LAKSHMI AMMAL POLYTECHNIC COLLEGE, K.R Nagar, Kovilpatti.
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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 & Division10th
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 leavingFrom / To / Duration
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13. Details of Experience in Industry Field (Chronological Order):
Sl.No. / Name of the Institution / Designation / Period of Service / Salary last drawn / Reason for leavingFrom / 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 :
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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 / RemarksFrom / 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
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