CCS HARYANA

AGRICULTURAL UNIVERSITY, HISAR

(Established by Parliament Act No. 16 of 1970)

APPLICATION FORM

For engagement of non-teaching staff

Affix latest coloured Passport size photo.
1. Name of post applied for
2. Name in full (in block letters)
3. Father's Name
4. Date of birth
5.a) Date of retirement
b) Name of Deptt./office at the time of retirement
6. Present postal address (in block letters)
7. Telephone No./Mobile No.
8. E-mail ID, if any
9. Employment Record:-
Designation of post held Period (given month & Year both) Name of the Deptt.
From To

I undertake that my work and conduct had been satisfactory preceding last ten years of retirement (no adverse entry in ACR and no punishment imposed by way of any departmental/criminal proceedings).

I certify that the foregoing information is correct and complete to the best of my knowledge and belief.

Signature

Certificate from Head of the Department

Certified that work and conduct of Sh./Smt. has been found satisfactory as per last 10 years CR and no punishment has been imposed by way of any departmental/criminal proceedings. Above information as furnished by the retiree is correct as per office record.

Signature with seal