Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
............................ Dated: .
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________________________________________________________________ Name of
Branch
drawn ____________________________________________________
1.
: ....
2.
3.
Sex (M/F)
: .
.
4.
Fathers Name
: ..
.
5.
Mothers Name
: ..
.
6.
Address
...
7.
(a) Correspondence
: ...
(b) Permanent
: ..
(c) Telephone
: . (d) E-Mail : ..
Marital Status
.
: .
8.
9.
Nationality
: ...
10.
Category (Gen/SC/ST/OBC/PWD) :
.
11.
: ..
: (Copy to be enclosed)
12.
Academic Qualifications
13.
Name of the
Institute
Research Degree(s)
___________)
Name of
Degree
Specialization
Board/University
Year
Admitted
Year
Completed
Percent
age/CG
PA
Rank/
Distinction
(If any)
Institution/University
Status
Date of
Thesis
submissio
n
15.
16.
Annexure
No.
(Annexure No.
14.
Type
Subjects
Agency Name
Date of
Award of
Degree
Title of
Thesis
(Annexure No.
Year
Extracurricular interests
:
.
17.
Referees Details
Name of Referee
18.
Designation
Present Employment
___________)
Office Address
Telephone/Mobile
No.
Professional
Relationship
(Annexure No.
Nature of
Employment
Employers
Name
19.
Designation
Period
From-To
Status of
Organization/
Institution/U
niversity
Post Held
From
Pay
Teaching/Professional/Research Employment
___________)
Employers
Name
20.
Status of
Organization/I
nstitution/Univ
ersity
(Permanen
t/Temporar
y/Contract/
Adhoc)
Gross
Pay
To
Nature of
Work
Place
(Annexure No.
Pay
Nature of
Employment
Nature of
Work
Reason
for
Leaving
Teaching experience as Post-Doctoral/Sr. Resident/Service Sr. Resident/Pool Officer etc. : (Annexure No.
___________)
Employers
Name
Status of
Organization/Institut
ion/University
Post Held
From
To
Pay
Nature of
Employment
Nature of
Work
21.
22.
Award Name
Date
23.
(Annexure No.
(Annexure No.
Type of membership
Date of membership
Positions held
Name of
Journal/
Publicat
ion
Ii the
journal
as per
UGC
specified
list (Y/N)
ISSN/I
SBN/R
ef No.
(If
any)
Title of
Publis
hed
Work
Vol.
and
No.
From
Page
No
To
Pag
e
No.
Date
of
Publi
catio
n
Impact
factor in
case of
referred
journal
Aut
hors
hip
SelfAsses
sment
score
of
API
Ann
exur
e
No.
Assessme
nt of API
by
Screenin
g
Committ
ee
24.
Research Publications (Books, Chapter in books, Other than referred journal articles)
Book Details
Level of
Publication
(National/Inter
national)
25.
Type
26.
Text of
Publication
Name &
address of
Publisher
Title of
book
Authorship
Title of
Chapter (If
applicable)
SelfAssessmen
t Score of
API
Annexu
re No.
Assessment
of API by
Screening
Committee
Research Projects (for type, status and nature of project refer shortlisting guidelines) :
(Annexure No. ___________)
Status
Nature of
Project
Title of
Project
Capacity
Name of
Funding
Agency
Value of
Project (In
Lakh Rs.)
Duration of
Project (in
months)
SelfAssessment
API Score
Assessment
of API by
Screening
Committee
Research Projects Output/Outcome (for type, detail of output and status refer shortlisting guidelines) :
(Annexure No. ___________)
Detail of
Output
Type
27.
Research Guidance
Type of Degree
28.
Name of Degree
Capacity
Status
Validity
from
Capacity of
Guidance
Status
SelfAssessment
API Score
Assessment
of API by
Screening
Committee
Status
Self-Assessment
API Score
Participation in Conference/Seminar/Symposia/Workshop
Type of participation
Value
Earned (Rs.
In Lakh))
Validity to
Number
Type
29.
Name of
Agency
Title of Paper
Date
SelfAssessment
API Score
Assessment of
API by Screening
Committee
Self-Assessment
API Score
Assessment of API
by Screening
Committee
Assessment of
API by Screening
Committee
30.
31.
32.
Category
Date
Venue
Sponsoring
Agency
(Y/N)
Role as Organizer
:
(Annexure No. ___________)
Capacity
33.
Nature of work
Duration in years
Statement about work done (teaching and/or other professional activities related to the discipline) so far and
significance of the professional contribution
:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
34.
35.
Statement about proposed Research/Professional activity and brief outline of proposal. If selected, how you
would like to develop your department and your area of interest
:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
I hereby declare that the information given by me in the Application is true, complete and correct to the best of my
knowledge and belief and that nothing has been concealed or distorted. If at any time, I am found to have
concealed/distorted any information or given any false statement, my application/appointment shall liable to be
summarily rejected/terminated without notice or compensation.
Date:-
________________
Signature of the applicant
Place:- _________________
()
Name of the Applicant
Place : ______________
_______________________________
Signature of Head of the Institution
Date: _______________
Name : _________________________
Fax: ________________
Designation : ____________________
E-mail : ____________________________
Address : _______________________
_______________________________
_______________________________
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