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Note: Prospective candidates are advised to study the Instructions carefully and then fill up the application precisely
and to the point in all respects. No column should be left blank. Incomplete application will be rejected
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ttach additional sheets, if required. No Certificates/ Testimonials should be attached along with application
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Advertisement No:
AB/Estt/2017/431
APPLICATION FORM
Date:
( for Faculty Positions) 16/06/2017
Last Date of
07/07/2017
submission
Post Applied For Academic
Grade Pay
Department
FEE REMITTANCE
Affix recent passport size
Issuing Bank & photograph
its Branch duly signed by candidate
DD No & date
Amount
If exempted,
reason thereof
1 Personal Information
Name of Applicant
( in full capitals)
Fathers name
Mothers Name
Spouse Name
Identification No
Aadhar
Passport/ Aadhar / Voter ID
/ Driving License (specify
any two)
4 PhD Qualification
Date of Whether Full Discipline/ University/ Date of Date of
Registration time or Part Department Institution thesis Award
time submission
Title of Thesis
Paper published in 1
the area of research
during the course of
PhD with impact 2
factor
Area of Research
Paper published in 1
the area of research
during the course of
PDF with impact 2
factor
6 Whether qualified UGC- NET/ SLET ( All India Level)
UGC-SLET UGC- NET
Subject Subject
Others
National
State
NCC
Others if any
b.
c.
Total
9 School Education Teaching Experience ( starting with the most recent)
Note: Experience of Visiting/ Guest Faculty paid on hourly/ session basis not to be included.
Institution Post Duration Experience PB & Gross Temp/
From To Y M G-Pay Salary Regular/
Permanent
a.
b.
c.
Total
3 4
5 6
7 8
9 10
11 12
b.
c.
Total
12 Administrative Experience
Organization Post Nature of Duration Experience Whether overlapping
Responsibility From To Y M with teaching/
Research experience
Yes/ No
a.
b.
c.
d.
Total
a.
b.
c.
d.
b. M. Phil/ M Tech.
15 Books Publication
*(Author Position- Single or Jointly)
Title of Books Author Publication ISBN
Position* (if any)
a.
b.
c.
d.
e.
16 Research Publications (other than during the course of Ph. D and PDF) (Paid Journals are not allowed)
*(Author Position- Single or Jointly)
Title of Paper Author Name of Year ISSN Impact
Position* Journal / (if any) Factor
Conference
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
17 Refresher/Orientation Courses/Training programme, FDP, MDP etc., attended
(Programme less than a week not to be included)
Conducting Organization Title of programme Duration of programme
From To
a.
b.
c.
d.
b.
c.
d.
b.
c.
d.
20 Character & Antecedents Report
Subject Comments
a. Have you ever been subject to any disciplinary
action, as a student and/or as an employee, If so
give full details.
Phone No Phone No
Mobile No Mobile No
E-mail E-mail
22 In other relevant information in support of candidature
Pay-in-PB
AGP
Basic
Name
Designation
25 Expected Salary/ Pay Protection sought with due Justification for consideration by Selection
Committee.
Expectation Justification
Pay-in-PB
AGP
Basic
DECLARATION
I hereby declare that I have read carefully and understood the instructions and particulars
supplied to me, and that all entries in this form, as well as, in attached sheets are true to the best of my
knowledge and belief. At any stage if any of the information furnished by me is found to be false or
incorrect, suitable action may be taken against me. If selected, I promise to abide by the rules and
regulations of the Institute.
Date:
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