Sardar Vallabhbhai Patel Institute of Nursing – Vasad
SUMMARY SHEET (To be written legibly or typed)
Name : Date of Birth:
Category:
Post applied for: Department:
Qualifications: Degree Class/Grade Year University
UG
PG
PhD
Others
Total Experience: Years Post Ph.D. Experience: Years
Teaching:
Position Basic Pay AGP From To
Professor
Associate Professor
Assistant Professor
Tutor
Industry: Years
Research: Years
Present Employer (if applicable) and monthly emoluments:
No. of Publications National International
Journal Papers
Papers in Conference Proceedings
Books
Chapters in Books
Patents
M.E. thesis Guided
Ph.D. thesis Guided
Total value (Rs. in Lakhs)
Projects
2 Lakhs 2 to 5 Lakhs 5 to 30 Lakhs > 30 Lakhs
Research
Consultancy
Awards / Distinctions, if any:
Place :
Date: Signature of the Applicant
Sardar Vallabhbhai Patel Institute of Nursing – Vasad
B/h. S.T. Bus Depo, Vasad – 388 306, Dist: Anand
Phone No: 9510782981, 82,83 & 84
Mail: contact@svitvasad.ac.in
Recent passport size
color photograph to
be affixed
APPLICATION FOR THE POST OF _______________________ in ________________
(Department)
SPECIALIZATION _________________________________________________________
1 Name in Full: Gender:
2 Nationality: Place of Birth:
Date of Birth: Age:
3 Category: Marital Status:
4 Particulars of Educational Qualifications:
Sr. Degree Obtained & Name of the Year of % of Class/
No. Branch / Specialization University/Institute Passing Marks/ Division
(specify) CGPA
1 Bachelor’s Degree
2 Master’s Degree
3 Ph.D. Degree
4 Others (if any)
5 Title of PG/Ph.D. Thesis with name of Ph.D. Guide.
Degree Title of Thesis Guide University
i) P.G.
ii) Ph.D.
6 Details of Experience:
i) Teaching Experience : years Post Ph.D. Experience years
Sr. Name of the organization Designation Date of Date of Last Pay Band and
No. where employed Joining leaving Grade Pay*
1.
2.
3.
4.
ii) Research Experience: years
Sr. Name of the organization Designation Date of Date of Last Pay Band and
No. where employed Joining leaving Grade Pay*
1.
2.
3.
4.
iii) Industrial Experience: years
Sr. Name of Industry Designation Date of Date of Salary Drawn
No. Joining leaving
1.
2.
3.
7 i) Total Research Publications / Presentations
Sr. Nature Published Accepted
No.
1. Books
2. Chapters
National
3. Refereed
Journals International
National
4. Presentations
(Proceedings) International
ii) No. of PG dissertations / Ph.D. thesis guided: P.G. Ph.D.
8 a) Minimum monthly Salary expected: Rs………………………………………
b) Present monthly salary. ………………………………………………. (Attach copy of latest salary slip)
c) Time required to join the Institute, if selected: _________________________
9 Honors / Awards / Distinctions received, if any:
10 Names 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:
Name:
Designation:
Address:
Email: Mob.No.
I) Name:
Designation:
Address:
Email: Mob.No.
11 I) Address for correspondence:
Email: Mob. No.
II) Permanent Address:
12 Any other information relevant to the Post applied for, such as:
i) Memberships/Fellowship and position of responsibility in Professional Societies:
a)
b)
ii) Attainments in sports and extra-curricular activities (including N.C.C.)
a)
b)
13 Candidate should submit BIO-DATA separately.
14 Copies of documents enclosed:
O School Leaving Certificate
O PG degree Certificate
O PG Last Two Semester’s Marksheet
O UG Last Two Semester’s Marksheet
O Ph.D. degree Certificate
O Experience Certificates
O Other University Endorsement Letter for the post of Director/Principal, Professor,
Associate Professor/HOD to consider teaching experience.
O UGC approval letter for the degree awarding private/deemed universities outside of
Gujarat.
O Latest Salary Slip
Caste Certificate, if applicable.
PAN
AADHAR
Declaration:
I hereby solemnly declare that the information furnished above is true and correct and I am responsible
for the veracity of the same.
Place:
Date: Signature of the Applicant
Important Note:-
1. Every application must be accompanied by self-attested photo copies of documents in
support of claims made by the candidate.
2. Applicant in service must forward application through the employer.
3. Incomplete application/s will be rejected.
4. Applicants called for Interview will have to come at their own cost.
(To be filled in by the present employer)
No Objection Certificate
Place: Signature of the Forwarding Authority:
Date: Designation:
Office Seal:
