NITR/RC/Application Form

SPONSORED RESEARCH, INDUSTRIAL CONSULTANCY

& CONTINUING EDUCATION CELL
NATIONAL INSTITUTE OF TECHNOLOGY ROURKELA
For Office use only
Serial Number of the Applicant:

__________/_____________
Paste here your
recent passport size
colour Photograph

_______________________
Sr. Asst.

Application for the Post of Project Officer/Research Associate/JRF/SRF/Technical Staff

(Application incomplete in any respect will summarily be rejected)

Non Student

1. Propose to enrol in a degree :

Ph.D.

M.Tech(Res.)

[Not Applicable to Technical Staff; Project must have a tenure of at least 18 months for Ph.D
and 12 months for M.Tech (R)]
2. Department /Centres to which applying for :
_______________________________________________
3. Name of the candidate in full
(Block Capital letters)

____________________________________________

4. Project Title

____________________________________________

5. Advt.No. with date

____________________________________________

6. Address for Communication

:
_______________________________________________
_______________________________________________
_______________________________________________

Tel. No.__________________________
7. Date of Birth

Email: ______________________________________

:
d

8. Sex

Male / Female

10. Class of category

11. Nationality

SC

9. Marital status :

__________________12.

ST

Married / Single

OBC
Mother Tongue

General

:______________

NITR/RC/Application Form

13. Academic career: (Enclose photo copies of the qualifying degree certificates and mark
sheets/grade cards showing the percentage of marks or CGPA from H.S.C onwards)
Name of Exams

School/
College

Board/
University

Broad Subjects of
Study

Year of
passing

% of Marks/
CGPA

H.S.C
H.S.S.C
Graduation
Post- Graduation
Any other

GATE / NET Score: Subject: ____________________ Score:________ Year: _______

14.

15.
Experience if any:
Organisation
Position

Duration

Nature of job

16.

Previous Research work and publication, if any: (Enclose copies of published or unpublished
work)
__________________________________________________________________________________
__________________________________________________________________________________
17. Record of past study as a sponsored candidate, or other contractual obligation, if any:
__________________________________________________________________________________
__________________________________________________________________________________
18.

I do not have a close relative among officers and faculty of NIT Rourkela
I am related to ----------------of -------------- Department

I do hereby declare that the information furnished in this application is true to the best of my knowledge
and belief. If admitted, I shall abide by the rules and regulations of the Institute and Halls attached to it.
If any information furnished in this application is found to be untrue, I am liable to forfeit the seat allotted
to me any time in future and legal action be taken against me.
____________
Date:
Enclosures: 1)

____________________________
Full signature of the Applicant
_______________________________2)___________________________

3)

_______________________________4)___________________________