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Ird Rec 4

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IRD Unit
Indian Institute of Technology Delhi
FORM NO. IRD/REC-4
Hauz Khas, New Delhi - 110 016, INDIA
Tel: 91-11-26591799, 26597534 Fax: 91-11-26854715
Email: arird@admin.iitd.ac.in Web: http://ird.iitd.ac.in

Application Form for Selection under IRD Sponsored Projects/Consultancies

Advt. No.: _____________________


Post Applied for: _______________
Click to affix a
Project No.: ___________________
Recent Passport
Size Photograph

Kashif Azmi
1. Name in full (in block letters) __________________________________
2. Address (in block letters)
(i) For Communication ___________________________________________________
624D/82, Azmi Manzil, Khawaja Bagh Colony, Chinhat, Lucknow, U.P

___________________________________________________

(ii) Present ___________________________________________________


Vellore Institute of Technology, Vellore, Tamil Nadu

___________________________________________________

(iii) Permanent ___________________________________________________


624D/82, Azmi Manzil, Khawaja Bagh Colony, Chinhat, Lucknow, U.P

___________________________________________________

(iv) Email: ____________________________


kashif187757@st.jmi.ac.in 9455551056
(v) Phone/Mobile: ________________________

3. Particulars of age and birth (as per Matriculation or equivalent Certificate)


07-09-1997
(i) Date of Birth (DD-MM-YYYY) ____________________ 25
(ii) Age: ____________________
(iii) Place of Birth _______________________
Uttar Pradesh, India (iv) Nationality: ______________
Indian

4. Other Particulars (Please Tick):


Gender: Male Female Marital Status: Single Married

5. Father’s Name ____________________________Mother’s


Rashid Azmi Name_______________________
Tahseen Bano

Spouse Name ____________________________

6. Category(Please Tick): SC ST OBC Ex.S.Men P.H. General


(Please attach photocopy of the relevant certificate)

7. Particulars of Qualification and Experience:


(Please feel free to attach a separate sheet in case of insufficient space. Original Certificate/testimonials in support of
qualification & experience would be required to be shown at the time of interview & joining (if selected).

(i) Qualifications (in reverse chronological order):-


Educational/Technical/ Main Subject Grades/ % of marks Year of Name of the University/
Professional Exam Division obtained passing Board
Pursuing/Passed
(Full Time/ Part Time)

Revised 01/2014
(ii) Whether NET/GATE Qualified (Please Tick): NET GATE

(iii) Whether registered for M.Tech./Ph.D.(Please Tick):


If yes, (a) Full time Part time
(b) University & Department: ____________________________________________

(iv) Total Experience (in reverse chronological order):

A. Experience Outside IIT Delhi


Employer Designation Period Length Nature of duties/ area of Salary Drawn (Rs.)
From To Yrs Months specialisation etc.

B. Experience/Employment Details in IRD Projects/Consultancies at IIT Delhi


Employee Designation Period Length Type of Project Last Salary
Code From To Yrs Months appointment No. Drawn (Rs.)
(Contract/
Adhoc/ Yearly
Contractual)

8. Whether employed in any organization outside IIT Delhi and pursuing studies at IIT Delhi? If
yes, Please provide details (Please attach supporting N.O.C. from parent organization):

9. Any Other relevant Information (Details of Special achievements, Awards, Trainings, etc., if any)

I hereby declare that all particulars in this form are correct and true to the best of my knowledge & belief
and nothing has been concealed therein. I shall bring the original degrees, certificates, other documents
in support of the above information for verification at the time of test/interview.

______________________________

PLACE : ______________ SIGNATURE OF THE APPLICANT


DATE : ______________ Revised 01/2014

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