Indian Institute of Technology Jodhpur

Application for Faculty Position

Web Advertisement No.: IITJ/ACAD/2013-14/05 Dated 02.12.2013

Application No. :
Name of Applicant in Block Letters

1. Basic Information

(a) Post Applied for Assistant Professor/ Associate Professor
/ Professor

Affix a recent
Passport size
Photograph
(b)Discipline Applied for EE/ ME/ CSE/ Mathematics/ CHM/ Phy/
Biology/ HSS/ MMSE
(c) Department in which Ph.D Degree
Received

(d) Area of Research

2. Details of Educational Qualifications (Please attach self-attested copies of Degree and Marksheets)
Level of
Degree/
Exam
Name of
Degree/Exam
University / College / Board Year of
Passing
Percentage
of Marks /
CPI / CGPA
Subjects
studied
or Discipline
X Class
XII Class
Bachelors
Masters
Doctoral
3. Details of Ph. D. degree
(i) Ph.D. Thesis Title

(ii) Area of Ph.D. Thesis Work
(iii) Date of joining of Ph.D. programme:
(iv) Date of Defense of Ph.D. Thesis:
(v) Date of Award of Ph.D. Degree:
(vi) Name(s) of Thesis Supervisor(s):

(vii) No. of years of Post- PhD work (if any) &
area(s) of specialization

(viii) Research facilities established by you
4. Teaching Experience Please provide details in Annexure A
(a) No. of Years of Teaching after PhD Degree
(b) No. of Theory Course Taught
(c) No of Laboratory Courses Handled
(d) Laboratory developed by you

5. (a)Teaching plan for next 5 years
(b) Research Plan for next 5 years




6. Details of Work Experience (in reverse chronological order)
Position
held
Organisation/ Institute Duration Total Period Last Pay, Scale of
Pay and Pay band
From To Years Months




8. List of Publications: (Published, Accepted or in Press)
Authors, Title of the paper, Journal Name, Volume, Issue, Year, Page numbers

Published from India Published from Abroad
Journals



9. List of Published Technical
Reports, Monograph, Books
and Best chapter


10. Number of Thesis/
Dissertations Supervised
Awarded Submitted In progress
Doctoral
Master
12. Number of Research
Projects
Completed On going Amount (Rs in Lakh)
PI
Co PI
13. Details of Patents Awarded

Submitted Under preparation
14. Details of Prizes, Medals, Awards, Honours
Name of Award:


Year of Award: Awarded by Awarded for
15.Membership/ Fellowship of Professional Societies, if any
Name Year By For
16. Personal Details
(a) Date of Birth
(b) Fathers / Husbands Name
(b) Gender Male / Female
(c) Marital Status
(d) Nationality
(e) Category (GENERAL/ OBC
(Creamy layer)/ OBC (Non-
creamy layer)/ SC / ST /
PWD (Person with
Disability)
Please specify category
(g) Permanent Address




Pin Code:
(h)Address for
Correspondence
Pin Code:
(i) e Mail
(j) Phone No with STD code
(k) Mobile No.

18. General
(ii) Time needed for joining the
post offered is


19.Additional Remarks:
Applicants may mention
here any special qualifications
or experience, e.g., in
organizations which have not
been included






20. List of Three Referees: (Name, Designation and Address, e-Mail, & Phone No) acquainted with
your work.
(i)
(ii)
(iii)


Declaration

a) I, hereby, declare that I have carefully read and understood the instructions and particulars
advertised and that all the information provided by me in this application are true to the best of my
knowledge and belief.
b) If at any time I am found to have concealed/ suppressed any material/ information or given any false
details, my appointment shall be liable to be summarily terminated without notice or compensation.
c) Were you ever declared medically unfit or asked to submit resignation or discharged/ dismissed?
YES / NO. If yes, give details in a separate sheet





Signature of the Applicant with Date


Note: Application complete in all respect should be submitted:

Professor B. Ravindra
Coordinator (Faculty Affairs)
Indian Institute of Technology Jodhpur
Old Residency Road, Ratanada
Jodhpur 342 011
Rajasthan, INDIA
Phome: (0291) 244 9041
eMail: fa@iitj.ac.in


Summary Sheet
Primary Information

Name: Date of Birth:
& Age (in years):
Category:
Phone / Mobile No.: Landline:
Present Address:

Degree Year of
completion
Univ./ Institute Marks %
Class X
Class XII
B.Sc/ B.Tech
M.Sc/ M.Tech
Ph.D
Title of Thesis:

Present Position :
Mention any other specific information ( if any):

Seeking
Placement as
Asst Prof.
(on contract)


Asst Prof. Associate
Prof.
Prof. Visiting
faculty
Open to suitable
placement & Pay
Number of years of experience
Total In India Abroad Teaching Research Industry Industrial
Research


Administrative
Number of publications Patents
Total Refereed Presentations Books Chapters
in a Book
Reviews Articles


Obtained Applied
for


Recognition received
Number of Membership of
Special
Awards
Rewards Citations Professional Bodies Special Committees, if any


Area of Specialization:






Summary Sheet (Contd...)
Checklist for Attachments


Put a ( ) tick mark YES box If the following documents are attached with your application

Sl.No Documents attached YES NO
Self-Attested Copies of Degree Certificates and Marks Sheets
Brief Description about Ph.D. Thesis Work
List of Publications (with complete details)
Photocopies of full text of 3 of your Best Publications
Your Teaching Plan for next five to ten years
Your Research Plan for next five to ten years
Application sent in Electronic form/ Hard copy
Have you sent your application through proper channel

Research / Teaching / Industry / Other Experience

Sl.No Documents attached YES NO
i. Pre-doctoral work
ii. Industrial experience
iii. Research Project Experience
iv. Concurrently with Ph. D
v. Post-Doctoral Research Work, if any
vi. List of courses taught to UG and PG classes
vii. Details of setting up of Laboratories
viii. Installation / Use of different types of instruments, systems, software, etc
ix. Self-Attested copies of Work experience Documents (if any)





(Name & Signature of Applicant with Date)