Institute for Post Graduate Teaching & Research in Ayurveda,

GUJARAT AYURVED UNIVERSITY, Jamnagar

APPLICATION FORM Paste your
recent
yhSkkf Passport size
Photograph
Advt. No._____________ here
Date : ___________ Name of Department:____________________
and sign
(nuhkk Lktkh) (kkhe) (rkkLkwt Lkk{ ) across

Application for the post of :_______________________________________________________

(su sk {kxu yhS fhkLke nku ku skLkwt Lkk{) :
To,
The Registrar, Gujarat Ayurved University
C/o. Office of the Director,
Institute for Post Graduate Teaching & Research in Ayurveda,
Gujarat Ayurved University, Jamnagar - 361 008

1. Full Name (Surname First) In Block letters_________________________________________

(kqhwt Lkk{, yxfke Yykk fhe)
_____________________________________________________________________________
1.1 Fathers / Husbands Name - For married women only) _____________________________
(rkkkLkwt / krkLkwt Lkk{ - Vk kherk eyku {kxu)
_____________________________________________________________________________
2. Present Address
(nkLkwt MkhLkk{wt, xurVkuLk Lktkh, E-{uR Mkkku) ___________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Tele. No :___________________ Mobile:__________________ E-mail:___________________
Permanent Address
(fk{e MkhLkk{wt, xurVkuLk Lktkh, E-{uR Mkkku)____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Tele. No :___________________ Mobile:__________________ E-mail:___________________
3. Date of Birth __________________Place of Birth ___________________Sex : Male /Female
(sL{kkhe) (sL{Mk) (rk) kwk/ Mke
Age_________ Years __________ Months Marital Status : Married/Unmarried
({h) (ko) ({kMk) ikrnf Mkrk : (kherk/ykherk)
Religion ___________________Nationality _________________ Domicile ________________
({o) (hkxekk) (hnuXk)

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4. Whether you belong to any reserved category mentioned below. If so, endorse certificate from
competent authority.
(k{u rLkBLkrrk yLkk{k koLkk Aku? u nk, kku ku MkkkrfkheLkwt {kkk hsq fhwt.)
SC ST OBC/SEBC NT NT
(y..) (y.s..) (yku.e.e.q yuMk.E.ke.Mke.) (yu.xe)
5. Are you physically handicapped.? If yes, endorse certificate from competent authority. Yes / No
(k{u kherhf kuzktk hkku Aku?u nk, ku MkkkrfkheLkwt {kkk hsq fhwt.) nk / k
6. Mother tongue ___________________
({kk]kkk)
7. Sr. No. Other Languages known Speak Read Write
{ keS kkkLke fkhe kkukk kt[kk kk

8. Educational Qualifications (Attach separate sheet for more details, if required)

(ikrf kfkk. sYh sku khkLke {krnke yk kkLkk{kt hsq fhe)
Sr. Exam. passed Board/Uni./ Stream Principal Year Percentage Remarks
No. kkMk fhu khekk Institution kn subjects ko xfkkhe LkkU
{ kkuzo/wrLk./MktMkk {w rkku

8.1. Typing and Computer knowledge ? Yes / No (If yes, attach certificate)
(xkRkk yLku fBqxh kkLkLke rkk) nk/Lkk (u nk, kku {kkk hsq fhku)
1. Typing (WPM): Gujarati _________Hindi _________English _________
xkRkk (.r{.zk) : kwshkke rnLe ytkuS
+
2. Computer : CCC____________CCC __________ PGDCA ________
fBqxh : Mke.Mke.Mke. Mke.Mke.Mke.+ ke.S.ze.Mke.yu.
9. If you have published articles or research papers or books, give details.
(uku ykk MktkuLk kkku ykk kwMkfku rMk fko nku kku kuLke rkk)
___________________________________________________________________________
10. Expected salary including allowances :
(yukWLMk Mkn yufthu fuxku kkkh {kLke khk hkku Aku.)
___________________________________________________________________________
11. When can you join if offered an appointment?
(u Lke{k{kt yku kku khke uzkE fku?) 2
___________________________________________________________________________

