SVIMS Recruitment 2015 Application Form For Research

Staff

APPLICATION FORM FOR RESEARCH STAFF IN VIROLOGY LAB,

DEPT. OF MICROBIOLOGY

LAST DATE

02-04-2015

Post applied for:

1. Name (in Block Letters)

2. Fathers Name

3. Address for communication.:

Contact Nos

Email id

4. Date of Birth

D D

M Y

Y Y

Age (yrs)

& Age

5. Nationality & Religion

6. Academic Qualifications:
S.No.

Qualification

Group subjects studied

College, Place of study

& University

Period of study
From

1. Degree

(.................. )
2.

PG Degree
(speciality)

(.................. )
3. Ph.D./equivalent

4. Others

To

7. Details of previous appointments / research / teaching experience:

S.No.

Position

Name & Address of the

Institution

From

To

Experience in years
& months

1.

2.

3.

4.

8. No. of research publications in indexed journals:

S.No.

1.

2.

3.

4.

5.

6.

Authors Listing

Title of the Paper

Journal Name /
Year / Vol. / Page
nos.

Whether
Indexed

9.

Details of previous experience in handling research projects under the supervision of Chief
Guide/Principal Investigator (number of research projects completed/submitted (mention only if
pre-proposal accepted in case of ICMR extramural projects)- the document should be
recommended and undersigned by the Principal Investigator to certify that the candidate is
capable of writing/handling research projects.
S.No Name of the Principal
Investigator
1.

Title of the Research Project

Funding agency

Project ID

2.

3.

4.

This is to certify that Ms/Mrs/Mr/Dr/_________________________ has been working/ worked in the

above mentioned project(s) under my supervision. During his tenure he/she was sincere and
hardworking; hence I am recommending him/her for the position offered by SVIMS.

Principal Investigator

10. CV should be attached along with the application in case of possessing additional
qualifications and research experience. (photocopies of certificates shall be attached
to support research / teaching experience in the form of workshops, training programs
and CMEs attended).
11. Are you prepared to be considered for a post lower than the one applied: YES / NO.

12. If the post is offered, how much period is required for joining ________________

DECLARATION
I hereby declare that the contents of the application form and documents /
certificates submitted by me along with the application are absolutely true, correct and
authentic.

In the event of any of the statement in this application / enclosures found incorrect or
false at a later date, the undersigned is liable for necessary disciplinary action as per the
rules.

PLACE :
DATE :

SIGNATURE OF THE CANDIDATE

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