Application for Faculty& Application for Faculty& Administrative Position Administrative Position

INDIAN SCHOOL OF MINES

DHANBAD-826004 JHARKHAND,INDIA

(Please Fill in BLOCK LETTERS) Advertisement No. Post Applied for Department Bank Draft No.& Date 1.Name in Full (First Surname) Affix here recent passport size photograph

Married

Single

Male

Female

(Please tick)

2. Address: Present

Permanent

FAX E-mail Telephone / Mobile 3. Date of Birth

Office:

Residence: 4. Nationality:

Day

Month

Year

5. Present Employment Designation Organization Date of joining Scale of Pay (Rs). Basic Pay (Rs.) Total Emoluments (Per month)(Rs.) 6. Basic Pay expected (Rs.) ______________________________________________

7. (a) Tick-mark the appropriate box if you belong to reserved category

(Please attach necessary caste certificate issued by an authorized officer only.)

SC

ST

OBC

PH

8. Total years of the experience after attaining essential qualification 9. Areas of Specialization 10. Current Areas of Research:
(Only for academic positions)

11. Academic Record starting with secondary education (Please attach Xerox copies of Degree Certificate) Examination Branch/ College/University Year Percentage Class/ Specialization /Institute /Grade Division

12. Employment: (particular of your past position (s)) Employer Position held Date of Joining

Date Leaving

of Pay with Scale of pay

13.Have you ever been discharged/suspended during your earlier employment? If yes, state reasons:

14 Special Awards/Honours received, if any: Year Name of Award/Honour

Name of Organisation

15 Membership of Professional Bodies: Name of the Body

Status of Membership: Life/Annual

16 Please mention below best five research publications and attach separate list of all publications: Sl.No Year Title of Publication Name of Journal 1. 2. 3. 4. 5. 17Names and addresses of three Referees (at least one of them should be familiar with your recent works) Name Occupation or position Address Fax E-mail Phone No.
(1) (2) (3)

18 Statement of Objectives (to be filled up in Candidates own hand writing) a) Please indicate as to why you wish to join ISM, Dhanbad. b) How in your opinion do you meet the job requirements as advertised? c) A short paragraph about the research /teaching/development projects you would like to undertake and the courses that you would like to handle at UG and PG levels.

19 I hereby declare that I have carefully read and understood the instructions and particulars supplied to me, and that all entries in this form as well as attached sheets are true to the best of my knowledge and belief. There are Date: Place: (Signature of Applicant) Note: Use separate sheet if necessary for any of the above items. attached sheets along with this form.

Indian School of Mines, Dhanbad ACKNOWLEDGEMENT

(All particulars to be filled by the applicant) (Write full mailing address on reverse and affix necessary postage stamps) Name (in BLOCK LETTERS)_____________________________________ Post Applied for Department ______________________________________ ______________________________________

_______________________________________________________________________ _ (for office use only) Received on ______________ _______________________

Signature of Receiver