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12. Please state previous experince or training in the follwing columns. (Attach separate sheet for
more details, if required)
(yLkw ykh kke{ ee nku kku kuLke rkk Lke[uLkk Lk{qLkk{kt ykkku. sYh sku khkLke {krnke
yk kkLkk{kt hsq fhe)
Sr. Name & Address Designation From Left on Pay Reason for Remarks
No. of the employer nkuku rLk{qf Akuzk Scale leaving Part / Full
{ LkkufhekkkLkwt kkhe kkhe kkkh kuh AkuzkLkwt fkh time
Lkk{ yLku MkhLkk{wt LkkU
kkxo/Vw xkR{
1
2
3
4
5
13. Are you having service agreement/bond with your present employer? Yes / No
If yes, please mention period etc., and give details separately.
(k{khe nkLke Lkkufhe{kt k{u fkuE fhkh fkuo Au? u nk nku kku kuLke {wk kuhu ykke ykkku.) nk / k
____________________________________________________________________________
14. Have you applied or been interviewed for any post in this University in the past? Yes / No
If yes, please mention post, and date of interview.
(yk knuk yk wrLkMkxe{kt k{u fkuR skk {kxu yhS fhue ykk YkY {wkfkk {kxu kkukk{kt
ykuk?u nk, nku kku fE skk {kxu yLku fE kkheu kuLke rkkku ykkku.) nk / k
___________________________________________________________________________
15. Please mention name of two reference who are not your relative and who can certify your
work and conduct.
(ku rkrck kykuLkk Lkk{ku ykkku fu suyku k{khk Mkkk Lk nku yLku k{khk fk{ yLku [krhkT ru
yrk ykke fu.)
1. 2.

(Ph.): (M) (Ph.): (M)

16. Details of membership of any professional/academic body.

(Mkke ykh ikrf MktMkkLkk Mk nku kku kuLke rkk)
___________________________________________________________________________
17. Any other relevant Information (Attach separate sheet for more details, if required)
(keS fkuE {krnke nku kku. sYh sku khkLke {krnke yk kkLkk{kt hsq fhe)
18. Particulars of Fees :___________ Name of Bank :_______________ Place :______________
(VeLke rkk) (kUfLkwt Lkk{) (Mk)
Demand Draft No.: ______________ Date: ____________________Rs.: ________________
(rz{kLz zk^x Lkt.) (kkhe) (Yrkk)

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19. List of Self attested copies of certificates/documents attached:
(M {krk MkxrVfux/MkkusLke LkfkuLkk rkzkLke rkk)
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
20. I ___________________________________________solemnly declare that the particulars
Furnished in this application are true and correct. I clearly understand that any misstatement
of fact contained herein or willful concealment of any material fact will render me liable to
Appropriate action as may be decided by University.
(nwt .............................................................................rkkkkqof nuh
ft Awt fu yk yhS{kt
k{kt yku k{k{ nfefk Mkk[e yLku he Au. nwt Mkkhe heku Mk{swt Awt fu kuxe nfefk ykh kku
ekqeLku k{kt yku kuxe nfefk {kxu wrLkMkxe Lke fhu ku kkkt {khe Mkk{u uu.)
Place: ______________Date: ______________ Signature of the Candidate: _______________
(Mk) (kkhe) (W{ukhLke Mkne)
21. No Objection Certificate:
This is to certify that Mr./Mrs........................................................................................is serving
in this institute / Organization from.....................................as.....................................................
......................................................................................................................................................
This is to further certify that there is no departmental inquiry/proceeding or vigilance inquiry or
contempt of court against the employee is pending.
Date :
Place : Signature of Employer with Seal

Lkk ktk {kkk :

ykke {kkk ykkk{kt yku Au fu e / e {ke / fw{khe ...........................................
.............................................y{khe MktMkk{kt.......................................
....................................................Lkk nkuk kh kkhe..................ke Vhu
ku Au. w{kt yk k {krk fhk{kt yku Au fu yk f{o[kheLke r{kt fkuE kkkfe kkkMk/kkueMk
kkkMk/fkuxoLkku rkhMfkh nk kqhkku Lkke.
kkhe :
Mk : kkkLkk zkLke Mkne yLku rMkku

Signature of the Candidate

(W{ukhLke Mkne)

