To,

ThePrincipal,

S. B. Jain Institute of Technology,

Management & Research,

Nagpur

Pin-441501(M.S.)

Subject: Application forthepostof ………………………………inthe Departmentof…………………………………….

Reference:Your advertisementdated ……………………………….Published in……………………………………………

Dear Sir,

Withreferencetoyourabovereferredadvertisement,Itheundersignedapplyherewith fortheabovereferred post.The details are as givenbelow.

………………………… …………………………. ………………………….

1.Name infull: (Surname)(First Name)(Middle Name)

2.Date of birth(DD-MM-YYYY): ……………………………………………………………………………………………..

3.Permanentaddress: ……………………………………………………………………………………………..

…………………………………………………………………………………………….

…………………………………………………………………………………………….

4.AddressforCorrespondence: ………………………………………………………………………………………………...

……………………………………………………………………………………………..

5.E-mail: ……………………………………………………………………………………………..

6.ContactNo.: Mob. ……………………………… Land line……………………………………..

7. Academic qualificationdetails:

Examination / Yearof
Passing / Nameof
Board/University / Division / %ofMarks obtained / Subjects offered (Specialization ifany) / Remarks,if any
SSC
HSSC / Diploma
UGDegree
PGDegree
Ph.D.
Any other

8. GATE Examination

Year / Score / Percentile

9. Employment details (In reverse chronological order).

Nameofthe Institution/ Industry / Postheld / Pay scale / Experience
Undergraduate / Postgraduate
From / To / Total / From / To / Total

10.TotalExperience ………….. Yrs.: Teaching (Regular)……………………………………… Years

Teaching (Ad hoc) ……………………………………… Years

Industry ……………………………………….. Years

Research……………………………………….. Years

Other……………………………………….. Years

11. Professional Membership(s)………………………………………..

12.Publication details:

Name of
Author(s) / Title of publication / Publisher / Name of
Journal/
Conference / Year / Remark(s)

13. Sponsored Research Projects Under Taken

Agency / Title / Amount / Period / Investigator / Co-Investigator / Status
On – going/ Completed / Submitted

14. Consultancy Undertaken

Agency / Title / Amount / Period / Investigator / Co-Investigator / Status
On – going /Completed

15. Research Guidance

Awarded / Thesis Submitted / Registered
Ph. D
Post Graduate
M. E. (by research)

16. Awards / Recognitions

17. Outreach Activities

Academic outreach activities (STTP/Workshop/Conference etc. organized as Advisor / Convener/Coordinator / Organizing Secretary etc.)
Academic outreach activities (STTP / Workshop / Conferences /Training etc. attended)
Expert lectures delivered

18. Communication Skills

Fluency of Language / Oral / Reading & Writing
English
Hindi
Marathi
Any other Foreign Language

19. No. of Books authored (Please provide details as annexure): ……………………………………………………

20. Important responsibilities discharged(Dean / HOD / Prof In-charge / Functional head)

a)………………………………………………………………………………………………………………………………………………

b)………………………………………………………………………………………………………………………………………………

c)………………………………………………………………………………………………………………………………………………

21. Apart from academics if there are any other areas where you can contribute

(Area of proven expertise)

......

………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………….

22. Software Skills: ………………………………………………………………………………………………………………………….

23. No. of Patents(Applied/Granted): ……………………………………………………………………………………………..

24. Religion: …………………………………………………………………………

25. Marital Status: …………………………………………………………………………

26. Caste Category: OPEN/SC/ST/VJ(A)/NT(B)/NT(C)/NT(D)/OBC/SBC

27. Caste: …………………………………………………………………………

28. MotherTongue: …………………………………………………………………………

29. Current Status of employment: Employed / Not Employed

30.Current salary drawn: …………………………………………………………………………

31. List of documents attached here with:

a) All qualifying examination’s Mark sheets/Degree/Diploma Certificate Yes/No

b) Experience Certificate Yes / No

c) Proof of Professional MembershipsYes / No

d) Birth Certificate (SSC or HSC Board Certificate)Yes / No

e) Two passport size recent photographsYes / No

f) University Approval letters if anyYes / No

32. For any other information please attach annexure.

Verification

Verified &signed at…………………………..onthis day …………………………………of …………………………………thatthecontentsinparts1 to31aretruecorrectto thebestofmyknowledge.If any avermentinthe aboveisfoundtobeincorrectIwouldbeliablefordisqualificationforthe appliedpost.

Place:

Date:Signature of Candidate