FAKIR MOHAN UNIVERSITY
VYASA VIHAR, NUAPADHI,
BALASORE, ORISSA 756020
Phone : (06782) 275787 Fax : (06782) 275768
APPLICATION FORM FOR THE APPOINTMENT OF TEACHERS IN THE P.G. TEACHING DEPARTMENTS
(The entries in this form should be made in English by the candidate in his/her best handwriting)
1.
a) Position Applied For: .
Subject..
b) Advertisement No. & Date:
c) Category (SC/ST/GEN/SEBC/PH): .
d) Bank Draft Number and Date: ..
2.
Full Name of the Candidate
in Block letters (Surname underlined):
3.
a) Date of Birth (In figure)
(In words)
: .
b) Birth Place: c) Passport No: .
d) Gender: .. e) Marital Status:
f) Nationality:
4.
a) Mothers Name
b) Fathers name
c) Mother Tongue
d) Any other language he/she can :
Read Write .. Speak
5.
Whether the candidate is qualified at UGC/CSIR NET(give details)
6.
Furnished details about Research Experience as JRF/SRF/PDF(Provide the proof from concerned
Institution in official letter head with letter number and date of joining and relief)
7. Mailing :
Email ID: ..
Permanent Address
Permanent Address
Mobile/Telephone No:
Mobile/Telephone No:
8.
Qualification in ascending order (one copy of all documents)
Sl
No.
9.
Examinations/ Degree
from Matriculation or
equivalent onwards
(Specify Hons. /
Distinction)
Name of the
University or other
examining body
Division/
Class
Perce
ntage
of
marks
Subject
Year
of
Passing
Field of Specialization
i)
Masters Degree stage
ii) M. Phil Stage
iii) Doctoral Degree Stage
iv) Post-Doctoral Research Stage :
10. Research Publications (Applicants of Associate Professor& Professor positions copies of 3 best peer
reviewed research papers and cover page of books if any to be attached)
a) Details of research paper published in:
I) National journals (Paper reviewed):
(Non-reviewed):
II) International journals (Peer reviewed):
(Others):
III) Chapter in books / Conference & Symposia Proceedings (With ISSN/ISBN Number):
b) Details of books authored/Edited (With ISBN Number) and names of all
authors:
c) Number of candidates supervised for Research Degree (M.Phil./Ph.D/D.Sc./D.Litt)
(Provide the list of candidates with year of award of Degree and copies of notifications
of the University)
Degree Awarded
Thesis Submitted
(With title of thesis) (With title of thesis)
M.Phil .
Ph.D
..
D.Litt /D.Sc.
.
.
d)
Details of Major/Minor research project and amount of the grant Undertaken as PI/CO-PI(mention the
funding agencies) of those projects: .
e)
Details of the seminar/conference attended and presented papers:
Invited/oral/poster (Provide list/Certificate to be produced along with API Score proforma):
Mention Chronologically with title of the paper presented, mode of presentation, venue and Data of
the Conference / Seminar, National / International / State Level / Regional):
.
11.
If appointed, when can the candidate join the Post:
12.
Membership or fellowship of learned societies or Accredited bodies
(Give details): ...
13.
Present scale of pay
Pay Band
14.
Sl
No.
AGP
D.A.
H.R.A
Any other
allowances
Total Emoluments
Teaching Experience (Experience certificate to be attached)
Sl
No.
15.
: Rs
Name of the
College /
University
Designaction
Nature of
the Post
(Tem./
Permanent
/ Ad-hoc)
Classes
Taught
UG
PG
Level Level
(Pass /
Hons.)
Period
(Give
dates
supportin
g of
joining
and
Relieve
order)
Length of
experience
Years month
s
Other experiences / employments
Name of post /
University / Institution
Date of
joining
Date leaving
Salary (scale of pay and
present basic pay)
Name & address of
the employer
16.
I) Have you ever been subjected to any disciplinary action as a student and /or as an employee?
II) Have you ever been dismissed /suspended from service?
17.
Any of the information in your support :
18 .
List of documents submitted with the applications :
1.
2.
3.
4.
. .
5.
6. ..
7.
..
8.
9.
10.
11.
12.
Declaration
I, solemnly declare that the entries made in this form are true to the best of my knowledge and
belief.
Date: .
Place : ...
Signature of the Candidate (in full)
CATEGORY III: RESEARCH, PUBLICATIONS AND ACADEMIC CONTRIBUTIONS
A)
(i) Published papers in journals ( Referred *& Non referred)
API Score:
Category IRefereed
-15
Category IINon- Refereed
-10
Refereed Journal: Wherever relevant to any specific discipline, the API score for paper in refereed Journal
would be augmented as follows: - (i) indexed Journals by 5 points; (ii) papers with impact factor between 1 and 2 by
10 points; (iii) papers with impact factor between 2 and 5 by 15 points; (iv) papers with impact factor between 5 and 10
by 25 points.
API for joint publications: Of the total score for the relevant category of publication, the first author and the
corresponding author / supervisor would share equally 60 % of the total points and remaining 40% shared equally by
other authors.
Sl.
No.
A)
Title
with
page number
Journal
Name
ISBN / ISSN/
Number
Referred / Non
referred
Whether
peerreviewed/
Impact
factor
(ii) Full papers in Conference Proceedings
Sl.
No.
Title
with
page
number
Details of
Conference
Publication
Article/Chapter
Title with page
numbers
ISBN / ISSN
no /
Book title,
Editor &
Publisher
ISBN
ISSN No
Whether
peerreviewed
No. of Coauthors(points
to be shared)
Article/Chapter
Title with page
number
Type
Book
(Book
Edited
book)
of
/
API Score
Whether
peerreviewed
Publisher
&
ISBN / ISSN
Nos.