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N.B. 1. Application with incomplete information will not be accepted.
kk.f. 1. yqhe nfefkke yhS Mefkhk{kt yku Lkn.
2. The application should be in the candidates own handwriting.
2. W{ukhu kkukkLkk nMkkkh{kt s yhS he
3. A candidate who is employed elsewhere should forward the application through his/her employer or should
attach a certificate (No Objection Certificate) from the employer that he/she has been permitted to apply for the
post in question, otherwise the application will not be considered.
3. u fkuE W{ukh keS fkuE MktMkk{kt Lkkufhe fhkku nu kku ku{u ku{Lke yhS kkukkLkk kkkrfkhe {khVk {kufe
ykk ku{u Mkh skk {kxu yhS fhk {kxu khkLkke ykk kLkwt {kkk (Lkk ktk {kkk)hsq fhwt, Lkn
kku yhS kkk hkk{kt yku Lkn.

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 ***
(FOR OFFICE USE ONLY)
WHETHER ELIGIBLE BY :
(1) Name of the Applicant :

(2) Post applied for :

(3) Submitted through proper channel? /NOC : Yes [_____] No [______]

(4) Caste certificate produced? : Yes [_____] No [______]

(5) All other requisite certificates produced? : Yes [_____] No [______]

(6) Application fee paid? : Yes [_____] No [______]

(7) Age : Proper [____] Over [____] Under [____]

(8) Essential educational qualifications : Yes [_____] No [______]

(9) Possession of requisite experience : Yes [_____] No [______]

(To be indicated clearly whether eligible or not) : _______________________________

Overall eligibility : _______________________________

Application Status : Accepted [______] Rejected [______]

If rejected, please specify the grounds (age, education, experience and computer qualification)
on which candidature is rejected :
1. Age :
2. Educational Qualification :
3. Experience :
4. Computer Qualification :
5. Others (Specify) :
6. SIGNATURE OF SCRUTINY COMMITTEE :
1._________________________________ 2. _______________________________
3._________________________________ 4. _______________________________
5._________________________________ 6. _______________________________

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 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

API PROFORMA FOR PROFESSOR/ DIRECTOR BASED ON PERFORMANCE BASED APPRAISAL

SYSTEM TO BE SUBMITTED BY EACH APPLICANT FOR APPOINTMENT ON THE POST OF
TEACHERS AND OTHER ACADEMIC STAFF AS PER UGC REGULATIONS, 2010

Minimum API Score Required for Direct Recruitment in Minimum Essential Qualification and Consolidated API
Professor/ Director. Score of 400 Points from Category III API

Advertisement No. and Date:

Name of the Applicant:

Date of Birth:

Post applied for and Subject:

Page1of6Name&SignatureofCandidate

 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

SNo. APIs Ayurveda/MedicalSciences Max.pointsforUniversityTeachers

APIScore Selfappraisal VerifiedAPI
allotted score Score
IIIA ResearchPaperspublishedin: RefereedJournals 15/publication NX15
Nonrefereedbutrecognizedandreputablejournalsand 10/Publication N1X10=
periodicals,havingISBN/ISSNnumbers.

Conferenceproceedingsasfullpapers,etc.(Abstractsnotto 10/publication N2X10=
beincluded)
TotalofIIIA
III(B) ResearchPublications(books, TextorReferenceBooksPublishedbyInternational 50/soleauthor; M1X50=
chaptersinbooks,otherthan Publisherswithanestablishedpeerreviewsystem 10/chapterin
refereedjournalarticles) a) Noofsoleauthorbook(s)=M1 aneditedbook M2X10=
b) Noofchapter(s)inaneditedbook(s)=M2

SubjectBooksbyOtherlocalpublisherswithISBN/ISSN 15/soleauthor M5X15=

numbers. and3/chapter
c) Noofsoleauthorbook(s)=M5 inEditedbooks M6X3=
Noofchapter(s)inaneditedbook(s)=M6
Chapterscontributedtoeditedknowledgebasedvolumes 10/Chapter M7X10=
publishedbyInternationalPublishers
Noofchapter(s)=M7

ChaptersinknowledgebasedvolumesbyIndian/National 5/Chapter M8X5

levelpublisherswithISBN/ISSN
numbersandwithnumbersofnationalandinternational
directories
Noofchapter(s)=M8

TotalofIIIB

Note:incasethreeauthorsforoneresearchpublication,theprincipleauthorget4pointswhileotherauthorseligiblefor2points

