Application for the Post of Professor, Associate Professor ...



2707005000Application for the Post of Professor, Associate Professor and Assistant Professors (Last Date for applying is 15th April, 2020)1Post applied for2Name3Photo4Gender (Male/ Female/ Others)5a) Date of birth DD / MM/ YYYYb) Age as on 01.03.2020 Years Months6Nationality 7Address for communicationa) Districtb) Statec) Pincode8Mobile no9Email10Religion (Hindu/Christian/ Muslim/ Others specify)11Mention whether SC/ST/OBC, if applicable13Whether physically handicapped?If Yes give details: Disability category: % of Disability:14) Educational Qualification (Mention the latest first) (You may add more rows if needed)Sl. NoQualificationInstitutionSpecialization Year of PassingGrade/ Percentage15) Details of Work Experience: (Mention the latest first) (You may add more rows if needed)Sl. NoEmployer detailsDesignationDate of JoiningDateof RelievingExperience (Years, Months)Salary DrawnReason for LeavingWork Profile16) Research/Consultancy Projects: (Mention the latest first) (You may add more rows if needed)Sl. NoTitle of Research Study/ ProjectFunding AgencyDuration DetailsFromTo17) Publication in Journals : (Mention the latest first) (You may add more rows if needed)Sl. NoTitle of paperName of JournalYear of PublishingRecognised by UGC (Yes/ No)Impact Factor (RG Journal Impact)Details18) Publications of Books: (Mention the latest first) (You may add more rows if needed)Sl. NoTitle of bookPublisher Year of PublishingISBN NoDetails19) Conference/ Seminar/ Workshop/ Training Involvement : (Mention the latest first) (You may add more rows if needed)Sl. NoName of InstitutionConference/ Seminar/ Workshop/ Training ThemeDate of participationSpecify Your Role (Organiser, Paper Presenter, Chair, Discussant, Others – give details)20) Research Supervision : (Mention the latest first) (You may add more rows if needed)20.A) Ph D AwardedSl. NoName of ScholarPh D TitleUniversity/ InstitutionMonth/ Year of AwardDetails20.B) Ph D SubmittedSl. NoName of ScholarPh D TitleUniversity/ InstitutionMonth/ Year of SubmissionDetails20.C) Ph D On-goingSl. NoName of ScholarPh D TitleUniversity/ InstitutionDetails20.D) M Phil AwardedSl. NoName of ScholarM Phil TitleUniversity/ InstitutionMonth/ Year of AwardDetails21) Other Professional Activities : (Mention the latest first) (You may add more rows if needed)(Involvement in Professional bodies, Expert Committees at the Global/ National/ Regional level, Involvement in Academic Administration (eg:- Board of Studies, Syllabus Committee etc)) Sl. NoName of ActivityCapacityDetails22) Any other details : (Mention the latest first) (You may add more rows if needed)Sl. NoDetails23) ReferenceSl. NoNameAddressDesignationMobileEmail12DeclarationI hereby declare that the information/ particulars given above is true and correct to the best of my knowledge.Place:Signature: Date:Name: ................
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