Whether
you
are
the main
author
API
Score
10
5
3
5
No. of Coauthors(points
to be shared)
B)
(ii) Books / Edited books Published as a Single Author / Editor
API Score Category I Text/ Reference Books by International Publisher
Category II Text / Reference Books by National/Soc / Univ. Publi.
Category III Subject Books by Other / Local Recognized Publi.
Sl. No.
Whether
you
are
the main
author
API Score-10
B)
(i) Articles / Chapters published in Books
API Score (per Art / Chap) Category 1 : International Publication
Category 2: National / State / Central / Societies Publisher
Category 3: Subject books by other / Local Publisher
Category 4: Chapters in Knowledge- based Volumes
Sl. No.
No. of Coauthors
( points to
be
shared)
Whether
peerreviewed
Whether
you
are
the main
author
API Score
Whether
you
are
the main
author
API
Score
-50
-25
-15
No. of Coauthors
( To be
shared)
C)
Ongoing and Completed Research Projects and Consultancies
(I & ii) Ongoing Projects / Consultancies
API Score for Projects:
Cat I: (Sc-Rs 30 lakhs + Non-Sc: Rs 5 lakhs+):
Cat II: (Sc-Rs 5 lakhs + Non-Sc: Rs 3 lakhs+):
Cat III: (Sc-Rs 0.5 lakhs + Non-Sc: Rs 0.25 lakhs+):
Other approved projects of Univ/Other agencies :
20
15
10
5
API Sore for Consultancies (with evidence of sanction)
(Sc For every Rs 10 lakhs + Non-Sc: For every Rs 2 lakhs + ) : 10
API Score for Quality Evaluation (with evidence letter from granting organization)
Major (Completed) Project Eval: 20
Minor (Completed) Project Eval: 10
Sl.
No.
Title
Agency
(Funding,
Commissionin
g and / or
Collaborating)
Period
Output/ Impact, i.e.
Book/Paper
/technology
/Process
Grants(s)/Amou
nt mobilized in
Rs. (Lakhs)
Whether Principal
Investigator / Coinvestigator/
Consultant/Qualit
y evaluator
API
Score
(iii& iv) Completed Projects / Consultancies
API Score for Projects :
Cat I: (Sc-Rs 30 lakhs + Non-Sc: Rs 5 lakhs+)
Cat II: (Sc-Rs 5 lakhs + Non-Sc: Rs 3 lakhs+)
Cat III: (Sc-Rs 0.5 lakhs + Non-Sc: Rs 0.25 lakhs+)
Other approved projects of Univ/Other agencies
API Sore for Consultancies (with evidence of sanction)
(Sc Rs 10 lakhs + Non-Sc: Rs 2 lakhs + )
:
:
20
15
10
5
:
:
API Score for Quality Evaluation (with evidence letter from grading organization)
Major (Completed) Project Eval :
Minor (Completed) Project Eval :
10
20
10
For patent / technology transfer / product / process:
International
National
Sl.
No.
Title
Agency
(Funding,
Commissionin
g and / or
Collaborating)
Period
Output/ Impact,
i.e.
Patent
/Process
Grants(s)/Amount
mobilized in Rs.
(Lakhs)
50
30
Whether Principal
Investigator/ Coinvestigator
or
Consultant
/
Quality evaluator
D)
Research Guidance / Supervision
API Score Ph.D awarded 10; Ph.D. Submitted 7;
M.Phil. awarded 3
Sl. No.
M.Phil
Ph.D.
Number Enrolled
Thesis Submitted
Degree
awarded
API Score
API
Score
(E) (i) Training Courses, Refresher Courses, Orientation Courses, Teaching-Learning- Evaluation
Technology Programmes soft skill Development & faculty Development Programmes (* Maximum score for
Refresher course =30)
Cat I : (Not less than two week duration) :
Cat II : (Not less than one week duration) :
Sl. No.
Programme
Duration
20
10
Organized by
API Score
(ii) Papers presented in Conferences, Seminars, Workshops, Symposia:If a paper is presented in Conference / Seminar is published in form of proceedings, the points would accrue for
publication under Category III (A-ii) and not under presentation under Category III (E-ii). The same publication /
presentation cannot be claimed for score in both.
API Score Category 1 International
Category 2 National
Category 3 Regional
Category 4 Local
Sl. No.
Title of the
Paper
presented
Title
of
Conference /
Seminar
Organized by
10
7.5
5
3
API Score (E)
Whether
International
/
National / State /
Regional University
Level
(iii)
Invited Lectures and Chairmanships at national / International Conference / Seminar etc.
(Copy of the Invitation letter from the organizer to be enclosed))
API Score Category 1 International
10
Category 2 National
5
Sl. No.
Title
of
Lecture
Title
of
Conference /
Seminar etc.
Organized by
Whether
International
National
API Score
/
IV. API SCORES under Category III (with application of capping)
Sub-Category
Research papers(in Journals,/ Full
paper in Conference proceedings)
B. Research publications
( Books, chapters in books)
C. Research Projects / consulters
Research Guidance
Training Courses and Conference /
Seminar, etc
Total
Total
API
Score under
categories
Cap as % of API
cumulative score
in application
30
25
20
10
15
Score
claimed
subcategory
capping
in
after
LIST OF ENCLOSURES: (Please attach copies of certificates, sanction orders, papers, book title-& content pages etc.
wherever necessary)
1.
2.
3.
4.
5.
6.
7.
8.
Forwarded by HOD / Head of Institute
(with seal)
Signature of the candidate with
Date:Address:
