Application No.
Application for Self Financed Programme
(Teaching)
Advertisement No. Dated:
APPLICATION FOR THE POST OF _____________________________
IN THE DEPARTMENT OF
Affix Passport
1. Name (in capitals) : size colour
Photograph
2. Date of Birth :
Age as on the date of
Advertisement : Y……..….M…...….D…….……
3. Place of birth :
Male Female Others
4. Sex (Tick ) :
5. Religion :
6. Nationality : Indian / ……………………………
7. Community (Tick ) OC SC ST OBC EWS :
(Please enclose a copy of the
Community Certificate)
8. Mother Tongue :
9. District & State :
10. Father’s/Spouse Name :
Occupation & Address (Strike out whichever is not applicable)
1
Address for Communication :
Residence: Office:
………………………………………………………………...... ..…………………………………………………………
……………………………………………………………………. ……………………………………………………………
…………………………………………………………………… ……………………………………………………………
Pin code: ………………………… Pin code: ……………………………………
Phone : …………………………Fax:……………
E-Mail :………………………………………………………… E-Mail :………………………………………
Mobile :………………………………………………………. Mobile: ……………………………………………
11. Present position
Designation ……….…………………………..
Scale of Pay ……………………………………
Gross emoluments ……………………………………
12. Educational Qualification : (Start from the latest)
(Please enclose xerox copies of the Certificates)
Sl. Examination Passed University / Institution Year of % of Class /Rank
No. (with main subject) Passing Marks
/Grade
1.
2.
3.
4.
5.
6.
13 (a). Details of Ph.D Degree
2
1. Date of submission of Ph.D Thesis :
2. Month and year of award :
3. Subject and Title of the Thesis :
Note: Candidates having Ph.D. Degree without NET/SET qualification are requested to enclose a Certificate
from the concerned University stating that the Ph.D. Degree is awarded in accordance with the University
Grants Commission (Minimum Standards and Procedure for award of Degree) Regulations 2009
13 (b) Post Doctoral work if any :
13 (c) Details of SLET / SET / NET /Similar Tests passed, conducted by UGC/CSIR/other agencies
accredited by the UGC
Name of the Eligibility Test Subject Month & Year of Passing
14 (a) Experience : Teaching
(Please enclose xerox copies of Service Certificates)
Sl. Position held Name of the Institution Duration Years of
No. From To experience
Y M D
1.
2.
3.
4.
14 (b) Experience : Administration
Sl. Position held Name of the Institution Duration Years of
No. From To experience
Y M D
1.
2.
3.
4.
5.
15. Research contributions :
Sl. Degree Research guidance (No. of Candidates)
No. Degree awarded Presently registered Synopsis submitted
1. D. Sc/D. Litt
2. Ph.D
3. M.Phil
3
16. Project undertaken :
Sl. Title of the Project Period of Funding Agency Funds allotted
No. Project
Ongoing:
1.
2.
3.
Completed:
1.
2.
3.
17. Publications: (Books/Book Chapters)
Sl. Title of the Chapter Title of the Book Publisher ISBN/ISSN
No. number
18 (a) E-Resources prepared (SWAYAM / MOOC / NPTEL …..)
18 (b) Research Papers / Articles Published :
Sl. Title of the Article Journal in which published Month / ISBN/ISSN SCOPUS/
No. Year of Number WOS/UGC
National International Publication CARE
JOURNAL
4
19. Training / Course undergone :
Sl. Nature of Training Participant/ Theme Name of the Duration
No. (Academic / Administration) Resource Person Institution From To
1. Workshop
2. Refresher Course
3. Orientation Course
4. Conference
5. Symposium
6. Congress
7. Seminar
20. Membership / Fellowship :
Sl. Name Institution Received
No.
1.
2.
3.
4.
21. Languages Known :
Sl. Name of the Language Read Write Speak
No.
1. Tamil
2. English
3. Hindi
4. Others
22. Other Skills :
Sl. Type of Skill Nature of Proficiency
No.
1.
2.
3.
4.
5
23. Check list of enclosure : (Tick in the appropriate column)
Sl. Enclosure Attached Not Attached
No. (Attach attested relevant Xerox copies)
1. Filled in application with enclosures
2. Age Proof – HSC Mark Statement
3. SSLC First Page / Mark Statement
4. Community Certificate
5. UG / PG / M.Phil / Ph.D Degree Certificates
6. SLET /SET / NET Certificates
24. Any other
25. I hereby declare that the entries in this form are true to the best of my knowledge and belief.
If selected, I will abide by the rules and general service conditions of the Institute.
Place:
Date:
Signature of Applicant
