Form A11

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FACULTY / Research Staff APPLICATION FORM

For the post of Professor Associate Professor Assistant Professor

SRF JRF Research Associate Research Assistant Project Assistant

In the Dept. of Civil EEE ECE CSE Mech. IT BT AI&DS BM

B.Arch MBA MCA English Maths Physics Chemistry

Reference : Advertisement in ______________________ appeared on _____________

1. PERSONAL DETAILS

Name

Father / Husband Name

Marital status : Married Un-Married

If married, Spouse : Employed Unemployed

Sex : Male Female

No. of Children :
Age : Date of Birth :
Community : FC BC MBC SC/ST
Religion :

Nationality : Caste :

Address for Communication Permanent Address

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Phone / Mobile : Email :

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 2. ACADEMIC QUALIFICATIONS *

Certificate / Full time / No. of

Diploma / Agg. subjects
Sl. Year of Part time / Class /
Degree Specialization %/ Institution University passed in
No Passing Distance Position more than
CGPA
(#) Education 1 attempt

1. S.S.L.C.

2. H.S.C.

3. Diploma

B.E. /
B.Tech. /
4. B.Arch. /
B.A /
B.Sc.

M.E. /
M.Tech./
5. M.Arch. /
M.A /
M.Sc.

6. M.Phil

7. Ph.D.**

* Attach Photo copies of relevant certificates

# Enter “Required Information” in the applicable rows.
# Enter “Not Applicable” in the non-applicable rows.
** If not completed, furnish year of Ph.D. Registration.
3. EXPERIENCE DETAILS *
i. Teaching (in Engg. Colleges only) – chronological order

Experience (in years

Experience (Duration)
Sl.No. Designation Department Institution & Months)
From (Date) To (Date) Years Months
1.

2.
3.
4.
TOTAL

Last Salary drawn (Gross) Rs…………………. / month

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ii. Others (Industry, Research, Teaching in Arts College / Polytechnic / School) – chronological order

Experience (in years

Experience (Duration)
& Months)
Sl.No. Designation Department Institution
From (Date) To (Date) Years Months

1.

2.
3.
4.
5.
TOTAL

4. PUBLICATIONS

Patents Granted/Published (give the Nos. Granted - Nos. (Country: ).

of Patents & Attach the photo copy of the Published - Nos. (Country: ).
first page of patent Granted/Published.)
Book Publications
(give the Title, Publisher & year of
publication)

Paper : Journal Publications (give the no. Level Total SCI Indexed Scopus Non –
of publications & Attach the photo copy of Nos. Indexed Indexed
the first page of the publications) International

National

Paper : Conference Publications (give the Level Total IEEE Elsevier/ Other
no. of publications) Nos. Proceedings Springer Proceedings
Proceedings

International :

National :

Quality of Publications h index : ; i-10 index : ;

Total No of Citations :

5. SEMINARS / CONFERENCES
Seminars / Conference organised (give the
Conference Theme/Title and the date)
Seminars / Conference attended (give the International :
numbers) National :
NPTEL/SWAYAM Courses attended and the
corresponding marks obtained

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 6. SPONSORED AND ACADEMIC RESEARCH

Sponsored Research :
Sponsored Research Projects Yes No

If ‘Yes’ provide details

Funding/Sponsoring Agency
Amount Sanctioned, Duration and Role : PI/CI
Academic Research :
Approved Research Supervisor Yes No

If Yes, University ___________________________

No. of Ph.D Scholars Completed _____________ No. of Scholars

No. of Ph.D Scholars Pursuing _____________ No. of Scholars

7. ANY OTHER INFORMATION

Membership in Professional bodies

Awards & Achievements (if any)

I declare that the above particulars furnished by me are true to the best of my knowledge

Place: SIGNATURE
Date : Name :

* Attach Photo copies of relevant certificates / documents wherever necessary.

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