Page2of6Name&SignatureofCandidate

 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

III(C) RESEARCHPROJECTS
III(C) SponsoredProjectscarried (a) MajorProjectsamountmobilizedwith 20/eachProject P1X20=
(i) out/ongoing grantsabove30.0lakhsNoofProject(s)=
P1
(b) MajorProjectsamountmobilizedwith 15/eachProject P2X15=
grantsabove5.0lakhsupto30.00lakhs
NoofProject(s)=P2
(c) MinorProjects(Amountmobilizedwith 10/eachProject P3X10=
grantsuptoRs.5lakh)
NoofProject(s)=P3
III(C) ConsultancyProjectscarried AmountmobilizedwithminimumofRs.10.00 10perevery RX10=
(ii) out/ongoing lakhs
Noof10Lakh(s)=R
CompletedprojectReport(Acceptancefrom 20/eachmajorproject Q1X20=
fundingagency) and10/eachminor
III(C) Completedprojects:Quality a) No.ofcompleted&acceptedMajor project Q2X10=
(iii) Evaluation project(s)=Q1
b) No.ofcompleted&acceptedMajor
project(s)=Q2
30/eachnationallevel O1X30=
outputorpatent/50
Patent/Technologytransfer/Product/Process /eachforInternational
III(C)
ProjectsOutcome/Outputs a) No.ofnationalleveloutput=O1 level,(outputorpatient)
(iv)
b) No.ofinternationalleveloutput=O2

O2X50=
TotalofIIIC

Page3of6Name&SignatureofCandidate

 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

III(D) RESEARCHGUIDANCE

III(D) Degreeawardedonly 3/each D1X3=

M.Phil./M.D.(Ayu)/MS(Ayu)
(i) No.ofcandidates=D1 candidate
Degreeawardedonly 2/each D2X2=
M.Pharma(Ayu)/MSCMedicinalPlant
No.ofcandidates=D2 candidate
M.Phil./M.D.(Ayu)/MS(Ayu)forco Degreeawardedonly 2/each D3X2=
guidance No.ofcandidates=D3 candidate
Degreeawardedonly 2/each D4X2=
PGDiploma
No.ofcandidates=D4 candidate
Degreeawarded 10/each D5X10=
Thesissubmitted candidate
Ph.D.Guide 7/each D6X7=
a) No.ofcandidates=D5
III(D) b) No.ofcandidates=D6 candidate
(ii) Degreeawarded 5/each D7X5=
Thesissubmitted candidate
Ph.D.Coguide
a) No.ofcandidates=D7 3/each D8X3=
b) No.ofcandidates=D8 candidate
TotalofIIID

Page4of6Name&SignatureofCandidate

 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

III(E) TRAINING COURSES AND CONFERENCE / SEMINAR / WORKSHOP PAPERS

Refreshercourses,Methodology (a) Notlessthantwoweeksduration 20/each T1X20=

workshops,Training,Teaching No.ofprograms=T1
III(E) LearningEvaluationTechnology T2X10=
(i) Programmes,SoftSkillsdevelopment
Programmes,FacultyDevelopment (b) Oneweekduration 10/each
Programmes(Max:30points) No.ofprograms=T2
ParticipationandPresentationofresearch
papers(oral/poster)in

III(E) a)Internationalconference 10each C1X10=

(ii) PapersinConferences/Seminars/ b)National 7.5/each C2X7.5=
workshopsetc.
c)Regional/Statelevel 5/each C3X5=

d)LocalUniversity/Collegelevel 3/each C4X3=

III(E) Invitedlecturesorpresentationsfor (a)International 10/each L1X10=

(iv) conferences/symposia/RoTP/CME/
TOT
(b)Nationallevel 5/each L2X5=
Statelevel/local 3/each L3X3=
III(E) 3DaysSpecialtrainingprograms (a)Nationallevel 5/each L4X5=
(v) conductedbystateGovernment/ (b)Statelevelorlocal 3/each L5X3=
centralGovernmentagencies/
institutions/councils
TotalIIIE

Page5of6Name&SignatureofCandidate

 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar
PartBoftheapplicationform

Note:fortheeachcategoryunderIII(E)(i,ii,iii,iv)maximum2presentationand/orparticipationofpapersin
trainingcourse,conference,seminarandworkshopwillbeconsidered.

Page6of6Name&SignatureofCandidate