National Institute of Oceanography, Goa.

(Council of Scientific & Industrial Research)
DONA PAULA, GOA-403 004, INDIA


1.*Name in full: (in block letters, as on degree certificate/ in case of change in name attach relevant certificate)
Title
First name
Last name
(in case of female candidate the appropriate title "Miss" or "Mrs." should be used.)
2.*Father's/Husband's name:
3.*Date and Place of birth
(a) Date: (dd/mm/yyyy)
(b) Place:
4.Address
(a) Correspondence:(*Local address)
(*City)
(*State)
(*Pincode/Post Office)


(*Email Address: Please mention only one email address which will be used to send acknowledgements)
(Telephone/Mobile No.)
(Fax No.)
(b) Permanent(*permamnent address)
(*City)
(*State)
(*Pincode/Post Office)
Note: Candidates must arrange for the redirection of communications to their address, if necessary.
5.* A citizen of India by
6.*Name the state to which you belong:
7.State whether you are a member of a Scheduled Caste/Scheduled Tribe/Other Backward Class.
8.*Are you related to any employees of the CSIR?
9.*Educational qualifications:

Exam passedDivision/Grade/% of marksYear of passingDuration of the Degree/DiplomaBoard/Univ.Major subjects studied


10.How have you been employed? Give particulars below:

OrganizationDesignation & Status(permanent/temporary)Scale of pay & last pay drawnDate of joiningDate of LeavingTotal period (yy.mm)Nature of duties


11.*Are you willing to accept the minimum initial pay offered? 
*If not, state at what is the lowest initial pay that you would accept in the prescribed pay scale.
12.Any additional qualifications such as membership of Societies may be mentioned here:
13.For S & T post only: Bibliographic details of thesis, published papers along with latest Impact Factor (IF=nn.nnn) of the journal in which the paper is published, patents, etc. (please group as National and International and number each item serially):
Attach the reprint(s) along with the printout of the application.

Number of research papers and patentsNationalInternational
Papers published
Papers in press
Patents applied for
Patents granted
14.For Ph.D. candidates: Provide title of the thesis and the abstract
15.Details of relevent work expertise as per the job requirement
List of enclosures



Date
Place
Signature