University of Peradeniya

Fields marked * are required. Please read all instructions carefully before completing this form.

Section I — Personal Details

Name in Full*

Rev./Mr./Mrs./Miss — If registered under another name, indicate in brackets.

Title

First Name

Surname

Name as registered in University (if different)

Postal Address*

Any change should be communicated immediately to the Registrar's Office.

E-Mail Address

Fax No.

Contact Telephone No.*

Mobile

Home

Office

Date of Birth & Age*

Please attach a copy of your Birth Certificate.

Date of Birth

Age (auto-calculated)

Nationality*

Civil Status*

Single Married Divorced Widowed

Citizen of Sri Lanka*

State whether by descent or by registration. If by registration, provide reference number and date.

By Descent By Registration

Section II — Qualifications

Educational Qualifications

Degree/Diploma & University	From	To	Course Followed	Final Exam Date & Result

Special Qualifications (Professional, etc.)

10.

Professional Registration & Board Memberships

Professional Body / Council	Registration Category	Registration Number	Effective Date

11.

Postgraduate Qualifications

State whether by coursework or research, duration, and effective date.

12.

Academic Distinctions, Scholarships, Medals, Prizes, etc.

Indicate the institution.

13.

Research Publications, if any

14.

Language Proficiency — Highest Examination Passed In

Sinhala

Tamil

English

Section III — Employment & Experience

15.

(a) Present Occupation

1. Post

2. Date of Appointment

3. Confirmed in Present Post?

Yes No

4. Place of Work

5. Salary Scale of Post

6a. Present Salary Step

6b. Allowances

(b) Previous Employment, if any

Department / Institution	Post	From	To	Reasons for Leaving

Experience, if any

Particulars of Bond Obligations to Higher Educational Institutions, if any

Obligatory Period

Amount Due

Section IV — Other Details

16.

Commendations / Punishments, if any

During your career in the University / Educational Institution.

17.

Extra Curricular Activities

18.

Any Other Relevant Particulars

Not included above.

19.

Names of Two Non-Related Referees*

Provide full name, position, and address of each referee.

Referee 1

Full Name Position Address Contact No.

Referee 2

Full Name Position Address Contact No.

20.

Experience Relevant to the Post Applied

Where a period of experience is a requirement, state the period and provide details.

Section V — Declaration

21.

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*

Full Name of Applicant (as signature)*

Section VI — Head of Department

22.

To Be Completed by the Head of Department (Where Applicable)

(a) Is the applicant on probation?

Yes No

(b) Was any disciplinary action taken against the applicant?

Yes No

Application for Works Engineer (Civil) Grade III submitted by:

Can be released Cannot be released

Date

Name & Title of Head of Department

Official Seal / Stamp Reference

Note: If space is insufficient, use a separate sheet and attach to the end.

Application Submitted Successfully

Sri Lanka — Established 1942

To Be Completed by the Head of Department (Where Applicable)