FOR OFFICE USE ONLY

Application Received on: Registration No.:

Ph No.:-0141-2227498

A P P L I C A T I O N F O R M F O R T H E P O S T O F P R I N C I P A L

Name of the College applied for:

Advertisement No.

DD No. Amount Dated: Name of Bank:

Affix your photograph here

Attested)

1. Name :( IN BLOCK LETTERS): _

2. Father's/Husband's Name: _

3. Date of Birth: Place of Birth: (Proof –Enclosure No. )

4. Present Age (As on last date of submission of application) :

5. Sex (Male/Female): 6. Marital Status:

7. Nationality: 8. Religion:

9. (a) Category (UR/SC/ST/OBC): (Proof of category- Enclosure No. ) (b) Do you belong to Physically Handicapped category): YES/NO

(If yes, enclose relevant certificate - Enclosure No. )

10. Address:

For Correspondence: Permanent Address:

PIN Code: Tel. No: Mobile No.


PIN Code: Tel. No: Mobile No.

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11. Academic Qualifications (Secondary School Examination Onwards):

Examination
/ Degree / Board/ University / Subjects/ Specialization / Year of
Passing / CGPA/
%Marks / Division / Proof
Encl.
High School/
Secondary Exam
Sr. Secondary
B.E. / B.Tech/
M.E. / M.Tech
Ph.D.
Others

12. Details of Experience in academic institution/research organizations (chronological order):

S. No. / Post Held / Organization / Period / Pay
Scale / Basic Pay or AGP/GP / Proof Encl. No.
From / To / Total
Duration

13. Details of Industrial/Field Experience (chronological order)

S. No. / Post Held / Organization / Period / Pay
Scale / Total Monthly Emoluments / Proof Encl. No.
From / To / Total
Durati on

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14. Details of Scholarships/ Rewards/ Honour with Proof (Enclose separate sheet, if necessary):

15. Details of Academic achievements with Proof (Enclose separate sheet, if necessary):

16. Developed / Participation in production of educational programs with proof (Enclose separate sheet,

if necessary):

17. Conducting Short Term/ Continuing Education Program/ Other Courses with proof (Enclose

separate sheet, if necessary):

18. Attended STTP/Conference/Workshop/Symposium etc.

19. Special Training/ Assignments (Enclose separate sheet, if necessary):

20. Publications (in numbers): (A)

S.
No. / PAPERS / Published
(Nos.) / Accepted
(Nos.) / Communicated
(Nos.) / Remarks
1 / Papers in Refereed International Journals:
2 / Papers in Refereed National Journals:
3 / Papers in Conferences /Symposia :
4 / Books :(Enclose Detailed List)
5 / Review/ Research/ Feasibility Reports : (Enclose Detailed List)

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(B) List of Publications in Journals

S.No. / Details (Author(s)/Title/Volume/Page/Year) / Cumulative Impact
INDEX (with proof)

(C) List of Publications in Conference Proceedings:

S.No. / Details

(D) Details of IPRs/ Patents etc. (Enclose separate sheet, if necessary)

_

21. Thesis Supervision (in numbers): (Enclose separate sheet, if necessary)

S.No. / Description / Awarded / Submitted / In Progress / Remarks
1 / Ph.D.
2 / M.E./ M.Tech./ M.Sc.
3 / Others

22. Sponsored Research/ Consultancy Projects : (Enclose separate sheet, if necessary)

S.No. / Name of Project / Funding
Agency / Amount / Status / Remarks
Completed / In Progress

23. Membership/Fellowship of Professional Societies/ Bodies:

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24. Administrative Responsibilities Held in chronological order (Enclose separate sheet, if necessary):

S.No. / Position Held / Organization / Period / Nature of
Responsibility
From / To

25. Give names, designations and addresses of at least two referees, not related to you but well acquainted with your academic and administrative performance and conduct:

(a)


(b)

Email

Mobile No.


Email Mobile No.

(c)


(d)

Email

Mobile No.


Email Mobile No.

26. Details of Present Employer

Name Address
of Present Employer / Contact
No. / Nature of Present Post [Mark( )] / Present Pay Details
Scale / AGP/GP / Other
Allowances / Total
Emoluments
Permanent
Temporary
Ad-hoc
Contractual

27. Is minimum basic pay, in the pay scale offered is acceptable to you? If not, your expectation:

28. If appointed, the minimum time you will require to join the post? _

29. Any other information you wish to give? (Attach extra sheet)

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DECLARATION BY THE CANDIDATE

I, hereby declare that the information given by me in this application form is t r u e to the best of my knowledge and belief. If, at any time, I am found to have concealed any material/information or given any false i n f o r m a t i o n , my candidature/ appointment may be summarily rejected

/terminated without any notice or compensation and I am liable for legal action against

me.

Place:


(Signature of the Applicant)

Date:

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The certificate to be given in the institute/organization/Industry's official letter pad

(This certificate must be signed by the Employer in case of the candidate already in service whether in Permanent/ Ad-hoc/ Temporary capacity)


Certificate From the Present Employer

No. Dated:

Forwarded, Shri/Smt./Dr. bearing the designation of

holds the post in our Institution/ Organization i n

Permanent /Temporary/ Ad-hoc/contractual capacity.

He / She, i s d r a w i n g t h e p a y i n t h e p a y b a n d / s c a l e


w i t h

A G P / G P . This Institution/Organization has no objection to the candidature of the applicant being considered for appointment to the post o f P r i n c i p a l i n

t h e c o l l e g e

Place:

Date:


(Signature of the Employer)

Name Designation

Seal of the Institution / Organization

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