NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY
(An institute of National Importance under MHRD, Govt. of India)
Second Floor, PKCE Campus, Nehru Nagar, Karaikal - 609 605
Application Form for Teaching Post
For office use
APPL. No:
WALK IN INTERVIEW
[Purely Temporary position on Contract basis]
Please read the information carefully on website prior to filling up this application form. You may use
separate sheet/s wherever required. Documentary evidence(s) is/are to be attached for the data provided
in this application failing which due weightage will not be given during scrutiny.
Advertisement No. & Date:
Post Applied for:
Please affix recent passport
size photograph
Department:
Specialization: ...
----------------------------------------------------------------------------------------------------------------------------------1. (i) Full Name (in BLOCK letters) : ..................
(ii) Fathers/Husbands Name :
.:............
(iii) Whether belonging to GEN/ SC/ST/OBC/PH: ..........
(Attach Certificate)
2. Date of Birth: 3. (a) Nationality: .... (b) Gender: Male / Female
(c) State/UT to which you belong: ........
(d)Marital Status: Married / Unmarried / Divorced .............
4. Postal Address for correspondence.
5. Permanent Address (with Phone no. & Mobile):
....
..........
.....
..............................
.....
...............................
.....Pin Code: ...........
....Pin Code: ..................
Phone No.: Office: ...
Phone No.: Office: ............
Res.: ......
Res.: ...............
(With STD Code)
Mobile No.: ....... ....E-mail ID: ..
6. (a) Educational Qualifications (Start with Highest Qualification):
Sl.
No.
Examination
Passed
Name of the
University/Board
Month
& Year
of
Passing
Subject/
Specialization
% of Marks/
Grade (CGPA)
Division / Class
(b) Have you qualified NET / SLET/GATE?
.........................
7. Prizes, Awards, Rank received etc. (if any, attach certificate): ....................
.........................................................
.........................................................
8. (a) Post held at present:
Post held
Date of Appointment
Nature of the Post
(Temporary/Probation/
Permanent)
Name & Address of
Employer *
* Copy of appointment order to be attached
(b) Present Pay Scale: AGP/GP Any other Pay:..........
Basic Pay: ........ Dearness Allowance: ..... Gross Pay: ..
Emolument: ..
(c) Type of organization (Government/Semi-Government/Govt. Aided/Autonomous Body/ Private etc.)
................
................
9. Professional Experience (In the reverse chronological order):
Sl.
No
.
Name of the
Employer
Post held
Period of Employment
From
Pay Scale and
Basic Pay
drawn
Total
Emolument
Reasons for
Leaving
To
10. (a) Total Experience:
(i) Teaching
U.G.:.Year(s)
..Month(s)
P.G.:.Year(s)
.. Month(s)
(ii) Research (excluding Ph. D duration) :
.Year(s)
.. Month(s)
(iii) Industrial
.Year(s)
..Month(s)
.Year(s)
..Month(s)
(b) Any break in Service: Yes/No
If yes, state the period of break & reasons:
.
11. (a) Thesis supervised: Ph. D. (If any)
Sl.
No.
Title of the Thesis Supervised
Completed (year)
In progress
(With Status)
Principal or
Co- Supervisor
In progress
(With Status)
Principal or
Co- Supervisor
(b) Thesis supervised: M. Tech. / M.S. / M. Phil.
Sl.
No.
Title of the Thesis Supervised
Completed (year)
(c) List of Publications (International Journals, Identify whether SCI): Attach the Reprint of SCI journals
only
Sl.
No.
Journal Name
with ISSN/doi
Impact
Factor
Vol.
No.
Year/Page Nos.
Authors
Title of the paper
SCI
Yes/No
(d) List of Publications (National Journals, Identify whether SCI): Attach the Reprint of SCI journals
only
Sl.
No.
Journal Name
with ISSN/doi
Impact
Factor
Vol.
No.
Year/Page Nos.
Authors
Title of the paper
SCI
Yes/No
(e) Research Activities (with documentary evidence):
Sl.
No.
Sponsored/ Consultancy
Projects
Duration (date)
From
Sponsoring
Authority
Funds
Sanctioned(Rs.)
Present Status
(Completed/
In progress)
To
(f) Conference/ Symposium (International level) attended (Applicable if full text of paper is published in the
proceedings):
Sl.
