/ INDIAN INSTITUTE OF SCIENCE, BANGALORE
Application for Post of Technical Officer
Advertisement No. R1(A)308-1/2014
  1. Name in Full:

2.Personal status: Married Single Male Female

Pin code

3.Address:

Present

Email id: ______Mobile No. ______Fax No.______

Pin code

Permanent

4.Date of Birth: 5. Nationality:

6.Present Employment:

Designation
Organization
Date of Joining
PB,GP/Scale of pay
Present Pay
Total monthly emoluments

7.Category:SC ST OBC PH GN

(For SC/ST/PH/OBC- non creamy layer category pl. attach self attested copy of certificate.)

8.Educational Qualification (Starting with Matriculation):

(Attach a separate sheet if necessary)

Course / School/College/ University/ Institution / Year of Joining / Year of Leaving / Percentage of marks / Class/ Division

9. Computer/Technical Courses/Training Attended (if any): (Attach a separate sheet if necessary)

Course / School/College/ University/ Institution / Date & Year of Joining / Date & Year of Leaving / Percentage of marks / Class/ Division

10.Employment Record in chronological order, ending with present job:

(Attach a separate sheet if necessary)

Name and Address of Organization / Designation / Dates / Period (MM-YY) / Pay Scale/Last salary drawn / Nature of Duties
(attach separate sheet to provide the details if necessary)
From / To

11. Brief resume of Research and Development work carried out (to be limited to 1000 words only).

12. Sponsored Projects:

Title / Funding Agency / Value / Duration / Co-investigators / Deliverables

13. Publications: (Please attach list)

(Please indicate the percentage of your contribution in each of the publications in the list attached by you)

Published in Journals : ------
Presented at Conferences/
Seminars/Symposia : ------
Submitted for publication : -----
Reports/Monographs etc.: ------
Others (Please specify) : ------
(Total)

14. Membership of Professional Bodies:

[[

15. Courses taught :

Year/Semester

/ Title of Course / No. of Credits / No. of students who / Taught alone/jointly / Any other remarks
Credited / Audited

16.Guidance of students :

Research:
ME/M.Tech ------
BE/B.Tech ------
Projects ------
Please indicate numbers.

17.List books and other education material developed. (Please attach separate sheet)

18.List projects in education/short term courses organized:

Sl. No. /

Course

/ Sponsoring agency /

Duration

/

Target group

/ Cost of course

19. Patents and Design Registrations: (Please attach separate sheet)

20. A brief summary of interaction with industry. (Please attach separate sheet)

21. Services provided (e.g. setting up of laboratories, software, network, testing, maintenance and operation of facilities, etc.

22. Visits abroad: (Please attach separate sheet)

23. Awards/Recognitions, if any : (Please attach separate sheet)

24. Future Plans (Max. 500 words only) (Please attach separate sheet)

25. Any other relevant information : (Please attach separate sheet)

26. Write Up: (use separate sheet):

One page write-up of your appreciation of the role and functions of the position and your appreciation of how you can contribute to the Institute as well as why you consider yourself to be suited for the post.

27.Names and Addresses of ( three Referees):

Name
Occupation or Position
Address
Phone No.
Mobile No.
E-mail
Fax No.

I hereby declare that all the details furnished above are true to the best of my knowledge and belief.

Date : ______

Place : ______

(Signature of Applicant)

List of Attachments: (Please tick mark against attached documents)

Self attested photo copies of certificates/ testimonials in proof of

Y / N
Y / N
Y / N
Y / N
Y / N

(i)Date of Birth

(ii)Non-GN Category

(iii)Educational qualifications

(iv)Experience

(v)Through proper channel

Note: An incomplete and/ or erroneous application is likely to be summarily rejected. If any query is not applicable to you, please write NA against it.

The application with all relevant enclosures should reach on or before April 1, 2014. DeputyRegistrar (Council Section), Indian Institute of Science, Bangalore-560 012, Karnataka