ACADEMY OF TECHNOLOGY

G T Road (Adisaptagram), Aedconagar,Hooghly-712121 Application form

No part should be left blank. Write NA if not applicable. [AFFIX PHOTO]

POST APPLIED FOR 1. Name of candidate in full (in capital letters) 2. Fathers Name 3. Address :(First name) :

DEPT

(Middle name)

(Last Name)

(a) Residential (Permanent) : (b) For Correspondence (c) e-mail : :

4. 5. 6. 7. 8.

(d) Date of birth(dd/mm/yyyy) : Nationality - Sex(M/F) -Marital StatusMother tongue :Other Languages Known :(Speak, Read & Write) Academic Qualification
Stream/ Discipline Board/ Council Name of School/ College/ University Year of passing Division/ Grade/ Class(wit h % of marks)

Examination/ Degree

10-class 10+2 Diploma/equivalent Graduate Post Graduate Doctoral NET, GATE, SLET etc Any other qualification

9. Joint Entrance Rank:

10. Experience Profile(in reverse order starting with immediate appointment)

Employers Name & Address Designation Date of Joining Date of leaving Nature of Experience Reason for Leaving

Industry

Teaching

11.

(a). No. of Publication in Referred Journal: (b)(i). No. of Conference Publication: (ii). No. of Papers presented in Conference: (c). Books & monographs: 12. Membership of Professional bodies: 13. Distinction, Prizes or Awards: 14. Research Guidance: (i) Doctoral Level: (ii) Masters Level: 15. Any other information candidate likes to highlight. 16. Joining by17. Last Salary Drawn Salary Expected 18. DECLARATION I declare that the entries made in this form are true to the best of my knowledge and belief.

Date: Place:

(Signature of the

application)