University
FACULTY
APPLICATION FORM
(Karunya Institute of Technology & Sciences)
(Estd. Under sec. 3 of the UGC Act 1956)
Karunya Nagar, Coimbatore 641 114
[CHRISTIAN MINORITY INSTITUTION]
Position applied for
Department
Have you applied for a post at
Karunya earlier; if so,
for what post and when
Please affix
recent Passport
size Photograph
(Application should be complete in all respects, Incomplete applications will not be considered)
A) PERSONAL DATA
Email id: .
1.
Name in full (in block letters) Mr./Mrs./Ms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
Mailing Address (In block letters)
Tel. No.
STD Code
Mob.No.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
Permanent Address (in block letters) Tel. No.
STD Code
Mob.No.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
3.
Date of Birth . . . . . . . . . . . . . . . . . 4. Religion . . . . . . . . . . . . . . . .5. Caste . . . . . . . . . . . . ..
(Certificate to be enclosed)
OC/BC/MBC/SC/ST
(For Official purposes only)
Remarks of the Selection Committee
Date of Interview:
1. . . . . . . . . . . . . . . . . . . . . . .
2. . . . . . . . . . . . . . . . . . . . . . . . .
3. . . . . . . . . . . . . . . . . . .
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....................
4. . . . . . . . . . . . . . . . . . . . . . .
5. . . . . . . . . . . . . . . . . . . . . . . . .
6. . . . . . . . . . . . . . . . . . .
........................
..........................
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6.
Marital Status
: Married / Single
7.
Children & Other Dependents
Name
Relationship
Age
___________________________________________
______________________
______
___________________________________________
______________________
______
___________________________________________
______________________
______
8.
Fathers / Guardians Name ________________________________________________________
9.
In case of emergency the person to be notified:
Name: __________________________________________ Relationship: ___________________
Address: _______________________________________________________________________
_____________________________________ Pin Code ________________ Tel No.___________
B) PHYSICAL DATA
10. a) Height: ______________ Cm
b) Weight: ______________ Kg
c) Eye sight (Wearing spectacles) Yes/No. If yes, power __________________
d) Blood group: _____________________
11. Have you any physical handicaps?
a) Sight (
b) Hearing (
c) Feet (
d) Hand (
If so, kindly provide details with regard to the extent it has hampered your normal working
_______________________________________________________________________________
12. Have you had any major operations/illness during the past 3 years? If so, give details
_______________________________________________________________________________
C) ACADEMIC QUALIFICATIONS
13. Kindly start with your highest qualification
Name of College /
School & Location
University/
Location
Degree /
Diploma*
Date of
Degree
Issued
Year of
Passing
Main Subject taken
Specialization
Percentage
Ph.D.
M.Phil
M.Sc./ M.E/
M.Tech.
B.Sc./ B.E/
B.Tech
Diploma / 12th
10th
* State whether :
Part time (P)
Full time (F)
Correspondence (C)
14. NET/SLET Completed Details.
______________________________________________________________________________
Class /
Rank
15. Kindly furnish details of Scholarship / Special merit awards?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
16. Kindly provide details on your extra-curricular activities / hobbies / fields of interest during your
college days,
a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
d) ____________________________________________________________________________
17. Briefly describe in about one hundred words why you choose or desire to choose teaching as a
profession, detailing your strengths and weaknesses as a teacher.
(You may attach a separate sheet of paper)
D) PROFESSIONAL INFORMATION
18. PREVIOUS TEACHING EXPERIENCE (Enclose copies of Certificate)
Name of Institution &
Place
Duration
From
To
Date
Date
Designation
Degrees
Handled
Reasons for
Leaving
19. PREVIOUS WORKING EXPERIENCE (Enclose copies of Certificate)
Name of Institution & Place
Duration
From
To
Date
Date
Total Experience: ___________________
Designation
Reasons for Leaving
Teaching : ____________ Industry : _____________
PG :
_____________ UG
: _____________
20. RESEARCH EXPERIENCE
a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
21. PUBLICATIONS
Kindly furnish list of Papers/Reports/Articles published by you. (Use additional sheets, if necessary)
a) ____________________________________________________________________________
b) ____________________________________________________________________________
22. SALARY STRUCTURE
Your present salary structure or last pay drawn (Last pay certificate may be produced at time of Interview)
a) Basic
b) Dearness Allowance
c) Additional D.A.
d) H.R.A.
e) C.C.A.
f) Any other
: Rs.
: Rs.
: Rs.
: Rs.
: Rs.
: Rs.
_________________
Total Salary per month
: Rs.
_________________
Expected Salary:
Basic Rs. ________________
Total Rs. ________________
Any other benefits
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
E) GENERAL INFORMATION:
23. Languages which you are proficient with:
Speak
_________________
Read
_________________
Write
________________
_________________
_________________
________________
24. Are you a member of any Professional Body / Institute / Society? YES/NO
_________________________________________________________________________________
25. Have you traveled abroad for training or studies? YES/NO
_________________________________________________________________________________
26. Do you (a) Smoke
Yes/No
(b) Consume Alcohol
Yes/No
(c) Other habits
27. If offered the post, time required to join _______________________________________________
F) REFERENCES
28. Please give the names of two references acquainted with your attainments. If related give details of
relationship
a) Name
: __________________________________________________________________
Address
b) Name
: __________________________________________________________________
: __________________________________________________________________
Address
: __________________________________________________________________
c) Additional information, if any (attach separate sheet)
: _________________________________
22. I hereby certify that the above information furnished by me is true and that I agree to appear for an
interview/test if required to do so
Date:
SIGNATURE
ANNEXURE TO BE FILLED BY CANDIDATES AS APPLICABLE
Karunya University, besides imparting vocational guidance also aims to inculcate in its students the
values and discipline. To enable us in this our endeavour, we would like to elicit the following
information from you which may be filled up prayerfully.
A) Your Church affiliation
B) Are you a member of any Christian organization? If so, could you please describe your role in the
organization?
C) Have you had a personal experience of salvation? If yes, please describe briefly.
D) What do you know about different aspects of the Jesus Calls ministry? How have you been associated
with it? Are you or your family members Partners?
(a) JCP - Yes/No (b) KET Yes/No (c) BETHESDA Yes/No (d) Young Partner? Yes/No.
K) Would you be willing to uphold the aims and objectives of the Karunya University, if you are appointed to
a faculty position at the University?
Date:
SIGNATURE
