ANNA UNIVERSITY OF TECHNOLOGY TIRUNELVELI

TIRUNELVELI - 627 007 Recent Passport size

photograph (5 cm X
4.5 cm) to be affixed.

APPLICATION FOR THE POST OF ______________________

1. Advt. No. & Date Recruitment Advt.No: 001/E(1)/TEACHING/2011 Dt 07.02.2011

2. Name in Full (Capital Letters)

(as in SSLC Certificate)
Day Month Year
3. Date of Birth
(enclose copy of SSLC Certificate)

4. Age as on 01.01.2011

5. Name of Father / Husband

Citizen of India
6. Citizenship Status
(tick the appropriate box) by Birth by Domicile

7. Member of Scheduled Caste /

Write SC, ST, MBC & DNC, BC,
Scheduled Tribe / MBC & DNC/
OC
BC/ OC
(Attach Community Certificate for
all others except OC)

Please indicate Ex-Serviceman /

Physically Disabled
(Attach Certificate)

8. Address for Communications

(Also furnish email, fax, telephone

number, mobile if any)

Pin Code………………………..
9. Permanent Home Address

Pin Code………………………..
10. Details of Demand Draft
Demand Draft No. Date Issuing Bank Amount (Rs.)
11. Details of Educational Qualification (Starting from SSLC onwards and attach attested copies)
Qualification Discipline University Class/Division Year of Passing

12. Professional Experience in chronological order upto the present post

Organisation Designation From To Scale of Pay

Year Month
Total Experience

13. Details of NET/SLET Qualification (if

applicable)

Number of Publications
14. (Attach Separate Sheet giving the details National International
of : Authors, title, year, Name of the
journal, Volume Number, Page Numbers)

15. Professional Affiliation, Indian and Foreign (Membership of Societies, etc.)

Organisation Year of Election Grade of Membership Remarks

16. Visits Abroad (for Professional Work or Training only)

Period of Visit
Country Purpose
From To
 Time required to join if
17. Present Basic Pay Minimum Basic Pay expected
offered the post

18. Names of Referees (Preferably of your Professional background)

Name and Designation Current Address

(a)

(b)

(c)

19. Any other relevant information. (Attach Separate sheets)

(Academic achievements, Honours / Recognitions received, Books published, Research
Guidance, Prizes, Research Consultancy / Project etc)
20. I hereby declare that the information given above is correct to the best of my knowledge
and belief and I fully understand that if it is found at a later date that any information given
in the application is incorrect / false or if I do not satisfy the eligibility criteria, my
candidature / appointment is liable to be cancelled / terminated.

Place :
Date : Signature of the Applicant

21. Endorsement of the Present Employer :

The application of Shri / Ms./ Dr. ___________________________________________

(Name and Designation of the applicant) for the post of

____________________________________, at Anna University of Technology Tirunelveli is forwarded to

the Registrar, Anna University of Technology Tirunelveli, Tirunelveli

.

Date : Signature of the Head of the Institution

Seal: