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National Institute of Technology Puducherry: Nehru Nagar, Karaikal-609 605

This document is an application form for a faculty position at the National Institute of Technology Puducherry. The form requests information such as the applicant's name, date of birth, nationality, gender, marital status, contact information, educational qualifications, prizes/awards, current and previous positions held, professional experience, teaching/research experience, thesis supervised, publications, and a declaration by the applicant that the information provided is accurate. The form requests detailed information to evaluate applicants for faculty roles at the institution.

Uploaded by

Ragul Kumar
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55 views3 pages

National Institute of Technology Puducherry: Nehru Nagar, Karaikal-609 605

This document is an application form for a faculty position at the National Institute of Technology Puducherry. The form requests information such as the applicant's name, date of birth, nationality, gender, marital status, contact information, educational qualifications, prizes/awards, current and previous positions held, professional experience, teaching/research experience, thesis supervised, publications, and a declaration by the applicant that the information provided is accurate. The form requests detailed information to evaluate applicants for faculty roles at the institution.

Uploaded by

Ragul Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form - I

NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY


(An institute of National Importance under MHRD, Govt. of India)
Nehru Nagar, Karaikal-609 605

Please read the information carefully on website prior to filling up this application form
You may use separate sheet/s wherever required.

Advertisement No. & Date:

Post Applied for :.

Department :.

Specialization :.

-------------------------------------------------------------------------------------------------------------------------------

1. (i) Full Name (in block letters) : ........

(ii) Fathers/Husbands Name :.....
(iii) Whether belonging to OC/ SC/ST/OBC/PH: .
(Attach Certificate)

2. Date of Birth:.. Age (as on date) ....

3. (a) Nationality : (b) Gender: Male / Female..

(c) State/UT to which you belong:

(d)Marital Status: Married / Unmarried / Divorced

4. Postal Address for correspondence.

..

..Pin Code: ....

Phone No.: Office:.. Res.:...Mob. No.:.......
(with STD Code)

E-mail ID:..............................

5. (a) Educational Qualifications (from matriculation onwards):
Sl.
No.
Examination
Passed
Name of the
University/
Board
Year of
Passing
Subject/
Specialization
% of Marks/
Grade
(CGPA)
Division / Class

Please affix recent
passport size
photograph


(c) Have you cleared NET / SET?
(For Non-Engg.Disciplines) .........................

6. Prizes, Awards, Distinction received etc. (if any):
......

......

7.(a) Post held at present:

Post held Date of Appointment Nature of the Post
(Temporary/Probation/
Permanent)
Name & Address of
Employer *


* Copy of appointment order to be attached

(b) Present Pay Scale: AGP: Any other Pay:..

Basic Pay:. Dearness Allowance: Gross Emolument:..

(c) Type of organization (Government/Semi-Government/Govt. Aided/Autonomous Body/ Private etc.)

.......

8. Professional Experience (In the reverse chronological order):
Sl.
No.
Name of the Employer Post held Period of Employment Pay Scale and
Basic Pay
drawn
Total
Emolument
Reasons
for
Leaving
From To








9. (a) Total Experience:

(i) Teaching U.G.:.Year(s) ..Month(s)
P.G.:.Year(s) ..Month(s)

(ii) Research :.Year(s) ..Month(s)

(iii) Industrial :.Year(s) ..Month(s)


10. (a) Thesis supervised: Ph. D.

Sl.
No.
Title of the Thesis Supervised Completed (year)

In progress
(With Status)
Principal or
Co- Supervisor


(b) Thesis supervised: M.Tech. / M.S. / M. Phil.

Sl.
No.
Title of the Thesis Supervised Completed (year)

In progress
(With Status)
Principal or
Co- Supervisor


(c) List of Publications (International Journals):

Sl.
No.
Name of the
Journal with ISSN
Impact
Factor
Volume
No.
Month/ Year/Page
Nos.
Authors Title of the paper





(d) List of Publications (National Journals):

Sl.
No.
Name of the
Journal with ISSN
Impact
Factor
Volume
No.
Month/ Year/Page
Nos.
Authors Title of the paper






11. Any other relevant information :.


DECLARATION


I declare that the statements made in this application are true to the best of my knowledge and belief.

I understand that misleading or wrong information supplied may lead to summarily rejection of
application /appointment (if found subsequently).

Date: ------------------------------------

Place: (Signature of Applicant)

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