PPG INSTITUTE OF TECHNOLOGY

Coimbatore – 641035.

Application Form for Faculty Position

APPLICATION FOR THE POST OF ______in ______

(Department)

SPECIALIZATION ______

1.Name in Full: ______Gender:______

(In Block Letters)

2. a) Father’s Name: ______Occupation: ______

b) Mother’s Name: ______Occupation: ______

3. Nationality: ______Religion:______

Date of Birth: ______Age: ______Marital Status: ______

OC / BC / OBC / SC / ST

4. Category

5. i)Particulars of Educational Qualifications:

Sl. No. /
Degree Obtained &
Branch / Specialization
(specify) / Name of the Institute / Year of Passing / % of Marks/ CGPA / Class/ Division
1 / Ph.D. Degree
2 / Master’s Degree
3 / Bachelor’s Degree
4 / Others (if any)

5 ii) Why are you passionate about teaching?______

______

5 iii) Area of interest ______
6. Title of U.G./P.G./Ph.D. Thesis with name and address of Ph.D. Guide

Degree / Title of Thesis / Guide / University
i) Ph.D.
ii) P.G.
iii) U.G.

7. Details of Experience:


i) Teaching Experience : Years Post Ph.D. Experience
Sl. No. / Name of the Institute where Employed / Designation / Date of Joining / Date of Leaving / Experience in Months / Salary drawn
1.
2.
3.
ii) Research Experience: Years
Sl. No. / Name of the Organization where Employed / Designation / Date of Joining / Date of Leaving / Experience in Months / Salary drawn
1.
2.
3.

iii) Industrial Experience: Years
Sl. No. / Name of Industry / Designation / Date of Joining / Date of Leaving / Experience in Months / Salary drawn
1.
2.
3.

8. i) Total Research Publications / Presentations(Attach reprints of best 5 recent publications)

Sl. No. / Nature / Published / Accepted
1. / Books
2. / Chapters
3. / Refereed Journals / National
International
4. / Presentations (Proceedings) / National
International

8. ii) No. of PG dissertations / Ph.D. thesis guided: P.G. Ph.D.

(Attach the titles of the Ph.D.s guided)

8.iii)Have you Passed any competitive exam? (Like GATE, GRE) :if yes specify the Score

______

9. Patents

Sl. No. / Name of the patent / Year / Organization
1.
2.
3.

10. Have you got Research Funding? If yes

Sl. No. / Name of Organization / Year / Amount (Rs.)
1.
2.
3.

11. Do you have contact with Industries? if yes

S.No / Name of the Organization / Name of the Contact Person / Contact number

12. (a) Minimum Pay Expected: ……………………………………………...

(Should not be treated as agreed even if called for Interview and selected)

(b) Time required to join the Institute, if selected: ______

13. Honours / Awards / Distinctions, if any:

14. Name and addresses of two professional referees (who are not related to the applicant) who are in a position to testify from their personal knowledge as to the fitness of the applicant for the post applied for:

i) Name: ______

Status: ______

Address: ______

______

E-mail and Phone: ______Mobile______

ii) Name: ______

Status: ______

Address: ______

______

E-mail and Phone: ______Mobile______

15. i) Address for correspondence: ______

______

______Phone No.______

Mobile No.______

E-mail address: ______

ii) Permanent Address: ______

______

______

16. Any other information relevant to the Post applied for, such as:

i) Memberships/Fellowship and position of responsibility in Professional Societies:

a)

b)

c)

ii) Attainments in sports and extra-curricular activities (including N.C.C.)

a)

b)

c)

iii) Language fluency:

Language / Read / Write / Speak

Declaration:

I hereby solemnly declare that the information furnished above is true, correct and complete and I am responsible for the veracity of the same.

Place:

Date:Signature of the Applicant

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