Application for Faculty

Position

INDIAN SCHOOL OF MINES

DHANBAD-826004
JHARKHAND,INDIA

(Please Fill in BLOCK LETTERS)

Affix here
recent passport
size
photograph

Advertisement No.
Post Applied for
Department
Bank Draft No.& Date
1. Name in Full (First Surname)

Marital Status:
Married

Gender:
Single

Male

Female
(Please tick)

2. Name of Father:

3. Address:
Present

Permanent

FAX
E-mail
Telephone / Mobile

Office:

Residence:

4. Date of Birth

5. Nationality:
Day

Month

Year

6. Present Employment :
Designation
Organization
Date of joining
Scale of Pay (Rs).
Basic Pay (Rs.)
Total Emoluments
(Per month)(Rs.)
7. Basic Pay expected (Rs.) ______________________________________________
8. (a) Tick-mark the appropriate box if you belong to reserved category
(Please attach necessary caste certificate issued by an authorized officer only.)

SC

ST

OBC

GEN

PH

9. Total years of the experience excluding the period of Masters and Doctoral
Degree, if obtained as full-time scholar
10. Areas of Specialization:

11. Current Areas of Research:

______________________________________________

(Only for academic positions)

12. Academic Record starting with secondary education (Please attach Xerox copies of Degree Certificate)
Examination Branch/
College/University Year
Percentage Class/
Specialization /Institute
/Grade
Division

13. Details of R & D Projects:

(i) Completed:
(ii) Ongoing:

14. Details of Consultancy Projects:

(i) Completed:
(ii) Ongoing:

15. Details of Ph. D Supervision:

(a) No. of Ph. Ds Supervised/Awarded as:

(i) Guide:
(ii) Co-Guide:

(ii) No. of Ph. Ds Supervising as:

(i) Guide:
(ii) Co-Guide:

16. Employment: (particular of your past position (s))

Employer

Position held

Date of Joining

Date
Leaving

of Pay with Scale

of pay

17. Have you ever been discharged/suspended during your earlier employment?
If yes, state reasons:

18. Special Awards/Honours received, if any:

Year

Name of Award/Honour

19. Membership of Professional Bodies:

Name of the Body

Name of Organisation

Status of Membership: Life/Annual

20. Please mention below best five research publications and attach separate list of all
publications (Mention whether the journals are SCI/SCOPUS/SSCI indexed):
Sl.No
1.

2.

3.

4.

5.

Year

Title of Publication

Name of Journal

21. Names and addresses of three Referees (at least one of them should be familiar with your recent works)
Name
Occupation or
position
Address

Fax
E-mail
Phone No.
(1)

(2)

(3)

22. Any other information (Please mention administrative responsibilities undertaken):

23. Statement of Objectives (to be filled up in Candidates own hand writing):

a) Please indicate as to why you wish to join ISM, Dhanbad.
b) How in your opinion do you meet the job requirements as advertised?
c) A short paragraph about the research /teaching/development projects you would
like to undertake and the courses that you would like to handle at UG and PG
levels.

24. I hereby declare that I have carefully read and understood the instructions and
particulars supplied to me, and that all entries in this form as well as attached sheets
are true to the best of my knowledge and belief.
There are

attached sheets along with this form.

Date:
Place:
(Signature of Applicant)

Note: Use separate sheet if necessary for any of the above items.

Indian School of Mines, Dhanbad

ACKNOWLEDGEMENT
(All particulars to be filled by the applicant)
(Write full mailing address on reverse and affix necessary postage stamps)

Name (in BLOCK LETTERS)_____________________________________

Post Applied for

______________________________________

Department

______________________________________

________________________________________________________________________
(for office use only)

Received on ______________

_______________________
Signature of Receiver

SUMMARY SHEET

Advt. No. _________________________ Dated: __________________

1.

2.

TITLE

SURNAME

Date of Birth

FIRST NAME

3. Age

4.Category

5. Mobile No.: _____________________________ Email ID:

___________________
6.

Educational Qualifications:

Examination
Passed

Branch/
Speciaisation

Collge/ Univrsity/
Institute

Year of
passing

Percentage/
Grade

Class/
Division

7. Experience with pay scale and present basic:

Employer

Position held

Date of
Joining

Date of
leaving

Pay with Scale of Pay

8. Total years of the experience (excluding the period of Masters and Doctoral
Degree, if obtained as full-time scholar):

9. No. of Research Publications (Mention whether the journals are SCI/SCOPUS/SSCI

indexed):

10. Details of Ph. D Supervision:

(a) No. of Ph. Ds Supervised/Awarded as: (i) Guide:
(ii) Co-Guide:
(ii) No. of Ph. Ds Supervising as:

(i) Guide:
(ii) Co-Guide:

11. Details of R & D Projects:

(i) Completed:
(ii) Ongoing:

12. Details of Consultancy Projects:

(i) Completed:
(ii) Ongoing:

13. Any other (Awards, Prizes, Achievements etc.) :