Phone: (0771) 2252700

jk"Vªh; izkS|ksfxdh laLFkku

Fax: jk;iqj
(0771) 2253104
NATIONAL INSTITUTE OF TECHNOLOGY RAIPUR Email: registrar@nitrr.ac.in
(An Institute
of National Importance) Website: www.nitrr.ac.in
G.E. Road, Raipur – 492010 (CG)

Walk –in – Interview

Candidate Assessment Sheet for the post of Temporary Faculty/Teaching
Assistant/Part Time faculty
Advertisement No. _________ Dated / Fix a Recent
/2019
Passport Size
Department ______________________________Date ___________________ Photograph
(Self
Name _______________________________________________ Attested)

Father’s/Husband’s Name _______________________________________________

Permanent Address _____________________________________________________

Contact No (With STD Code) ______________________ (O) _____________________ (R)

Mobile No __________________________________________________________

E-Mail __________________________________________________________

Present Address _____________________________________________________

_____________________________________________________
Details :

S. B.E/B.Tech./MCA/M.Sc./ M.E./M.Tech. % Ph.D. With Industrial Teaching

No M.A. % Marks obtained in Marks obtained in Year of Experience Experience
Grand Total or CGPA Grand Total or Award (in Yrs) (in Yrs)
CGPA

1 2 3 4 5 6
2
3
Enclosure Supporting Documents:
1. Photocopies of the qualification in the chronological order i.e. Ph.D, PG., UG etc.
2. Photocopies of the teaching & industrial experience.
3. Others, if any.
DECLARATION
The information given above is correct as per my knowledge and I undertake that I will join the
department /institute, if selected within seven (07) days of receiving order.

Place: Signature of the Candidate

Date:
Name________________________