NATIONAL INSTITUTE OF TECHNOLOGY

WARANGAL 506 004 (T.S.) INDIA

Advt. No. Admn. 01/2015

Application Form for Faculty Position

Application Fee: (DD should be drawn in favour of the Director, NIT, Warangal
payable at Warangal on SBH, NIT Branch (IFSC Code: SBHY0020149) Recent passport size
color photograph to
or any other Nationalised Bank payable at Warangal. be affixed

DD No. Date Amount Name of issuing Bank

APPLICATION FOR THE POST OF _______________________ in ________________

(Department)
SPECIALIZATION _________________________________________________________

1. Name in Full: _____________________________________________

Gender:_______
(In Block Letters)

2. a) Fathers Name: _________________________________ Occupation: ______________

b) Mothers Name: ________________________________ Occupation: ______________

3. Nationality: _____________________ Place of Birth : ____________________

Date of Birth: _____________ Age: __________ Marital Status: __________________

4. Category: SC ST OBC UR PWD

In case of OBC, whether belong to creamy layer Yes / No
(If No, enclose OBC Certificate issued after 01.04.2015 based on income of 2014-15.)

5. Particulars of Educational Qualifications:

Sl. Degree Obtained & Name of the Year of % of Class/
No. Branch / Specialization University/Institute Passing Marks/ Division
(specify) CGPA
1 Bachelors Degree
2 Masters Degree
3 Ph.D. Degree
4 Others (if any)
N.B.: Every application must be accompanied by photo copies of documents in support of claims made by the candidate in respect of
date of birth, academic qualifications, practical training, experience, caste, projects, publications, consultancy etc.
6. Title of Ph.D. Thesis with name and address of Ph.D. Guide. (Enclose Abstract of Thesis)

Degree Title of Thesis Guide University Year of Award

Ph.D.

7. Details of Experience:

i) Teaching Experience : years Post Ph.D. Experience: years

Sl. Name of the Designation Date of Date of Last Pay Service
No. organization where Joining leaving Band and Regular/Contrac
employed Grade Pay t
1.
2.
3.
4.

ii) Research Experience: years

Sl. Name of the Designation Date of Date of Last Pay Service
No. organization where Joining leaving Band and Regular/Contrac
employed Grade Pay t
1.
2.
3.
4.

iii) Industrial Experience: years

Sl. Name of Industry Designation Date of Date of Salary Service
No. Joining leaving Drawn Regular/Contrac
t
1.
2.
3.

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 8. i) Total Research Publications / Presentations
Sl. Nature Published Accepted
No.
1. Books
2. Chapters
National
3. Refereed
Journals# International

4. Presentations# National

(Proceedings) International

# Attach a separate sheet with list of all publications / presentations as per Annexure - I.

8. ii) Research Projects:

Sl. Title of the Project Amount Funding Period Remarks
No. in Rs. Agency (Completed/ Ongoing)
1.
2.
3.
4.

8. iii) No. of PG dissertations / Ph.D. thesis guided: P.G. Ph.D.

(Attach the titles of the Ph.Ds guided)

9. Patents
Sl. No. Name of the patent Year Organisation
1.
2.
3.
4.

10. Consultancy
Sl. No. Name of Organisation Year Amount (Rs.)
1.
2.
3.
4.

11. Administrative Responsibilities held

Sl. No. Responsibility held duration

1.
2.
3.
4.

12. (a) Minimum Pay expected: Basic and AGP: ...

(Should not be treated as agreed even if called for Interview and selected)

(b) Time required to join the Institute, if selected: _________________________

13. Honours / Awards / Distinctions, if any:

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14. Name and addresses of three professional referees (who are not related to the applicant)
who are in a position to testify from their personal knowledge as to the fitness of the
applicant for the post applied for:

i) Name : __________________________________________________
Status : __________________________________________________
Address : __________________________________________________
__________________________________________________
e-mail and Phone : ______________________________Mobile______________
ii) Name : __________________________________________________
Status : __________________________________________________
Address : __________________________________________________
__________________________________________________
e-mail and Phone : _____________________________Mobile_______________

iii) Name : __________________________________________________

Status : __________________________________________________
Address : __________________________________________________
__________________________________________________
e-mail and Phone : _____________________________Mobile_______________

Candidates shall enclose at least three reference letters (Sealed and Stamped).

15. i) Address for correspondence: _____________________________________________

_____________________________________________
_________________Phone No.____________________
Mobile No.___________________
E-mail address: ________________________________

ii) Permanent Address : _________________________________________________

_________________________________________________
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 _________________________________________________

16. Any other information relevant to the Post applied for, such as:
i) Memberships/Fellowship and position of responsibility in Professional Societies:
a)
b)
c)
d)

ii) Attainments in sports and extra-curricular activities (including N.C.C.)

a)
b)
c)
d)
iii) Language fluency:
Language Read Write Speak

17. Copies of documents enclosed:

i)
ii)
iii)
iv)
v)
vi)
vii)

Declaration:

I hereby solemnly declare that the information furnished above is true and correct and I
am responsible for the veracity of the same.

Place:

Date: Signature of the Applicant

N.B. Every application must be accompanied by photo copies of documents in support of claims made by the
candidate in respect of date of birth, academic qualifications, practical training, experience, caste,
projects, publications, consultancy etc.

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 (To be filled in by the present employer)

FORWARDED / NOT FORWARDED

Place: Signature of the Forwarding Authority:

Date: Designation:

Office Seal:

(TO BE USED BY THE INSTITUTE OFFICE ONLY)

Date of Receipt:

Registration No. 01/2015/___________ Signature of the Receiving Officer

ANNEXURE I

Attach a separate sheet indicating the list of publications as per the format given
below:

Journal publications:
Sl.No Title and the Authors of Name of the National/ Year / Vol./ SCI
. the paper Journal International Page No. Yes/No

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List of Journal Publications outside Ph.D. Thesis:
Sl.No Title and the Authors of Name of the National/ Year / Vol./ SCI
. the paper Journal International Page No. Yes/No

Conference Publications:
Sl.No. Title and the Authors of the Name of the National/ Year and Place
paper Conference International

The above information submitted by me is true and I am responsible for the veracity
of the same.

Signature of the Applicant