Format For The Application Form

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MAULANA AZAD
NATIONAL INSTITUTE OF TECHNOLOGY
BHOPAL 462 051

APPLICATION FOR TEACHING FACULTY RECRUITMENT
March, 2014

1 (a) Post applied for :
(b) Department:
(c) Specialization:
Affix here
Self Attested Latest
Passport Size
Photo

2. Name (in Capitals):
3 Fathers/Mother/Husbands name:
4 a) Address for communication (in Capitals) b) Permanent address (in Capitals)

Email :

Phone :

Mobile :

Pin

Pin

(5) a) Date of Birth :

b) Age ( In years) :

(6) a) Nationality:

b) Religion :

c) Caste : d) Caste category ( GEN/OBC/SC/ST/PWC) :

e) Gender : Male/ Female f) Martial status: Single/ Married

2
g) Identification No :
(Passport/Adhar /Voter ID)

(7) GATE/NET/CAT Qualification : Percentile/Marks: Year:

Discipline:

(8) Educational Qualification (UG Degree onwards)

Degree/Diploma Subject/
Discipline
University/
Institution
% of marks Grade Year of
passing

:
(9) Teaching Experience: (In chronological order)*

Name of Employer Designation Nature of
duties
Period
From To Years and
Months

*Attach experience certificate from the employer.

(10) Publications: (Provide list of publications on separate sheet) :

National Journal :

International journal (High light SCI journal and impact factor) ;

National Conference :

International Conference :

3
(11) Research project Undertaken

Name of the
sponsoring
Agency
Project title

Amount
sanctioned
Period of the Project Status
Completed/
Ongoing From To

(12) Thesis Supervision/Guidance
(List of candidates shall be furnished along with details of Title of thesis and year of award)

Independent experience
in guiding Research
students.
Awarded
(In figures)
Under submission
(in figures)
In progress
(In figures)

Ph.D

M.Phil/M.Tech/M.Plan

(13) Research publication
Attach the sheet containing Title of the paper, Author(s) names, Name of the Journal, Year, ISSN ( If any
and Impact factor.

(14) Books Publication
Attach the sheet containing Title of the Book, Author(s) names, Publication, Year, ISNN ( If any)factor.

(15) Administrative experience
Attach the sheet containing details

(15) National/ International Training programme/ workshop/ conferences/ symposium attended
Attach the sheet containing Title of the programme, Duration of the programme, conducting organization

(16)National/international symposium/STTP/ workshop/conference organized
Attach the sheet containing Title of the programme, Organizing Secretary/ Coordinator, Duration of the
programme

(17) Additional remarks, if any
(Attach Separate sheet, if necessary)

DECLARATION

I hereby, declare that I have read carefully and understood the above information and that all the entries
in this application form are true to the best of my knowledge and belief.

Place :
Date :
Signature of Candidate
4
Additional Informations

Advertisement No.

Date

Last date of submission

1.Fee remittance

Issuing bank & its branch

DD No. & date

Amount

If exempted reason for

2.Character & Antecedents report
Subject Comments
Have you ever been subject to any disciplinary
action, as a student and/or as an employee, if so
give full details

Have you ever been dismissed/suspended from
service/employment. If so please give full details

Were you involved in any criminal, if yes, give full
details

If any case pending against you in the court, if yes,
give full details

3.Name and address of two referees
Name & address Name & address

E mail:

Mobile

E mail

Mobile

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4. Details of Present employment
Name of the
Organization

Date of joining
Whether regular
permanent/temporary

Pay band and Basic
Pay in PB AGP

Signature of forwarding
authority

Name and designation

5. Patent/ awards

Attach the sheet containing File number, date and brief description of patent. Attach the sheet containing
the name of the award, organization and description of the award.

6. Subject taught in last five years
(i)

(ii)

(iii)

(iv)
DECLARATION

I hereby, declare that I have read carefully and understood the above information and that all the entries
in this application form are true to the best of my knowledge and belief.

Place :
Date :
Signature of Candidate

Format For The Application Form

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