INSTITUTE OF NANO SCIENCE & TECHNOLOGY

(An Autonomous Research Institute of Department of Science and Technology,

Government of India)

Habitat Centre, Sector-64, Phase-10, Mohali-160062, Punjab

APPLICATION FORM

(Post-Doctoral Research Fellow Programme- February 2018 Session)

(Please fill the form in BLOCK CAPITAL LETTERS only)

To be filled in by the candidate / For Office use
Details of application fee
DD No.: ______Date of Issue:______
Name of the Issuing Bank: ______
(Please write your name at the back of the DD) / Application No:
Date of Receipt:
  1. Name of the Applicant Dr./Mr./Ms. ______

(In block CAPITAL letters)

2. Father’s/Mother’s: ______

3. Gender: ______4. Date of Birth: ______Age (as on 01.02.2018) _____Y____M____D

5. Marital Status: ______6. Spouse’s Name ______

6 Do you belong to GEN/ SC/ ST/ OBC/ PH category*______

*(Please enclose self-attested copy of the certificate, if applicable)

7. Present Mailing Address

8. Permanent Address

  1. Details of academic record [in chronological order from highest up to matriculation]

(Self-Attested copies of the mark sheets/certificates to be enclosed)

Sr. No. / Degree/ Exam (with discipline) / University / College / Board / Year of Passing / Percentage of Marks / CPI / Class/Grade/Rank / Subjects Taken
  1. Employment Record/Research Experience: (including Post doctoral) [Details in chronological order, starting with present employment up to the first employment] (Self-Attested copies to be enclosed)

Sr. No. / Organization
(also specify whether Govt./PSU or Autonomous body or /Private) / Post Held
(Also specify whether regular or contractual) / Scale of pay/ Pay Band and Grade Pay / Duration
(Exact dates to be given) / Total period
(in years) / Nature of duties
From / To
  1. Total Experience in years as on (01-08-2017): ______
  1. Brief Details of Research Experience: ______

______

  1. A complete List of Publications in given format indicating Impact Factor must be attached in a separate sheet. Alongwith this sheet, copies of front-page of each publication be enclosed.

S.No. / Title / Author(s) / Name of Journal / Year / Volume / Page / Impact Factor
(SCI index by Thomson-Reuters) / Citation

DECLARATION

I certify that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed/distorted. If, at any time, I am found to have concealed/distorted any material information, my candidature shall be rejected and/ or my appointment as Postdoctoral Fellow shall be liable to be summarily terminated without any notice/compensation.

Dated: Signature

Place: Name: ______

Checklist of Enclosures by Ph.D. Aspirants. Tick () the boxes.

  1. Photograph duly pasted on the application form.
  2. Demand draft of application fee
  3. Proof of date of birth
  4. Self-Attested copies of Certificate in support of age, educational qualifications

(mark sheet & Certificates of class X and above).

  1. One page Synopsis of Ph.D. Thesis and 3 page write up of research proposed to be taken up.
  2. Self-attested copy of valid reserve category certificate from

competent authority if applicable (SC/ST/OBC(non creamy layer)/PH)

  1. Self-attested copy of experience certificate if any

Note: Please make sure that all the relevant enclosures are attached with the application form. Incomplete applications will be rejected