ANIL NEERUKONDA INSTITUTE OF TECHNOLOGY & SCIENCES

(Affiliated to AU, Approved by AICTE & Accredited by NBA)

SANGIVALASA-531 162, Bheemunipatnam Mandal, Visakhapatnam District

Phone: 08933-225083/84/87 Fax: 226395

website: www.anits.edu.in
Email: principal@anits.edu.in

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APPLICATION FORM FOR .... POSITION

ate in Capitals
ecords)

(Photo)

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gory

C & ST)

r Academic Records)

/ Husband

ondence (in Capital letter with PIN

STD Code

Male / Female

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Married / Single

Academic Qualification (Give particulars commencing from 10th Class)

S.
No.

Examination

Year of
Passin
g

Board /
University to
which
affiliated

School/Colle
ge attended

specializatio
n, if any

Aggre
gate
% of
Marks

Divisi
obtai
d

12

13

Particulars of higher academic qualification

for which working, if any, (Give the title of
Program, Institution where registered,
duration and probable date of completion)

14

Title of Under-Graduation Project, if any

15

Title of Dissertation
Graduate level, if any

16

Title of Ph.D. Thesis, if any

17

Particulars of Prizes won, if any

18

Particulars
of
received, if any

/ Thesis at Post-

Academic

Scholarships

Particulars of Academic Publications, if any, (if necessary use separate sheet)

19

S. No.

Title of Publications

Name of Journal or Proceeding of Conference

together with Month & Year of Publication

Work experience after obtaining the recruitment, qualification for the post of Professor,
Associate Professor, Assistant Professor, (if necessary, use separate sheet)
Period of
S.
Designation
Employer
Employme
Nature of Duties
No.
nt

20

If you have teaching experience during the last 3 years, indicate:

a) Courses taught
i)
ii)
III)
iv)
v)
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vi)
b) Laboratory Work conducted
i)
ii)
III)
iv)
v)
vi)

c) Projects guided: Under-Graduate / Post Graduate

i)
ii)
III)
iv)
v)
vi)
d) Particulars of Experience in Institutional Administration, if any:
i)
ii)
III)
iv)
v)
vi)
If employed, Details of last pay drawn:
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a) Scale of Pay

: Rs.

b) Basic Pay

: Rs.

c) Gross Salary

: Rs.

If selected, Joining time required

Any other Relevant Information (if needed, use

separate Sheet)

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Station
Date

:
:

Signature of the
Applicatant