APPLICATION FORM (Advt. No. 1/2012) University of Allahabad Post Applied for ......

Plan/Non Plan (Strike which is not applicable) Specialization Post .(only if in the same cadre)

1.

Name (in Block letters):

Past self attested Recent Coloured Photograph

2. 3. 4. 5. 6. 7. 8. 9.

Fathers Name/Mothers Name/Husband Name: Current Designation & Grade Pay: Department/Organization Date and Place of Birth: Sex: Marital status: Nationality: Indicate whether belongs to SC/ST/OBC category:

10. whether person with Disability : Yes/No : If yes PH/VH/MH percentage of disability : (Please enclose attested copy of certificate) 11. Address for Correspondence (with Pincode): Telephone No: Email address:

12. Permanent Address (with Pincode): Telephone No:

13. Academic Qualifications (Matric till post graduation): Examinations Name of the Board/ University Year of Passing Percentage marks obtained Division/ Class/ Grade Subject

High School/Matric Intermediate B.A./B.Sc./B.com/ B. Mus/ LL.B M.A./M.Sc./M.Com/ M. Mus LL.M Others examination, if any 14. Research Degree(s) Degrees M.Phil Ph.D/D.Phil D.Sc/D.Litt Title Date of award University

15.

Appointment held Name of Employer Date of Joining Joining Leaving Salary with Grade Reason of leaving if any

Designation

16. Period of teaching experience: P.G. Classes (in Years) U.G. Classes in (years) (Please enclose certificate) 17. Research Experience excluding years spent in M.Phil/Ph.D/D.Phil in (in Years) (Please enclose certificate)

18. Fields of Specialization under the subject/Discipline 1 2 3 4 5

19. Academic Staff College Orientation/Refresher Course attended: (Please enclose certificate) Name of the Place Duration Sponsoring Course/Summer School Agency

20. RESEARCH, PUBLICATIONS AND ACADEMIC CONTRIBUTIONS (A) Published Papers in Journals (Please enclose evidences) S.N. Title with page Journal ISSN/ISBN Whether No. of Conos. No. peer reviewed. authors / Impact factor, if any

Whether API you are Score the main author

B (i) Articles/Chapters published in Books (Please enclose evidences) S.N. Title with Book ISSN/ISBN Whether No. of Whether page nos. Title, No. peer Coyou are editor & reviewed. authors the main publisher author

API Score

(ii) Full papers in Conference Proceedings S.N. Title with page nos. Details of ISSN/ISBN No. of conference No CoPublications authors

Whether you are the main author

API Score

(iii) Books published as single author or as editor (Please enclose evidences) S.N. Title Type of Publisher & Whether No. of Whether API Score Book & ISSN/ISBN Peer Coyou are with Authorship No. Reviewed author the main page author nos.

( C). Ongoing and Completed Research Projects and Consultancies (C)(I & ii) Ongoing Projects/Consultancies (Please enclose evidences) S.N. Title Agency Period Grant/ API Score Amount Mobilized (Rs Lakhs)

C (iii & iv) Completed Projects/Consultancies (Please enclose evidences) S.N. Title Agency Period Grant/ Amount Whether Policy API Mobilized (Rs. Documents/Patent Score Lakhs) as outcome

(D) Research Guidance (Please enclose evidences) S.N. Number Thesis Submitted Enrolled M. Phil or Equivalent Ph.D or Equivalent

Degree Awarded

API Score

E(i)

Training Courses, Teaching-Learning-Evaluation Technology Programmes Faculty Development Programs (not less than one week duration) Duration Organised by API Score

S.No. Programme

E (ii) Papers presented in Conferences, Seminars, Workshops, Symposia S. Title of the Title of Organised by Whether API N. paper Conference/ International/ Score presented Seminar etc National/State/Regio nal/University or College Level

E(iii) Invited Lectures and Chairmanships at National or international Conference/ Seminars etc. (Please enclose evidences) S.N. Title of Title of Organised Whether API Lecture/ Conference/Seminar by International/ Score Academic etc National/State Session

IV. SUMMARY OF API SCORE Criteria Last Academic Year Total-API Score for Assessment Period Annual Av. API Score for Assessment Period

II

Teaching, Learning and Evaluation related activities Co-curricular, Extension, Professional Development etc Total I+II Research and Academic Contribution

III

Please give details of any other credential, significant contributions, awards received etc. not mentioned earlier. S.N. Details (Mention Year, Value etc. where relevant)

Statement of purpose : (500 words)

Future Research proposal to be under taken : (1000 words)

Name of Referees (at least 3) 1. From the present/previous employer, if employed. Or If conducting Research or pursuing studies letter of recommendation from Research Supervisor 2. Two recommendation letters from academician of reputed in the Area.

List of Enclosures: (Please attach, copies of certificates, sanction orders, papers etc. wherever necessary) 1 2 3 4 5 6 7 8 9 10

I certify that the information provided above is correct

Signature of the applicant Place & Date

Signature of HOD/School Chairperson/Principal Note : 1. The candidate who are presently employed will have to produce a certificate in original from the Head/Registrar of that Institution regarding their APIScores 2. The candidates who are working as P.D.F., R.A., etc. will have to produce a certificate in original from their Guide/Supervisor/PI which should be countersigned by the H.O.D. for their API-Scores 3. The individual PBAS proforma duly filled along with the enclosures, submitted will be duly verified by the University as necessary and placed before the Selection Committee. 4. In any of the fields if the space provided is not sufficient additional space may be added or separate annexure may be enclosed with reference at the prescribed field position.

Appl. No.

University of Allahabad
(Please fill this Proforma neatly handwritten or typed) Note : - No enclosure with this proforma is permissible

.
(to be filled in by Office)

Post applied for . Deptt. . Specialisation . . . Name . Date of Birth Mailing Address (with Tel. No./e-mail/ Fax No.) Present Scale Present basic Pay Rs. p.m. Present gross emoluments Rs. ..p.m. pin Present Employer (Institution) .. SC/ST/OBC/PH (VH or OH) . Total Teaching Experience .. year(s)months Total Research Experience .. year(s)months Total Administrative Experience .. year(s)months Present Post .. NET cleared/appeared.year. Academic qualifications Exam. Year Division % of Marks University Publications & Research Work (give number) Published Under Publication/ Unpublished Books Research Papers Articles

Title of Ph.D. thesis Experience Post held/ From Pay Ph.D./ M. Phil. Under Research in Submission Progress

Institution

To

Awarded

AREAS OF SPECIALISATION

Recommendation of the forwarding authority

Signature of Applicant...

Signature of forwarding authority with seal.

Date

10