UNIVERSITY OF MYSORE

Crawford Hall, Mysuru-570 005, Karnataka State.

APPLICATION FOR TEACHING POST

(SUBMITTED IN TEN SETS)

Please type or write in BLOCK LETTERS

BACKLOGPOST

CURRENTVACANCY
(Mark to be
made

Advertisem
ent
No
Post
Professor
Applied
for
Associate
(Tickmark to
be
made)

Affix your

Professor

Passport
recent
size photo

Assistant Professor (PG)

Assistant Professor (UG)

Subject
Area of
Specializati
on

DETAILS OF APPLICATION
FEES PAID
DD No.

DD Date

Bank Name

Amount
Rs. _______

1 FULL NAME
(in block letters)
Gender

Mal
e

Femal
e

(Tick mark to be made)

Marital Status
(Tick mark to be made)

Marrie
d

Un Married

Name of the
Mother
Name of the Father
Name of the
Spouse
1

12

CATEGORY
SC

(Tick mark to be made)

ST

CAT I

HORIZONTAL RESERVATION
Woman

Rural

Cat.
Cat. IIB IIIA

Cat. IIA

Cat.
IIIB

GM

(Tick mark to be made)

Physically
Handicapped

Ex-Service
Man

Kannada
Medium

Project
Displaced

Enclose certificate issued by the competent authority. Application without required

certificate will
be consider under GM category

HYDERABAD-KARNATAKA

(Tick mark to be

made)

SC

HORIZONT
AL
Woman

ST

Cat.
IIA

CAT I

RESERVATION

Cat.
Cat. IIB IIIA

Cat.
IIIB

GM

(Tick mark to be

made)

Rura
l

Physically
Handicapp
ed

Ex-Service

Kannada

Project

Man

Medium

Displaced

Enclose certificate issued by the competent authority. Application without

required certificate will
be consider under GM category

4 ADDRESS FOR CORRESPONDENCE :

PERMANENT ADDRESS : -

Mobile No. :
2
Telephone
Office

STD CODE :

Residence

STD CODE :

E-mail

KNOWLEDGE OF
5 KANNADA

Writing
Reading

6 DATE OF

Place of
Birth

BIRTH
Day
Month
Age as on last date of
application

Year

Nationalit
y

17 PRESENT EMPLOYMENT DETAILS :

Desigantion
Name of the
Organization
Scale of Pay with
AGP/GP
Current Basic Pay
Total
Emolumen
ts (per
month)

Mother
Tongue

18 ACADEMIC RECORD STARTING WITH SSLC : (Attach photocopies)

Certificate
/Degree

Branch/Specializat Board/College/Institut
ion
e/
Year of
University
Completion/
Passing

Percentage/
CGPA

SSLC

PUC
3

UG Course

PG Course

PG Diploma
Ph.D
NET/SLET/SET

09 EMPLOYMENT
(particulars of your employment in chronological order starting with recent
Employment) Enclose Supporting Documents
Name of the
Employer

Post
held

10 EXPERIENCE
PG
UG

Date of
Joining

Date of
Leaving

Gross
Salary

Pay Scale Permanent /

Temporary

(in no. of years) (enclose supporting documents)

Experience certificate should be enclosed. Otherwise it will not be considered.

4

11 RESEARCH EXPERIENCE :
Designation

Institution of
Affiliation

Area of Research

Period

The period spent for acquiring M.Phil and/or Ph.D Degree will not be considered as
research experience

RESEARCH
12 GUIDANCE :
Completed (Ph.D)

Ongoing
(Ph.D)

Completed (M.Phil)

Ongoing
(M.Phil)

13 PUBLICATIONS :

Published
Internationa
National
l

Research Papers :

Books :

14 PATENTS

Gra
nted
:
Filed
:

Accepted/ In Pres
Internationa
National
l

15

CONFERENCES/SEMINARS/WORKSHOPS/SYMPOSIA/TRA
INING PROGRAMMES ATTENDED : (ATTACH
PHOTOCOPIES OF THE CERTIFICATES)

Year

Conference/Seminars/Worshops
Symposia/Trainings attended

Title of paper presented/ Delivered

Lecture/
Chaired Sessions

16 RESEARCH PROJECTS :
Name of the
Research
Project

PI/Other(s)

Date of
Date of
Commencemen
t
Completion

Funding

Amount

Agency

Sanctioned

17 AWARDS /FELLOWSHIP/ MEMBERSHIP IN ACADEMIC

BODIES/ SOCIETIES
AND EDITORSHIP OF REPUTED JOURNALS :
Name of the Body/Society

Name of
Award/Fellowship/Nature of
Membership/Editorship

18 EXPERIENCE IN ADMINISTRATIVE POSITIONS :

19

Consolidated API score from category II/III of table I/II

in appendix III of UGC Regulations 2010 and its
amendments 2016 (details shall be furnished as per
Annexure -1)

20

ANY OTHER RELEVANT INFORMATION :

Please give details of any other credential, significant contributions, awards
received etc., not mentioned
Sl.
No.

Details (mention Year, Value etc., whereever

relevant)

DECLARATION
I hereby declare that all information given in this application are
true, complete and correct to the best of my knowledge and
belief. I understand that in the event of any information being
found false, incomplete or incorrect, my candidature is liable to
be cancelled/ my application is liable to be terminated. I hereby
agree to and abide by the rules and regulations of the University.
Place :
Date :

Signature of the Candidate

CERTIFICATE TO BE FURNISHED BY THE CANDIDATES WHO ARE

PRESENTLY WORKING :
Certified that Sri/Smt ______________________________________________ hold
a
permanent/temporary post of ______________________________________
(Designation)
in

the

Department/

University/ Organization

______________________________________
been

of

from _______________ having

appointed therein under the rules of recruitment. He/She is permitted to

apply for the said
post.

Place :
Date :

Signature of the appointing authority

department/with name and seal
8

LIST OF ENCLOSURES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Signature of the
Candidate