POSTGRADUATE INSTITUTE OF AGRICULTURE

UNIVERSITY OF PERADENIYA

SRI LANKA

FORM OF APPLICATION

POST APPLIED FOR:

1.	Name in Full: Rev./Mr./Mrs./Miss [Underline Surname]

[If registered as a student in a University under any other name,

please indicate such name within brackets]

2.	Postal Address

[Any change should be communicated immediately]

3.	Contact Telephone No & Email Address

4.	Date of Birth & Age

[Please attach copy of Birth Certificate]

5.	Nationality –

6.	Civil Status-

7.	Whether Citizen of Sri Lanka-

[State whether by descent or by registration;

if by registration, give reference number and

date of certificate of citizenship]

8.	Educational Qualifications [Please attach copies of all relevant certificates]
University Education
Degree/Diploma, etc. & Name of the University	From	To	Course Followed	Date of Final Exam & Results (Class)
9.	Special Qualifications [Professional, etc. – Please attach copies of all relevant certificates]
10.	Postgraduate Qualifications [State whether by course work or research, duration and effective date – Please attach copies of all relevant certificates]
11.	Academic Distinctions, Scholarships, Medals, Prizes, etc., [Indicate the Institution from which such awards have been obtained – Please attach copies of relevant certificates]
12.	Research Publications, if any [If space is insufficient, please use a separate sheet]
13.	Proficiency on Languages : Highest Examination passed in, Sinhala - Tamil -- English -
14.	(a) Present Occupation : 1. Post : 2. Date of appointment to such post : 3. Whether confirmed in the present post : 4. Place of work : 5. Salary scale of the post : 6. Present salary : (b) Previous Employment, if any (with experience), with dates and periods
Department/ Institution	Post	From	To	Reasons for Leaving
Experience, if any
Particulars of Bond Obligations to Higher Educational Institutions/Institutes if any: NO OBLIGATIONS. Obligatory Period :- Amount Due : -
15.	Commendations/Punishments, if any, During your career in the University/ Institution.
16.	Extra-Curricular Activities
17.	Any other relevant particulars [Not included above]
18.	Names of two Non related referees [With positions and addresses] Name Address
19.	Where a period of experience is a requirement for the post applied, state period of such experience with details: [Please attach copies of relevant certificates]
20.	I hereby certify that the particulars submitted by me in this application are true and accurate. I am aware that if any of these particulars are found to be false or inaccurate, I am liable to be disqualified before selection and to be dismissed without any compensation if the inaccuracy is detected after appointment. …………………… …........................................ Date Signature of Applicant
21.	[TO BE COMPLETED BY THE HEAD OF THE DEPARTMENT WHERE APPLICABLE] (a) Is the applicant on probation? Yes / No (b) Was any disciplinary action taken against the applicant? Yes / No (c) I recommend/ not recommend the application. ………………………………………….. Date Signature of Head of Department Note: If space not sufficient to enter the details under each column use a separate sheet and attach to the end.