jF / EDUCATIONAL QUALIFICATION : m) f / ACADEMIC :

tv.

Sl.No.

nj nj tuExamination Passed

tUlYear

kbg /ju tF /

ju tirMarks / Grade Class/

Rank

f iya /gfiy fHf

Institution / University

siy KJiy13 (M) jlR iy / Typing Grade Lower Higher (thf g zgjhufSF kL) j Tamil

My English

13 () f fa / mDgt : Computer Knowledge / Experience -------------------

4

14 (m) bjh Eg / TECHNICAL :

tv.Sl.No.

nj nj tu / Examination Passed

tUlYear

kbg /ju tF /

ju tirMarks /

Grade Class /Rank

f iya /FG

Institution /Board

14 (M) mDgt / EXPERIENCE :

tv.

Sl.No.

gahW myJ gaha WtdbgaU gj bgaU.

jfhf / ujuName of the post holding /

held with name of the Institution.

Temporary / Permanent

g a ga

tufNature of Duties

fhy ms

Durationbkhj tUlf

Total No. of Years

KjFrom

tiu To

5

15. w jftf / ANY OTHER INFORMATION :

16. izfgLs rhjf goa : ( tir r vw F Lf) CHECK-LIST OF ENCLOSURE : ( Tick in the Appropriate Column)

t.v.

Sl.No.

iz(Ra rhbwhgl eff kL)

Enclosure( Self-attested photocopies only)

izfgLsJAttached

1. taJ rhW w rhj / Age Proof Birth Certificate

2. gf rhj Kj gf / SSLC Firstpage

3. rh rhj / Community Certificate4. caiy g / nkiy g / gla/

sfiy/KJfiy rhjf / siy MtP / KidtSSLC / +2 / Diploma / UG / PG Degree Certificates / M.Phil / Ph.D

5. jil ik rhW ( g U)No Objection Certificate if already employed

6

6. Wahf bgw Ca rhW ( g U)Last Pay Drawn Certificate if already employed

7. Ul rhW / Proof of Address

8. edlij rhW / Conduct Certificate

9. ntiy th mYtyf g milEmployment Registration Card

10 jlR, f f rhjf Typewriting , Computer Education Certificates

cW bkh / DECLARATION

nkny bfhLfgLs midJ gufS rahdit kW cikahdit vd rhwnw.

I declare that all the information given above are true and correct to the best ofmy knowledge.

eh / DATE : zgjhu ifbahg SIGNATURE OF THE CANDIDATE

7

mYtyf cgnahfF kL : FOR OFFICE USE ONLY

zgjhu mr (cik) rhjf neKf nj nghJ rghfglJ

ORIGINAL CERTIFICATES SUBMITTED BY THE CANDIDATE AT THE TIME OF INTERVIEW WERE VERIFIED

bra aFe

8

GENERAL CONDITIONS :

1. Employees of Government Departments / Government Undertakings shouldsend their application through proper channel (OR) they should produce NoObjection Certificate from their employers at the time of interview. NoTravelling Allowance / Daily Allowance will be paid for attending the interview.

2. The envelope containing application should be superscribed Application for the post of --------------------------------------------.

3. The Department reserves the right to fill or not to fill any of the post(s) withoutgiving any reason whatsoever therefor.

4. The filled-in applications should be addressed to The Executive Director,Tamilnadu Science and Technology Centre, Gandhimandapam Road,Chennai 600 025 and sent under Registered Post. Application shouldreach the addressee on or before 18.03.2015 before 5.45. p.m.

5. Age - Relaxable in deserving cases by the Chairman, on the recommendationof the Executive Director.

6. Age is relaxable in the case of BC, MBC, SC / ST as per the existing order of the Government.

7. Applications with incomplete details and not made in the required manner areliable to be rejected.

8. No correspondence of any kind will be entertained.

9. Applications will not be received at the office in person.

10.Before the interview, trade test / written test as the case may be will beconducted and candidates selected accordingly.

EXECUTIVE DIRECTOR