Professional Documents
Culture Documents
Self attested
photograph
DD Number
Amount & Date
Name of issuing bank
Day
Month
Year
Year
Month
Day
Age on 16.11.2015
5. a) Marital Status : Married/Unmarried
b) Gender : Male / Female
6. a) Permanent address
Phone (withSTD
code)/ Mobile No.
7. Nationality
Religion
8. Category OBC (VH)/GEN (HH)/GEN
(OH)
Percentage of disability
(please attach true copy of certificate )
b) Correspondence Address
E-mail ID
Specialization
Board/University
Passing
Year
Class/
Division
% marks/
CGPA
10th
12th
Bachelors Degree
Masters Degree
Ph.D.*
Others (if any)
*Please mention date of award of PhD degree.
11. Thesis/Dissertation topic of
(a) PG __________________________________
(b) Ph D __________________________________________
12. Field of Specialization ______________________________________________
13. Details of employments:
(i) (a) Teaching Experience
S.No.
Name and
address of
employer
Total..
Designation
Payscale
From
Post PhD..
To
Duration
in
yy/mm/dd
Reasons
for
leaving
(ii) Industry
S.No. Name and
address of
employer
(iii) Research
S.No. Name and
address of
employer
Designation
Payscale
From
To
Duration
in
yy/mm/dd
Reasons
for
leaving
Designation
Payscale
From
To
Duration
in
yy/mm/dd
Reasons
for
leaving
14. Research Activities: (Specify total No. and attach list of publication in the each category as
per format given)
(a) Paper publications in International Journals
(i) In SCI
S.No. Title of paper
Co-author(s),
if any
Name of the
Journal
Vol. &
Year
Pages
Name of the
Journal
Vol. &
Year
Pages
Name of the
Journal
Vol. &
Year
Pages
Title of paper
Co-author(s),
if any
Title of paper
Co-author(s),
if any
Title of paper
Co-author(s),
if any
Date &
year
S.No.
Title of paper
Co-author(s), if
any
PG
Guided
Ongoing
Status
(Completed/
ongoing)
Date &
year
Nature of Work
Co-supervisor
(if any)
Date
Publisher with
address
Co-consultant, if
any
course
Amount
Completed/
ongoing
Accomplishment
Responsibilities
1st Reference
Name
Name
Position
Position
Address
Address
Phone No.
E-Mail ID
Phone No.
E-Mail ID
24. Did you previously apply for any post in this Institute? If yes, give particulars:
.
APPLICANTS DECLARATION
I hereby declare that I fulfill the eligibility conditions to the post and that the statements
made by me in form are true, complete and correct to best of my knowledge and belief.
Place:.
Signature of Applicant
Date..
Name
NO OBJECTION CERTIFICATE TO BE FURNISHED BY THE CANDIDATE WHO IS
ALREADY IN EMPLOYMENT, REGULAR/TEMPORARY BASIS.
Certified that Mr/Ms.--------------------------Son/Daughter of Shri---------------------------------------------is a permanent /temporary /adhoc employee of the department/ institution/
organisation since-------------------------------. The Department/Institution/organisation has
no objection if he/she is appointed in National Institute of Technology Patna against the
posts advertised by the NIT Patna vide advertisement No.