UNIVERSITY GRANTS COMMISSION UGC: HUMAN RESOURCE DEVELOPMENT CENTRE Saurashtra University Opp. Girnar Boys Hostel, University Campus, Rajkot - 360 005. Gujarat - India Phone: 0281-2577679 Fax: 0281-2585204 Website : www.hrdcrajkot.org E-mail : info@ascrajkot.org, kaladhar@ascrajkot.org Affix APPLICATION FORM FOR ORIENTATION / REFRESHER COURSE your recent Passport size To The Director, UGC: Human Resource Development Centre, Saurashtra University, Rajkot - 360 005. photograph Sir, I wish to join the Orientation programme / Refresher course in subject commencing from to . I shall abide by the terms and conditions of the course/programme and will attend each and every session and will participate in every possible way. My Particulars are given below :1. Name : Dr. / Mrs. / Miss. / Mr. : 2. College / Department : 3. Name of Affiliating University : 4. Official address : Phone No. :( 5. Residential address Fax : ( ) ) : Phone No. : ( Mobile No. : ) E-mail ID: 6. Educational Qualification : Name of Degree 7. Designation : 8. Status : 9. Details of Joining on 1st Subject Specialization On probation / Permanent Lecturership appointment at Date 10. Basic Pay as on this date 11. Type of the College : 12. Caste : 13. Category : OPEN College Subject Rs. Grant in Aid / Self Finance SC ST OBC 14. Break-Up of Teaching Experience at degree level : Name of University / College 15. Full-time Experience Total Y/M From to From to From to Particulars of Orientation Programmes/Refresher Course completed by me so far OP/RC University Date to From 16. Details of DD :- DD No. Date : Name of the Bank: The particulars given above are correct and I accept full responsibility for the same. Yours Faithfully, Date : FOR THE USE OF THE COLLEGE PRINCIPAL / AUTHORITY I hereby permit Mr./Ms. _____________________________________________________________ to join the above programme at the UGC: Human Resource Development Centre,Rajkot and I allow him / her to be away from the Institute From __________________ to _________________ The particulars as stated by him / her are true to the best of my knowledge. More over the affiliation No. of this college is ________________________________________ Date _____________________ Name and Address of Institution : ___________________________________ ___________________________________ (Signature of the Principal or Statutory Authority) ___________________________________ ___________________________________ Pin : SEAL OF INSTITUTION Please Note : The form will not be considered, if... (1) The information given above is incomplete in any respect. (2) Recent passport photograph is not affixed. (3) DD of Rs. 1000/= (non-refundable) is not attached.
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