No.
Name of the International
Conference/Symposium with Venue
Month/ Year /
Page No.
Vol. No./
Issue No.
Title of the paper
(g) Conference/ Symposium / Training Programs (National level) attended (Applicable if full text of paper is
published in the proceedings):
Sl.
No.
Name of the National
Conference/Symposium / Training
Programmes with Venue
Month/ Year
/ Page No.
Vol. No.
/Issue No.
Title of the paper
(h) Conference / Seminar / Workshops organized as Coordinator/Chairperson:
Sl.
No.
Title of the Conference /
Seminar / Workshop organized
Month/Year
Venue
Sponsoring Authority
(i) Summer / Winter Schools/ Training Programmes organized / attended:
Sl.
No.
Title
Venue
Duration
Sponsoring Authority
(j) Experiments or Computational design projects added to Teaching labs:
Sl.
No.
Name of the Lab. & Institute
Title of the Experiment / Design
Project
Year in which added
(k) Any E-learning material prepared for Teaching / Laboratory:..............
.............
12. Administrative experience: (e.g. Dean /Hostel Warden/HOD etc.)
Sl.
No.
Name of the
Assignment
Duration
Nature of responsibility
13. Membership of Technical Societies :..........
(Including Membership no.)
............
14. Extra Curricular Activities: ..........
............
15. Please give details of three referees (Not related to the candidate), At least one should be the current /
previous employer:
(i) Name: ..............
(i) Name: ..................
Designation: .............
Designation: ........
Full Address:........
Full Address: ......
...................
.....................
...................
.....................
Contact No. ..........
Contact No. ............
E-mail:..........
E-mail:......
16. Any other relevant information
:.............
................
................
DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief.
I understand that misleading or wrong information supplied may lead to summarily rejection of
application /appointment (if found subsequently).
Date:
Place:
-----------------------------------(Signature of Applicant)
--------------------------------------------------------------------------------------------------------------------------------
Summary Sheet for Teaching Posts
National Institute of Technology Puducherry, Karaikal 609 605
(All data to be filled by the candidate with documentary evidence for scrutiny)
Name of the Candidate:
Post applied for:
Sl
No
1
Degree
Department:
Name of Institute/ University
U.G.
P.G.
Ph.D.
Experience
( In Years / months)
AGP 6000 / 7000
/ 8000 or
equivalent
Year of Passing
% of Marks /
Grade (CGPA)
AGP 9000 or
equivalent
AGP 10,000 or
equivalent
Teaching / Research
After P.G.
Teaching
Research
Industrial
Total
Administrative
Experience
No. of Publications in
SCI Journals only
After Ph.D.
Internationa
l Journal
National
Journal
Internation
al
Conferenc
e
National
Conference
P.G.
(Ongoing)
P.G.
(Completed)
Ph.D.
(Ongoing)
Ph.D.
(Completed)
No. of Thesis
Supervised
No. of Conferences /
Seminars / workshops
Organized
Sponsored Research
Projects
Nos
Consultancy Projects
Nos
No. of Books
No. of Patents
International Level
Project Amount
(Rs. 2 lakhs to < 5
lakhs)
National Level
Project Amount
(Rs. above 5 lakhs)
Project Amount (Rs. In lakhs)
Authored
Co - authored
For
Office
Use
10
Providing this information is Mandatory. If space is left blank answer will
be considered as NO.
Answer
Yes /
No
(i) Are you B.Tech. / M.Sc. / M.A. from IIT / NIT/IISc?
(ii) Are you M.Tech. / Ph.D. from IIT / NIT/IISc?
(iii) Have you worked on any teaching post in IIT / NIT/ IISc/Govt.
Organization?
(iv) Have you been a rank holder during Academic Career in
NIT/IIT/IISc/University?
(v) Have you prepared e-learning materials (Teaching/Lab)? / Do you have
exposure/expertise in equipments (research/lab)? /Have you cleared
NET/SLET
(vi) Branch of study: B.Tech. / B.Sc / B.A :
Branch of study: M. Tech. / M. Sc / M.A:
Ph. D Title:
Note:
1. Kindly enclose 1 best published papers in SCI (Science Citation Index)
Journals only.
2. Above information should be supported with certificate/Degree/Documents
Place:
Date :
Signature of the candidate
