Government Aided Autonomous Institution Affiliated to ANNA University

COIMBATORE INSTITUTE OF TECHNOLOGY,

(Government Aided Autonomous Institution Affiliated to ANNA University)

Avinashi Road, Civil Aerodrome Post,

Coimbatore – 641 014.

Application for the Post of PROFESSOR / ASSOCIATE PROFESSOR

(Separate Application should be filled for each post)

1. / Details of Post applied for / :
1.1 / Department / :
1.2 / Area of Specialization / :
2. / Name of the Applicant / :
3 / Address for Communication / :
Pin code / :
Telephone No (with STD Code) / :
Mobile Number / :
E mail ID / :
3.1 / Permanent Address / :
Pin code / :
Telephone No / Mobile No with STD Code / :
Day / Month / Year
4. / Date of Birth / :
5. / Gender / : / Male / Female
6. / Nationality / :
7. / Details of Academic Qualifications:
(Start from the most recent degree and list up to SSLC)
(Attach self attested copies of certificates)
Degree / Specialization / Institution / University / Year of Passing / % of Marks / CGPA / Class
8. / Title of Ph.D Thesis / :
9. / Details of Experience (Proof to be enclosed)
Name and address of the Institution / Organization / Post Held / Pay Band / Basic Pay / Period of Service / Duration
From / To / Year / Month / Day
Total
(Start from the most recent experience)
10. / Membership in Professional Societies / :
10.1 / Total number of Membership in Professional Societies / : /
11. / Awards & Honors received, if any (Attach Separate Sheet) / :
12. / Study Tour
Country Visited / Period of Visit / Purpose of Visit
From / To
13. / Whether API evaluation form is enclosed / : / YES / NO
14. / List of enclosures (Arrange all the enclosures in the following order):
i) / Certificates for Academic Qualifications from the recent acquired qualification / Yes / No
ii) / Certificate for Additional Qualification / Yes / No
iii) / Proof for Experience / Yes / No
iv) / Certificate of the Present Employer, if the Applicant is employed / Yes / No
v) / List of Ph.D candidates guided with copy of proof / Yes / No
vi) / Proof for Post – Doctoral Experience / Yes / No
vii) / Conference / Workshop / Seminar / Short Term Course etc. Organized / Attended with proof / Yes / No
viii) / Research Publications in Journals and Conferences / Yes / No
ix) / Publications of Books, Patents, Monographs and General Articles etc., / Yes / No
x) / Sponsored Research Projects with Proof / Yes / No
xi) / Testing and Consultancy Projects with proof / Yes / No
xii) / API Score self – evaluation as per norms in the format (must be enclosed) / Yes / No

DECLARATION

I hereby declare that all the information given in this application are true to the best of my knowledge and belief.

Place:

Date:

Signature of the Applicant