Lokmanya Tilak Jankalyan Shikashan Santha,Nagpur

Priyadarshini Group of Institutions

Application Form for the Post of Assistant Professor

Photo
To,
The Secretary, LTJSS
Plot no. 270, Lokmanaya Tilak Bhavan,
Near NMC Water Tank, Laxmi Nagar
Nagpur 440022.

I
General Details Application for the Post of Assistant Professor
Department
College
Demand draft no.
Drawn on Bank

II
Personal Particulars
Full Name
Marital Status
Nationality
Date of Birth
Address for Correspondence
Permanent Address
Contact Number
Email Address

III
Education Qualification(In chronological order starting from highest)
Degree Discipline Name of Year of % of marks Class/Div
College/University passing

IV
Professional Experience(Years).(In chronological order start from present employment)
Teaching Experience (Please mention the status whether Adhoc or Regular appointment)
Industrial Experience
Research Experience(Approved R & D laboratories/Research Assistant)
From To Organisation Job Profile Position & Status Approval no.

*Approval letters of the concerned authority be enclosed.

V
Research Publication
Publication details International Journal(In Number)
Journal paper (Google Scholar Indexed)
Journal paper (SCI Indexed)
Journal paper (Scopus Indexed)
Journal paper (Refereed/ Peer reviewed)
Journal paper:-
Sr. No Author(s), Title, Journal Name, Publisher, Volume no., Year, Page no., Impact Factor, No. of Citation
1
2
3

VI
Membership of Professional bodies
Sr. No. Name of Professional Body Membership no. (if any) Duration of Membership
1
2

VII
Awards/Recognitions

*Please attach properly indexed relevant documents point wise. All the certificates should be duly attested.

Declaration by the Candidates

I, hereby certify that all the information submitted is true and in case the information provided by me
is found to be false, the college reserves the right to cancel the candidature and take appropriate action.

Date:
Place: Signature of the candidate

List of the Document Attached

Sr. No Name of Document Page No.