Part Time Counsellor/Psychologist Application Form

Before you begin: keep scanned copies of your photograph, signature, Class X, Class XII, Bachelor's and Master's certificates, experience certificate(s) and desirable qualification certificate (if any) ready (PDF, unless stated otherwise). Fields marked * are mandatory. Incomplete or incorrectly filled applications may be rejected.

* Mandatory field

Please correct the following before submitting:

Personal Details

Name of Post*

Full Name *

Father's Name *

Date of Birth *

Age (21–62 years)

Gender *

Mobile No. *

E-Mail Address *

Permanent Address (with PIN code) *

0 / 300

Correspondence Address (with PIN code) *

Same as permanent address

0 / 300

Education Qualification

S.No.	Education Qualification	Passing Year	Marks Obtained	Percentage	Action
1
2

Employment History

Optional. If you start a row, employer, period and designation are required.

Employer / Organization	Period of Service	Designation	Remuneration	Detailed Description of Work	Reason for Leaving	Action

Professional Trainings / Certifications

Optional. If you start a row, organization and details are required.

Organization	Details of Training / Certificate	From	To	Action

Photograph, Signature & Supporting Documents

Applicant Photograph *

JPG or PNG only, maximum 2 MB.

Applicant Signature *

Scanned signature on white paper. JPG or PNG only, maximum 1 MB.

Class X Certificate / Marksheet *

PDF only, maximum 5 MB.

Class XII Certificate / Marksheet *

PDF only, maximum 5 MB.

Bachelor's Degree Certificate / Marksheet *

PDF only, maximum 5 MB.

Master's Degree Certificate / Marksheet *

PDF only, maximum 5 MB.

Experience Certificate(s) *

PDF only, maximum 5 MB. Merge multiple certificates into one PDF.

Desirable Qualification Certificate

PG Diploma in Guidance & Counselling and/or M.Phil. in Clinical Psychology from an RCI-recognized institute. PDF only, maximum 5 MB.

Declaration

I hereby solemnly declare that all the above-mentioned statements are true and correct to the best of my knowledge and belief. Nothing is false or has been concealed/ distorted. If at any time I am found to have concealed/ distorted any material/ information, my appointment shall be liable to termination without notice.

I have read and agree to the above declaration. *

Place *

Date