ST. XAVIER’S UNIVERSITY, KOLKATA
Application FormforFacultyPosition
Position applied for ______
Area of specialisation ______
1.NameinFull:
2.Father’s/Husband’sName:_
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3.DateofBirth:_/__ _/_
Ageason15.11.2017__years__months
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4.MailingAddress:
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5.PermanentAddress:
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6.Email id ______
7.Telephone no. (With STD Code)______(b) Mobile______
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8.(a)Gender(M/F):
(b)MaritalStatus:(c)No.ofdependents:
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9.Nationality:
10.Category(SC/ST/OBC/RC/General):
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11.ObjectivesforapplyingatSt. Xavier’s University, Kolkata
12.Subject(s)CurrentlyTeachingat UG/PG/level:
13.AreaofResearchInterests:
14.TopicofPh.D.(for the candidate who has completed Ph.D)
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15.EducationalQualificationsrecognizedbyAIU/UGC/anyotherstatutorybody(inreversechronologicalorder)
Sl.No. / ExaminationPassed / University/Institution / Subjects / Yearof
passing / %ageofMarks / Class/Division
1
2
3
4
5
6
7
[Self-attested photocopies of the mark sheets/grade sheets and certificates are to be submitted along with application form.]
16.NET/SET Examination qualified: Year______[Self-attested photocopy of the certificate to be submitted along with application form, if applicable as per UGC rules.]
17.FulltimeWorkExperience(inreversechronologicalorder)
(a)
Sl.No. / NameoftheEmployer / PeriodofService / Position/Designation / ScaleofPayBasicPay / Reasonforleaving
From (date) / To
(date)
(b)Totalworkexperience:years
(c)Total TeachingExperienceat UG/P.G.level:years
(d)TotalPost-Ph.D.TeachingExperienceatUG/P.G.level:years
18.DetailsofPublicationsandResearchworks(Pleaseattachseparatesheetifnecessary):
(a)ResearchPapersPublishedin UGC Recognised Journals
S.No. / Co-authors / Year / TitleofPaper / Journal / JournalCategory / Vol. / No. / pp.
Ifrequired,pleaseattachseparatesheetsinsameformat.
(b)ResearchPapersPublishedin other Journals with ISSN no.
S.No. / Co-authors / Year / TitleofPaper / Journal / JournalCategory / Vol. / No. / pp.
Ifrequired,pleaseattachseparatesheetsinsameformat.
(c)BooksAuthored/edited
Sl.No. / NameofBook / Co-authors / Publisher / YearofPublication
(d)ResearchProjectsUndertaken
Sl.No. / NameofResearchProject / Co-Investigator / FundingAgency/Amount / Status
(e)Ph.D.Supervision:
Sl.No. / Scholar’sName / YearofRegn. / Ph.D.Topic / University/Institution / Co-super-visor(s) / Status
19.ExperienceofAdministrativeResponsibilitiesinAcademicInstitutions:
From(date) / To / AdministrativePosition / Majorresponsibility
20.Anyotherinformationyoumaywishtoadd:
21.ProfessionalReferences(Two)
22.Declaration:
Ideclarethattheaforementionedinformationiscorrectandcompletetothebestofmyknowledgeandbeliefandnothinghasbeenconcealed/distorted.IfIamfoundtohaveconcealed/distortedanymaterialinformation,myapplicationshallbeliable tosummarilyterminationwithoutanynotice.Ifofferedappointment,Iwilljoinonspecifieddateandsubsequentlytakeupthe University assignmentsasandwhenrequired.
Date:
Place:SignatureoftheCandidate
Please note that application in hard copy will be accepted through speed post/ registered post addressed only to:
The Registrar,
St. Xavier’s University, Kolkata
Premises No. IIIB – 1, Action Area IIIB
P.S. New Town Kolkata 700 160
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