MZ ZH Njhopy El GG Gy Fiyf Fofk Jpur Rpuhg Gs SP: Anna University of Technology, Tiruchirappalli

mz;zh njhopy;El;gg; gy;fiyf;fofk;> jpUr;rpuhg;gs;sp
ANNA UNIVERSITY OF TECHNOLOGY, TIRUCHIRAPPALLI

TIRUCHIRAPPALLI - 620 024
Affix your
passport size
APPLICATION FOR THE POST OF _____________________________________ photograph
and get it duly
IN THE DEPARTMENT OF_______________________________________________ attested
(Advt. No. AUT-T/ 02-2010, Dated: 18.12.2010)
Details of the Demand Draft For Office Use only
(to be filled by the candidate)
Name of the Bank : Application. No. :
Branch :
DD Number : Date of receipt of application :
Value and Date :
1. Name of the applicant in full
with initials at the end :
(Capital Letters)
1.1 Name of Husband / Father :
2. Present employment details :

2.1 Present post held and
scale of pay :
3. Address
3.1 Address for communication :
Pincode :
3.2 Telephone No. / Mobile No.

(with STD Code) :
3.3 Fax No. (with STD Code) :
3.4 E-mail I.D. :
3.5 Permanent Address :
Pincode :
3.6 Telephone No. / Mobile No. :

(with STD Code)
Day Month Year
4. Date of Birth :
4.1 Age as on 30.11.2010 :
4.2 Place of Birth, District and State :
5. Community (Please tick) :

ST SC MBC/DC BC OC
6. Nationality (please tick) :
Indian Foreigner
7. Academic Qualifications
7.1 General Educational Qualification :

(Start from the most recent degree and list up to SSLC)
Year Average
Institution where University / Branch / Marks /
Degree of
studied Board Specialization CGPA &
Passing Class
7.2 Details of NET / SLET Qualification :

(For Degree holders in Science)
7.2.1 Whether qualified NET / SLET :
7.2.2 Year of passing

8. Teaching experience (Evidence to be enclosed)
Present Period of service Duration

Name & address of
employment Scale of
the Institution / Post held
(service upto Pay
Organisation From To Y M D
30.11.2010)
Total
9. Publications (List only those that are already published or accepted for publications in
professional journals, text and reference books)
National International
9.1 No. of publications published in
National and International Journals :
9.2 Details of publications as per the given order (to be given in a separate sheet)
Authors, Title, Year, Name of the Journal, Vol. No., Page Numbers
9.3 No. of books published :
9.4 Details of books published as per the given order (to be given in a separate sheet)
Authors, Title, Year, Name of the Publisher
10. Details of supervision / Research Guidance

M.E. / M.Tech. / Ph.D.
M.Sc./M.Phil.
10.1 No. of students supervised / Researchers :
guided
11. Membership in Professional Societies
11.1 Total number of Membership in

Professional Societies :
11.2 Details of Membership in Professional

Society and Country of incorporation :
(Use separate sheet, if necessary)
12. Prizes, Medals and other Honours received,

if any (Use separate sheet, if necessary) :
13. Travel or study abroad
Period of visit
Country visited Purpose of visit
From To
14. Languages known :
Language Speak Read and write Speak, read & write
15. Are you in award of any research scheme,

that is sponsored or supported by Local
(TNSCST, etc.) or National (UGC, CSIR, ICAR,
DST, etc.) or International (UN, UNESCO, WHO,
FAO, etc.) Agency ? If yes, give details:
Grant number, Status of the project and any
other particulars (Use separate sheet as necessary) :
16. Name and address of two persons (not

related by blood or marriage) from whom
confidential reference could be had :
1. 2.
17. Name & address of two persons from
whom you have enclosed your testimonials :
1. 2.
18. Any other information you would like to

present for consideration in support
of your candidature
(Use separate sheet, if necessary) :
19. List of enclosures (please ensure that the enclosures are attested and are attached with
all the three copies of the application)
i. copy of Proof of Date of Birth :
ii. copies of the academic qualifications :
iii. copy of community certificate :
iv. pay certificate :
v. service certificate :
vi. if any other, specify :
20. Whether possible to join the post

immediately on receipt of the appointment
order. If not, the time required to join the
post be specified :
21. Have you been placed on probation, censured,

suspended or dismissed by any School, College
or University authority and/ or by any employer?
If yes, explain the circumstances (be specific) :
DECLARATION BY THE CANDIDATE
I hereby declare that all the information given in this application are true to the best of my
knowledge and belief, that I have pursued the copy of instructions to candidates and that I will abide
by the service conditions of the Anna University of Technology, Tiruchirappalli if selected.
Place :
Date :
Signature
CERTIFICATE OF THE PRESENT EMPLOYER, IF THE APPLICANT IS EMPLOYED

Certified that Dr. / Thiru / Tmt / Selvi …………………………………….. is a temporary
/ permanent / regular employee of our Institution. He/She has experience in our Institution for
……………… years …………….. months and …………..days.
Signature:
Name:
Office Seal with date: Designation:
Address:

MZ ZH Njhopy El GG Gy Fiyf Fofk Jpur Rpuhg Gs SP: Anna University of Technology, Tiruchirappalli

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mz;zh njhopy;El;gg; gy;fiyf;fofk;> jpUr;rpuhg;gs;sp

ANNA UNIVERSITY OF TECHNOLOGY, TIRUCHIRAPPALLI

1.1 Name of Husband / Father :

2. Present employment details :

3.2 Telephone No. / Mobile No.

3.3 Fax No. (with STD Code) :

3.4 E-mail I.D. :

3.5 Permanent Address :

3.6 Telephone No. / Mobile No. :

4.1 Age as on 30.11.2010 :

4.2 Place of Birth, District and State :

5. Community (Please tick) :

6. Nationality (please tick) :

7.1 General Educational Qualification :

7.2 Details of NET / SLET Qualification :

7.2.1 Whether qualified NET / SLET :

7.2.2 Year of passing

Present Period of service Duration

9.3 No. of books published :

Authors, Title, Year, Name of the Publisher

10. Details of supervision / Research Guidance

11. Membership in Professional Societies

11.1 Total number of Membership in

11.2 Details of Membership in Professional

12. Prizes, Medals and other Honours received,

14. Languages known :

Language Speak Read and write Speak, read & write

15. Are you in award of any research scheme,

16. Name and address of two persons (not

18. Any other information you would like to

20. Whether possible to join the post

21. Have you been placed on probation, censured,

CERTIFICATE OF THE PRESENT EMPLOYER, IF THE APPLICANT IS EMPLOYED

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