Indian Institute of Social Welfare and Business Management
Application Form for Appointment
(Application should be routed through proper channel)
Self attested recent
passport size
photograph of the
applicant
To
The Director
IISWBM
Management House
College Square West, Kolkata – 700073. (a) Name of the Department
(b) Post applied for
(c ) Specialization, if any
With reference to your Advertisement No. dated for the above mentioned
post, for which the last date of submission of application is , I present myself as an applicant for the same.
My bio-data and other relevant particulars are attached along with filled in Academic/Research Score as desired.
Yours faithfully,
…………………………………………….
(Signature of the Applicant)
Dated ………………………………, 20……………… Name :
Place : …………………………………………………..
BIODATA
1. Name (in block letters)
2. (a) Present Position
(b) Present Employer (if any)
3. (a) Address for communication (in block letters)
(b) Permanent Address
(c) Phone: (Landline) (Mobile)
(d) email Id
4. (a) Date of Birth c c c c c c c c (b) Age (as on the date of Advertisement)
5. Gender :
6. Nationality :
7. (a) Name of Father
(b) Name of Mother
8. Marital Status (a) Single/Married
(b) Name of Spouse (If Married)
9. (a) Whether belonging to Scheduled Caste/Scheduled Tribe/OBC-A/OBC-B/PH : Yes No
(b) If yes, please tick in appropriate box/boxes SC ST OBC-A OBC-B PH
(Attach Certificate)
SC
10. Educational qualifications (chronologically starting from Secondary Examination)
Examination Board/ Year of Class or % of marks Subject studied Any other
passed University Passing Divn. or Credits information
11. Whether Qualified at NET/SLET/SET
(mention the year in which qualified and submit documents)
12. Research Degree Awarded (Ph.D/D.Sc/D.Litt etc.)
(a) Name of the Department & University
(b) Title of Thesis
(c) Date of Research Degree Awarded
13. (a) Post-Doctoral Research Experience (if any):
Sl.No. Category Topic Place Period
(b) Research Project
Sl.No. Title Funding Agency Period Amount
(c) Consultancy:
Sl.No. Title Funding Agency Period Amount
14. Publications: (a) Number of papers in peer-reviewed or UGC listed Journals
(b) Number of published Books/Monograph etc.
(c) Number of Conference Papers etc.
[(i) A list of publications with the names of all authors, ISBN/ISSN No, with impact factor must be
attached.
(ii) Copies of not more than ten publications which are most important in your opinion must be
attached.)]
15. Details of Employment in chronological order (Gaps, if any, should be explained)
Slno. Employer Post Held From To Scale of Pay and Remarks, if any,
pay drawn indicating reason
for leaving any
post.
16. Teaching Experience
Slno. Level Degree College/University/Institute Duration Total
Under Pass
Graduate
1. Hons.
Others
2. Post Graduate
3. Any other
17. Administrative/Professional Experience (State briefly the nature of work with No. of years)
Slno. University/Institute/Organization Post Held Nature of Work Duration
18. Present pay and Allowances
Scale of pay Basic Pay Allowances Gross amount drawn
19. If selected, time required to join
20. Particulars of extracurricular activities, if any
21. Any other information that may be considered
22. (a) Have you ever been dismissed/removed/asked to retire from services : Yes No
(b) If yes, give details
23. Give the names of not more than two referees (with designation, full address, Phone No., e-mail id.)
(a) …………………………………………………………………………………………………………………………………………………………………….
(b) ……………………………………………………………………………………………………………………………………………………………………..
I certify that the above statements are true to the best of my knowledge and belief.
I accept that in case any information is found to be incorrect or in case there is any suppression of facts, this application is
liable to be rejected.
Signature of the Applicant
Date :
Place :
N.B, (a) Self attested copies of all documents and testimonials are to be enclosed with the application.
(b) Attach extra sheet/sheets whenever necessary.
