application_english - University Grants Commission - Sri Lanka

SPECIMEN APPLICATION FORM
PROMOTION TO THE POST OF
CLERK I STORE-KEEPER! SHROFF GR.ll - 2013
. Eligible year for Promotion: 1-'_____-'
Medium I wish to sit the Examination: SinhalaD EnglishD TamilD
(Please Put a tick (v") in the relevant cage)
01. Name
(i). Mr.lMrs.lMiss: ...................................................................................................................... .
(ii). Full Name: ........................................................................................................................... ..
( Ill. ...) N arne Wit . h' Inltla .. I s: ................................................................................................................
(iv). National Identity Card Number : ......................................................................................... .
02. Place of Work
(i). Universityllnstitute: .............................................................................................................. .
(ii). DivisionIDepartment: ........................................................................................................... .
(iii). E-mail Address: .................................................................................................................. .
(iv). Contact Telephone Number : .............................................................................................. .
03. Present Post and Experience.
(i). Confirmed D Not Confirmed D (Please Put a tick ("") in the relevant cage)
(ii). (a) No. of years in Grade III: .......................................................................................... ..
(b) Date of appointment to the Post (Grade III) ............................................................
(iii). CasuallTemporary period if any; From:................
04. Eligibility :(Please Circle what is relevant)
To.: ............. (CasuallTemporary)
Completion of 10 years
Completion of 06 years
Both categories
YeslNo
YeslNo
YeslNo
05. Written Examination
Did you sit the written examination conducted for the above promotion previously ............... ..
If so, please furnish the information given below:
(i). Date/s: .............................................................................................................................. .
(ii). Eligible year: ................................................................................................................... ..
(iii). Index No.: ........................................................................................................................ .
(iv). Marks scored:
(a) PaperI­
(b) Paper II ­
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06. Salary particulars:
a. Salary Code: ..........................................................................................................................
b. Salary scale as at 31.12.2012:............................................................................................... .
c. Monthly salary as at 31.12. 2012 (exclusive ofthe allowances):
d. Date ofAppointment: ............................................................................................... : .......... .
e. Date of Increment: ............................................................................................................... .
07. Particulars of service from the date of joining the University:
Period of Service
University/Institute
Post
From To
I
i
08. Particulars of posts held in other Institutions - Public/State Corporations:
Period of Service
Post held
Department/Corporation
From
To
I
09. Any other Qualifications obtained [In addition to G.C.E.(OIL)]:
(i)....................................................................................................................................
(ii)....................................................................................................................................
(iii)...................................................................................................................................
(iv)...................................................................................................................................
(v)...................................................................................................................................
10. Extra curricular activities:
(i).....................................................................................................................................
(ii)....................................................................................................................................
(iii)...................................................................................................................................
(iv)...................................................................................................................................
(v)...................................................................................................................................
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11. Job Description
(i). Duties assigned at present.
a .............................................................................................................................
b .............................................................................................................................
c .............................................................................................................................
d .............................................................................................................................
e .............................................................................................................................
f ..............................................................................................................................
g .............................................................................................................................
(ii). Duties performing at present ....................................................................................
a .............................................................................................................................
b .............................................................................................................................
c .............................................................................................................................
d .............................................................................................................................
e .............................................................................................................................
12. Have you taken no-pay leave for employment or study abroad:........................... .
13. Ifyou have obtained such leave please indicate the date of commencement and
t.be date of expiry of leave:
I
I
I
I
From
To
Total No of Years
,
No of Years
Years Months
i
1 j
I certify the information given in this application is true and accurate, and agree to abide by the
rules and regulations of the examination. I am aware that if any information given in this
application if found to be false or inaccurate before or after being promoted to the said post, my
promotion is subjected to a cancellation.
J
i
Date: .................. ..
Signature ofApplicant
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Registrar/Deputy Secretary/Deputy Registrar/Senior Assistant Secretary/
Senior Assistant Registrar/Assistant Registrar
I certify that the job description given in Item No.ll is correct.
