Application for the Post of Principal

LAKSHMI AMMAL POLYTECHNIC COLLEGE, K.R Nagar, Kovilpatti.

Affix Recent Passport
Size
Photograph

APPLICATION FOR THE POST OF PRINCIPAL

1. Name of the applicant :

2. Father`s Name:

3. Age with Date of Birth:

4. Permanent Address:

5. Present Address:

6. Phone No/Mobile No:

7. E-Mail address:

8. Nationality / Religion / Community / Caste:

9. Sex : Male / Female

10. Marital Status : Single / Married

No.of Children:____ Sons / ____ Daughters

11. Educational Qualifications:

Educational Qualification / Name of the Board / College / University / Year of Passing / % of Marks / GCPA & Division
10th
HSC
UG :
Branch :
PG:
Branch:
Ph.D
Others

12. Details of Experience in Academic / Research Institutions including present employment (Chronological Order):

Sl.No. / Name of the Institution / Designation / Period of Service / Salary last drawn / Reason for leaving
From / To / Duration

Page 1 of 3

13. Details of Experience in Industry Field (Chronological Order):

Sl.No. / Name of the Institution / Designation / Period of Service / Salary last drawn / Reason for leaving
From / To / Duration

14.Details of Fellowship / Award / Honours Received (Attach separate sheet if required):

15.Details of Academic Achievements (Facility Created, Special Laboratory Established, Books Authored, etc,..-Attach separate sheet if required):

16.Details of Contribution to College including Admissions / Placements of Students (Attach separate sheet if required):

17.Details about Participation / Conducted Short Term Courses / Training / Conferences / Workshops / Symposium etc.. (Attach separate sheet if required)

18.Details about Research Papers / Publications in Journals / Conferences :

Page 2 of 3

19.Membership / Fellowship of Professional Bodies / Societies

20.Administrative Responsibilities Held in Chronological Order (Attach separate sheet if required):

Position Held / Organization / Nature of Responsibility / Period / Remarks
From / To / Duration

21.Give Name, Designation and Address of atleast two references ( not related but well acquainted with your academic performance and conduct)

I)
E.Mail ID :
Mobile No : / II)
E.Mail ID :
Mobile No :

22. Computer Proficiency : Yes / No

23. Expected Salary:

24. Joining time required if selected:

25. Any other additional Information:

Signature of the Applicant

Place:

Date:

Note : Xerox Copies of Educational Qualification, Experience and Other Certificates / Testimonials for Proof

of the all information furnished should be sent along with the filled in application.

For College Office use:

Originals Verified

Signature of Official checking this record

Name & Designation

Page 3 of 3