APPLICATION FOR THE POS

ALL THE SECTIONS ARE MANDATORY

DATE OF APPLICATION
PERSON
Name
Date of Birth
Sex
Email ID
Contact number
Current address
Permanent address
Are you currently employed?
If not please explain why
Current Company
Current Role
Length of Service
Total Current Salary (INR)
Basic Current Salary (INR)
Benefits other than Salary
Expected Annual Salary (INR)
Notice Period
Available Start Date
If required, are you willing to relocate to Pune?
Reasons you are looking for a new job

How did you learn about Instem?

What abilities do you believe you can bring to Instem?

How do you think working for Instem will align with your career development?

Would you be willing to provide two references from your current/previous

employers?

E
Name and Location of University

Degree
Classification
Subjects Studied
Industry Training
INDUST

Nonclinical/ Clinical Research

Nonclinical/ Clinical Data Management

Regulatory Submissions e.g. FDA, EMA
Regulatory Requirements e.g. 21 CFR Part 11, Part 58 etc.
ICH Guidelines
CDISC Standards e.g. SDTM, ADaM, SEND, CDASH
Terminologies/ Vocabularies in Clinical/ Nonclinical
Testing
Process Documentation
Microsoft Tools
Any other tools/ applications used in Clinical/Nonclinical Research
EMPLOYMENT HISTORY (Ple
Company Name Location
Role/Title
Start Date/Leaving Date
Duration

Tasks Performed

Company Name Location

Role/Title
Start Date/Leaving Date
Duration
Tasks Performed
Reason for Leaving
 APPLICATION FOR THE POSITION OF INFORMATION SCIENTIST
ALL THE SECTIONS ARE MANDATORY. INCOMPLETE APPLICATIONS MAY BE REJECTED.

PERSONAL INFORMATION
Dr.Amol s Kshirsagsar

male
a_crv07@yahoo.com

flt no.201 A block,2nd flr.shreea plaza, nr. Pawasha ganapati mandir,NDA road ,warje malwadi pune
851, soham nr. Maharajamangal karyalaya,ring road,laxminagar,phalan dist-satara 415523
resigened on 5th dec 2016
resigened on 5th dec 2016
MEDICAL PRACTICE
CONSULTANT
na
4.5 lacs PA
NA
NOT ANY
5.5 lacs PA TAKE HOME
WITHIN 20 DAYS JOINING IS POSSIBALE
15 th MAR 2017
AT PRESENT BASED IN PUNE
career move.exploring new opporunities.

cosulting firm
I belive I can bring real passion and energy to this role. Ihave been working in highly regulated research environment with s
22 multinational research projects within span of 7 years of dedicated service.As good team player i can work in fast pacin
exp. in clinical data managment and regulatory requirment can make diffrence in achivieng project timelines and company

as dedicated team player I belive in respect, Empowerment, Creativity, Integrity, Passion, and Enjoyment
during my careear growth. I am glad o know company respects and belives in these core values.

yes

EDUCATION
institute of clinical research mumbai. &Shivaji university
B.A.M.S. P.G.D.C.R.
RESEARCH
NA
INDUSTRY EXPERIENCE
CLINICAL RESEARCH,INTERNAL MEDICINE 10 YEARS

CLINICAL DATA MANAGEMENT,PHARMACOVIGILANCE ,PROJECT MANAGEMENT

REGULATORY SUBMISSIONS O FDA, EC, AND OHER REGULATORY AUTHORITIES

YES
CERIFIED .WORKED ON 22 ICH GCP RGULAED PROJECTS
YES
Yes
CLINICAL TESTING
YES
YES,WELL VERSED
MEDIDATA RAVE ,INFORM,ORACLE CLINICAL,IXRS IVRS,WEB BESED EMR
EMPLOYMENT HISTORY (Please list beginning from most recent)
K.E.M.HOSPITAL RESEARCH CENTRE ,PUNE
RESEARCH OFFICER
5th MAY 2010 TO 5th DEC 2016
6 YRS 8 MONTHS
Perform specific protocol procedures like interviewing subjects, taking vital signs, and performing electrocardiograms
Interpret protocols advise treating physicians on appropriate dosage modifications or treatment calculations based on patie
Develop advertising other informational materials to be used in subject recruitment
Contact industry representatives to make sure equipment software specifications necessary for successful study completion
Confer with health care professionals to define the best recruitment practices for studies
Track enrollment status of subjects and document dropout information like dropout causes subject contact efforts
Review proposed study protocols to evaluate factors like sample collection processes, data management plans, and potenti
Record adverse event and side effect data confer with investigators regarding the reporting of events to oversight agencies

NUTRI INTERNATIONAL PUNE

RESEARCH FELLOW
JUL2007 O APR 2010
2YEARS 4MONTHS
LITRATURE SEARCHING, PRODUCT DEVLOPMENT
NEW JOB OPPORTUNITY