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) Fathers Name: _________________________________ Occupation: ______________
b) Mothers Name: ________________________________ Occupation: ______________
3. Nationality: _____________________

Religion:

Date of Birth: _____________ Age: __________

OC

BC

OBC

SC

_____________

Marital Status: __________________

ST

4. Category

Caste:

5. i)Particulars of Educational Qualifications:

Sl.
No.

Degree Obtained &

Branch /
Specializ
ation
(specify)
Ph.D. Degree

Masters Degree

Bachelors Degree

Others (if any)

Year of
Passing
Name of the Institute

% of
Class/
Marks/ Division
CGPA

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 :
Sl.
No.

Name of the
Institute where
Employed

Years
Designation

Post Ph.D. Experience

Date of
Joining

Date of
Leaving

Experience
in Months

Years
Salary
drawn

1.
2.
3.
ii) Research Experience :
Sl.
No.

Name of the
Organization
where Employed

Designation

Years
Date of
Joining

Date of
Leaving

Experience
in Months

Salary
drawn

1.
2.
3.
iii) Industrial Experience:
Sl.
No.
1.
2.
3.

Name of Industry

Designation

Years
Date of
Joining

Date of
Leaving

Experience
in Months

Salary
drawn

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

Sl.
No.
1.
2.
3.
4.

Nature
Books
Chapters
Refereed
Journals
Presentations
(Proceedings)

Published

Accepted

National
International
National
International

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

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

P.G.

Ph.D.

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

Year

Amount (Rs.)

1.
2.
3.

10. Have you got Research Funding? If yes

Sl. No.
Name of Organization
1.
2.
3.
11. Do you have contact with Industries? if yes
S.No

Name of the Contact

Person

Name of the Organization

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:

3

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
4

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