PHARMACY COUNCIL OF INDIAdspharmacycollege.com/pdf/2.pdf · EI,..Beida from 15-03-2003 to...

PHARMACY COUNCIL OF INDIA

STAFF DECLARATION FORM

From

Teachers Name EJeyaseli Florance (as on University Degree certificate)

Recent Passport size photo of the Employee Signed by DeanPrincipal of the College

Date ofBirth amp Age 23111977 amp 40

Qualification

RPharm

MPharm

College amp University

KM College of Pharmacy Madurai

amp Dr MGR Medical

University

Pune College of Pharmacy Pune

amp Pune University

Year

1998

2001

Registration No with State Pharmacy

3363 Al

Name of the State Pharmacy Council

Tamil Nadu State Pharmacy Council

I

(PhD)others PRIST University Pursuing

Copies of Registration Certificate and University degreeIPGlPhD be attached

Present Designation As=s=o=ci=a=te=P=roD=es=s=o-=-r_________~______

Department Pharmacognosy

College Dhanalakshmi Srinivasan College of Pharmacy

Ciry~======______________________________________________

Nature of appointment PermanentlTemporaryAdhooHonoraryPart time

Whether belongs to OGlSCSTIOBCEx serviceOthers

Contd on page 2

2

Permanent Residential Address of employee _----Beth=alH-o-u==s-e-S-o-uth~E=acha~m~patt=i--_______

Manachanallur Taluk 621 005

Copy of PassportNoter CardlRation CardlP AN NoElectricity BillDriving License Attached as a proof of residence

STD Code Phone No

Phone amp Fax Number Office ____________________________

with Code Residence ____--9443-6=2=87-7-4---________

E-mail addresstoflorance2001yahoocom

Date ofjoining present institution -05--0-o6-2-0-1~7--______as Associate Professor (Designation)

Details of the previous appointmentsteaching experience

Position Name of

Institution From To

Total Experience in

years

Cherraans College of Pharmacy 101052001 28022003 I 01 Y r 09 Months

Lecturer Omar al Mukhtar

University 15032003 26052007 04 Yrs 02 Months

Reader Assistant Professor

Farooja College of Pharmacy 151112007 31082009 01 Yr 09 Months

Professor StJohn College of Pharmacy 0110712014 31052017

i 02 Yrs 10 Months

Principal i

1) Before joining present institution I was working at Stjohn College of Pharmacy as_ Professor and relieved on 31052017 after resigningretiring (relieving order is enclosed from the previous institution)

2) I hereby undertake that I have not given my name as teaching faculty in any other Pharmacy institution for teaching any Pharmacy course and not working in any where other than this institution Pharmacy CollegelMedical CollegelDental CollegelIndustryCommunity PharmacylHospital PharmacyGovt Serviceany other service in the State or outside the State in any capacity full-timepart-time other than the above

Contd on page 3

-------------------------

3

3) I have drawn total emoluments from this college as under (Please fill the data of last academic session) - shy

I Amount Received TDS

bull April 20 May 20

I June 20 July 20

i August 20 bull September 20

October 20 November 20 December 20 January 20 February 20 March20

(Copy of my form 16 (TDS certificate) for the last financial year is attached)

PAN AHIPJ0763A Circle

Declaration

1 I have not worked at any other pharmacy collegeinstitution or presented myself at any inspection during my employment in this college

2 It is declared that each statement andor contents of this declaration made by the undersigned are absolutely true and correct In the event of any statement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accepted that such misdeclaration in respect to any content of this declaration shall also be treated as a gross misconduct thereby rendering the undersigned liable for necessary disciplinary action (including removal of his name from Register of Registered Pharmacists)

Signature of the Employee

Date Place

Endorsement

This endorsement is the certification that the undersigned has satisfied himselflherself about the correctness and veracity of each content of this declaration and endorses the abovementioned declaration as true and correct In the event of this declaration tuming out to be either incorrect or any part of this declaration subsequently tuming out to be incorrect or false it is understood and accepted that the undersigned shall also be equally responsible besides the declarant hi selflherself for any such misdeclaration or misstatement

Date Place

middotDHANALAKAHMI SRINIVASAN COLLEGE OF PHARMACY Thuraiyur Road Perambalur - 621 212

02062017

APPOINTMENT ORDER

To

EJeyaseli Florance

Bethal House South Eachampatti

Manachanallur Taluk

Trichy 621 005

With references to your resume and based on the interview conducted by the

selection committee of Dhanalakshmi Srinivasan Charitable and Educational Trust

you are selected as a Associate Professor in our Proposed Dhana1akshmi

Srinivasan College of Pharmacy Perambalur

Kindly send your willingness to accept the appointment along with 2

photographs and photocopies along with your Original certificates Relieving order

and Experience certificate

You should obey all the rules and regulations of our College of Pharmacy as

per the discussion

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8 I r PIiiIf Sdivasan Charitat Educatbd TNIt DIY

JOINING LETTER

From

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005

To

The Principal

Dhanalakshmi Srinivasan College of Pharmacy

Perambalur - 621212

Respected Sir

Subject EJeyaseli Florance Joining as Associate Professor on 05062017 - reg

With reference to the appointment order I am Joining duty as your institution as

Principal in the Dhana1akshmi Srinivasan College of Pharmacy in the FN of 05062017

Herewith I am submitting my original cel1ificates ID proof and two photographs as per your

instruction for verification I will abide by the rules and regulations of the trust and College

Thanking You

Yours Sincerely

pound j~lJV)~ Jto~ (1 tz

Place Perambalur

FItrranQ middotBOARD OF fU~iHER SeCONDARY EXAMINAIION

~ TAMIL NADU

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DEPARTMENT OF GOVERNMENT EXAMINATIONS MADRAS 600 006

HIGHER SECONDARY COURSE CERTIFICATE GENERAL EDUCATION

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ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF TAMIL NADU

Certified that

E JEYAS~ELI ~LORAN~E appeared for the MAR1994

Higher Second8ry EX8mination 8mi JJI8ined the following markr

-r--- SUBJECT I MARKS OSTAINeD FOR 2[)Q

TAiHt 165 ONE sn~ FIVE

EtlGLISH 158 ONE fIVE EiGHT

PHYSICS 162 ONE S1 TWO

CHEMISTRY 187 ONE EI GHr SEVeN

166 ONE E I GHl Slrx VIAnle MA TItS 187 ONE EIGHJ SEVEN

TOTAL MARKS 1045 ON ZERO FOUR FIVE1--_____---__----________ bull ____~______I

GROUPmiddot CODE 501

OATE OF BIRTH REGISTER iii- -- I - - TMR CODe NO amp DATE

1-------_23__1_1_7_1_ -_1---_68_2_6_~middot~~J 6067388 25050 1994 SCHOOl

I-~------------------------------I MINIMUM FOR A PASS 70 MARlS OUT OF 200 IN EACHSlJBJtCT THrSlNC(WOES PASSIIilGijNOER THE COMPAFmJlENnL SYsiEM ALSO - ~~iltilfr

~ - bull ~ t bull

r SecretBtyE letfasQeliCandidatehI Signature

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TAMIL NADU PHARMACY COUNCIL CKENNAI

PHARMACIST REGISTRATION CERTIFICATE

J

CERTIFICATE NO 3363 Al DATED 13th July 1998----------- shy

THIS IS TO CERTIFY-THAT EJEYASEELIFLORANCE BPharm

($H(I daughter of c Ebinasar ) whose date of birth is

Z3rd Noyember 1977 ( Njneteen Seventy Seven ) has been duly registered as a

REGISTERED PHARMACIST and is entitled to all the privileges granted under The Pharmacy Act 1948 (Central Act No VIII of 1948)

as amended to regulate the practice of Pharmacy in the State of Tamil Nadu

IN WITNESS whereof are herewith affixed the seal of the Tamil Nadu Pharmacy Council and the SignatJre of the Registrar of the said Pharmacy Council

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Signature of the Candidate Re tIS rar

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Note (1) This certificate shall remain in force till 2nd September 2018 days of grace upto 2nd December 2018 ~ The above Photograph is due for change on 02092018 This Certificate is issued afresh on 23092013 g

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TAMIL NADU PHARMACY COUNCIL i

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CHENNAIc ltii 0 FORM -Io ( See Rule 79 (2) ) CD

ru c lt Registration of Additional Qualification ru (Under Section 35 of The Pharmacy Act 1948)omiddot l

CD a omiddot l rrJhe addztional cBJiploma (9ertficate cBJegree appearing below has i i

been imerted in the (3(eg-tster if 92harmacistsfor the Caml cJadu~ () c ltii ~tate agaimt the name ifthe following 0(eg-tstered 92ham1acist 0 o

Name8 3

Registration Number amp Date

DiplomaCertificateDegree already registered

DiplomaCertificateDegree now registered

Date of Addl Qualification Regd

E JEYASEELI FLORANCE ~

3363Al 13-Jul-1998

BPharm

MPharm (PHARMACOGNOSY)

R~~13092006 =

(Affiliated to the Tcminadu Di MSR Medical University Chermai) Approved by Ttlf Govt of Tarnilnadu Chennai

NoAll india Council lor Technical Education New Delhi Recognised by Pharmacy Council of Indla New Deihi

Datc)

Dalcd 11 middotmiddotmiddot06 - 2007

EXPERIENCE CERTIFICATE

This is to certify that Miss E Jcynsccli Florance MPharm worked

as a Lecturer in Department of Pharmacognosy in our institution iiom

10 - 05 2001 to 28 02 - 2003

During this period she handled Pharmacognosy and Advanced

Pharmacognosy t()r Degree Students

Her character and conduct were f(Und to be excellent during her

serVIce

Best wisbes j()1 her future endeavors

lIt- nltgtlpw ftemanfstoltegeof Pharm40t

17SASlruvan1 Milin Road jl1ingl1p~iaYlOl Pidv~ QQtDbatole-flA1039

New No 521 (Oid NO 278-A) Siruvanj Main Roal1 Telungupalr3yarn Pirivu Coirnbatore - 641039 () 0422-2343380 2341(166 2346194 Fax 04222341066

E rnaH ciilspllarmacyvsninet

TO WHOMSOEVER IT lVIAY CONCERN

This is to certify that MrsJeyaseeU Florence is working as a Lecturer in the Department of Pharmacognosy College of Pharmacy Omar al Mukhtar University EIBeida from 15-03-2003 to 26-05-2007During the selvice period she has taught Pharmacognosy and Phytochemistry for the PlIarmacy students

SIte has proved herself as a good teacher dl0 has ta ken keen interest in teaching and research She has the ability to make the students understand the snbjectmatter effectively She is enthusiastic activeaud logical in approach She has proved to be a sllccessful and efficient as a lectnrer in the

I wish ber all the best in her f

ProfSaber Dean Members Affairs College of harmacy liversity Omar al ukhtar Univelsity EJBeida ElBeida Libya Liby~

RlFAmiddotIIUL-MtJSLlMEEN EDUCATIONAL TlnJST REeD1

FARDOOIA COLLEGE OF PHARMACY Farooqia Road Eidgah Ground Tilak Nagar Mysore-21 Karnataka INdia

Pecognised by Pharmacy Council of India amp Alllndie council for Technical Education New Delhi Affiliated to Rajiv Gandhi University of Health Sciences Karnataka

0821-2491974 Fax No 0821middot2491454 e-mail pharmacyfarooqiuYllhoocom website wwwfarooqiaorg

Date 02092009


This is to certify that Mrs E Jcyasecli Florance MPharm worked as Asst Professor and Head of the Department of Pharmacognosy in our College during the period of 151112007 to 31082009 Her character and conduct were

bull c

found to be good during the service

I wish her aU the best in her future endeavor

11 (ProfMManjunatha)

Principal Farooqfa College of Pharmacy

Mvsore


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TO VHOilSOEVER IT MAY CONCERl

This is to certify thaC ~lrsEJ(yaseeH Fornnce is working as ltI Lecturer in tht Department of Ph~lrnllH~ognosy mId Phyto(hemistry College of Pharmacy Oll1nral il1kht~lr University Tohful from 01-10-2009 to 31-01-2010

During this period her tellehing character and conduct were found to he

excenent

Dean CoHrge of Pharmacy OnHlr allrlukhhU University El-Brida Libya

iIr wd ioiHlnlmed Eis~l ctor of rhe Slat Vlcmbers Affairs

Oll1ur HI [ulhrll Unjcrsity

rU-Beida Uhya

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9010343536 E-mail stjohncQP9mail~com

nflmiddotfmiddot bull 1() bull Date

RELIEVING CERTIFICATE

This is to certify that MrsEJcyaseeliflorance~Do Ebinezarhas worked in our college

~s Proiessorfrom l stJuly 2014 to 31 st Ma 2017 She is having two years ten months and thirty

days of teaching experience in our Institution The request of MrsEJeyaseeliflorance has been

examined and decided to consider her request and relieved her [Tom the college

lhetefore~ MrsEJ eyaseeliflorance is here by relieved from the post of Professor St

John cOllegeofPharmacy Yellapurtoday ie on 3105201TAN

We acknowledge the service rendered by MrsEJeyaseeliflorarrce to this Institute and we

wish alltliesuccess in her future assignment

To MtsjeyaseeliFlorance

Date31 052017 Place Yellapur

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Enrollment No 00000035952311

To J cloil~O ltlJi1edt E Jeyaseeli Florance WIODhayabaran

~ 6166 North Street 1i3 South Eachampatli Manoachanallur Talult

~ Kalpalayam ~ Kalpalayam

Tiruchira ppalli 0) Tamil Nadu 621005 9443628774

~ 1111II~1l11lIillllllliIUIIlHlllrl~ MD317511885FH

~oile eQ1ltr fdoa1tS Your Aadhaar No

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INFORMATION l1li Aadhaar is proof of identity not of citizenship

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III Aadhaar is valid throughout the country

bull Aadhaar will ~e helpful in availing Government I and Non-Government services in future

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Address WIO Dnayabaran 6166 North Street South Eachampatti Mannachanallur Taluk Kalpalayam Kalpalayam Tiruchirappalli Tamil Nadu 621005

6473 1989 26~1

1947

2

Permanent Residential Address of employee _----Beth=alH-o-u==s-e-S-o-uth~E=acha~m~patt=i--_______

Manachanallur Taluk 621 005

Copy of PassportNoter CardlRation CardlP AN NoElectricity BillDriving License Attached as a proof of residence

STD Code Phone No

Phone amp Fax Number Office ____________________________

with Code Residence ____--9443-6=2=87-7-4---________

E-mail addresstoflorance2001yahoocom

Date ofjoining present institution -05--0-o6-2-0-1~7--______as Associate Professor (Designation)

Details of the previous appointmentsteaching experience

Position Name of

Institution From To

Total Experience in

years

Cherraans College of Pharmacy 101052001 28022003 I 01 Y r 09 Months

Lecturer Omar al Mukhtar

University 15032003 26052007 04 Yrs 02 Months

Reader Assistant Professor

Farooja College of Pharmacy 151112007 31082009 01 Yr 09 Months

Professor StJohn College of Pharmacy 0110712014 31052017

i 02 Yrs 10 Months

Principal i

1) Before joining present institution I was working at Stjohn College of Pharmacy as_ Professor and relieved on 31052017 after resigningretiring (relieving order is enclosed from the previous institution)

2) I hereby undertake that I have not given my name as teaching faculty in any other Pharmacy institution for teaching any Pharmacy course and not working in any where other than this institution Pharmacy CollegelMedical CollegelDental CollegelIndustryCommunity PharmacylHospital PharmacyGovt Serviceany other service in the State or outside the State in any capacity full-timepart-time other than the above

Contd on page 3

-------------------------

3




I June 20 July 20





Declaration




Date Place

Endorsement


Date Place


02062017

APPOINTMENT ORDER

To

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005









per the discussion

ChIef ~


JOINING LETTER

From

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005

To

The Principal


Perambalur - 621212

Respected Sir






Thanking You

Yours Sincerely


Place Perambalur


~ TAMIL NADU

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-------------------------

3




I June 20 July 20





Declaration




Date Place

Endorsement


Date Place


02062017

APPOINTMENT ORDER

To

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005









per the discussion

ChIef ~


JOINING LETTER

From

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005

To

The Principal


Perambalur - 621212

Respected Sir






Thanking You

Yours Sincerely


Place Perambalur


~ TAMIL NADU

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02062017

APPOINTMENT ORDER

To

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Manachanallur Taluk

Trichy 621 005









per the discussion

ChIef ~


JOINING LETTER

From

EJeyaseli Florance


Manachanallur Taluk

Trichy 621 005

To

The Principal


Perambalur - 621212

Respected Sir






Thanking You

Yours Sincerely


Place Perambalur


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JOINING LETTER

From

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Manachanallur Taluk

Trichy 621 005

To

The Principal


Perambalur - 621212

Respected Sir






Thanking You

Yours Sincerely


Place Perambalur


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6473 1989 2631 cj~ ~~cf cj~ rtrn~



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6473 1989 26~1

1947

$LWyI p1i)l1

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excenent




rU-Beida Uhya


Cel96663435369666323334 9366153134994946511














r)wmrlcl ~cU tloro6








6473 1989 2631 cj~ ~~cf cj~ rtrn~



~(I Female

GOVOfTmant of India

c1rdamp~



dJtle5Cl~







__- _-shy


6473 1989 26~1

1947

Cel96663435369666323334 9366153134994946511














r)wmrlcl ~cU tloro6








6473 1989 2631 cj~ ~~cf cj~ rtrn~



~(I Female

GOVOfTmant of India

c1rdamp~



dJtle5Cl~







__- _-shy


6473 1989 26~1

1947

r)wmrlcl ~cU tloro6








6473 1989 2631 cj~ ~~cf cj~ rtrn~



~(I Female

GOVOfTmant of India

c1rdamp~



dJtle5Cl~







__- _-shy


6473 1989 26~1

1947

PHARMACY COUNCIL OF INDIAdspharmacycollege.com/pdf/2.pdf · EI,..Beida from 15-03-2003 to...

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Transcript of PHARMACY COUNCIL OF INDIAdspharmacycollege.com/pdf/2.pdf · EI,..Beida from 15-03-2003 to...