I recommend/do not recommend * this applicant for promotion.
Head of DepartmentIDivision
Dept.lDivision .............................................. .
Date: ..... / ...... .!......
(* Delete whichever is inapplicable)
Ref. No.
SecretarylUniversity Grants Commission
I certify that the particulars given in items 1 to 13 are correct according to the applicant's
personal file.
The special report in the prescribed form which was sent along with the advertisement,
completed by the Head of the Division/Department and one copy of this application have
been retained in the applicant's personal file.
Secretary(U GC)lRectorlDirector/ Registrar
University/Campus/ Institute: ........................................................................................................... .
Date: ......!......I.. ....
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SPECIAL REPORT THAT SHOULD BE SUBMITTED BY A CANDIDATE ALONG WITH AN
APPLICATION FOR PROMOTION
Instructions to
(a)
(b)
Candidates:
Part one of this Special Report should be filled by the candidate. The candidate is
also responsible to obtain leave particulars certified by the authorities concerned
before handing over the application.
Head of Divisionsffiepartments
The Head of the Division/Department is responsible to fill the Part Two of the
Special Report on the basis of his knowledge and experience of the conduct and
work perfonned by the applicant. The Head of the Division/Department is also
requested to make his recommendation and forward this Special Report along
with the application for promotion.
PART ONE
Post applied for : ........................................................................................................................... .
(1). The Employee:
(i)
(ii)
(iii)
(iv)
(v)
Name of Employee: ......................................................................................... ..
Date of Birth :............................. Age as at 31 st Dec. 2012 ................. Years
(yy IMM/DD)
Present Post: ........................................................................................................
Date of appointment to the present post: ........................................................... ..
DatelDates of previous appointment/s with designations.: ............................... ..
(vi)
Educational Qualifications: ................................................................................ .
(2). List of Duties:
1.
2.
3.
4.
(3). Particulars of leave taken durin1! the last 03 vears·.
I Cate20ry of Leave 2012 2011 2010
; (a) Casual
I
I(b) Vacation
! (c) Medical
~Study
. (e) No-Pay
I (t) Half-Pay
Signature of Candidate
Signature Certified Officer ........................................ ..
Name: ......................................................................... .
Designation: ...................................... Date: ........ ..
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PART TWO
(4). Administration Report
(a). Work Performance:(Please describe the work performed by the employee in
terms of quantity and quality expected in the job/post).
(a). Scope for work improvement: (Describe the nature of work which
should have been improved by the employee during the period, in terms of
quantity and quality) ..................................................................................................
(b).
(c)
Strength of employee:
(What are the assets ofthe employee that are useful to the University).
(i). Skills 1. Communication: ...........................................................................
2. Writing: .........................................................................................
(ii). Performance :.................................................................................................
(iii). Special Contributions: ...................................................................................
Weaknesses:
(i). Inadequate skills: ...........................................................................................
(ii). Absence from work place: .............................................................................
(iii). External obstacles which have influenced the performance ..........................
(iv).
(v).
(vi).
Resistance to change : ................................................................................. ..
Delays in attending to work: ........................................................................ ..
Any other: .................................................................................................... ..
(d).
(e).
(t).
(g).
Employee's improvement during the period:(Describe the manner in which the
employee has improved himselflherself during the period) ..................................... .
Commendations:(received during the last three years prior to becoming eligible
for promotion.) .......................................................................................................... .
Employee's failure:
(Identify situations of failure, negligence and any other damages caused to the
University, its property, work, goodwill etc.). ......................................................... ..
Punishments:(received during the three years immediately before the date on
which he/she became eligible for promotion)
(5). Are there any actions which might be taken which would lead to higher levels
of career achievements
(6). Any other comments: .............................................................................................. .
(7). Recommendation for Promotion: ......................................................................... ..
Signature of Recommending Officer:
Designation of Recommending Officer:
Date recommended .......1....... .1.......
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