DISCIPLINE: Referred FACULTY CODE:

Name and Department of the Staff (NGI) referred:

APPLICATION FORM BFA (SENIOR)

(Applicable for the Members of Faculty from Self-Financing Colleges and Universities with
10 to 25 years of experience and still in regular service.)

1. Name (in Block Letters) :

2. Date of Birth :

3. Designation : Recent Photo

4. College / Institution / University :

5. Department :

6. Discipline :

7. Area of Specialization :

8. Address for Communication :

a) Mobile No. :

b) Email ID :

9. Qualification

Name of University
Degree Specialization Year of University % of Marks
the Degree Rank if any
Passing

1
Bachelors

Masters

M. Phil.

Ph. D.

D. Sc. /
D. Litt.

10. Additional Qualification

S. No. Course Major Specialization University Duration

1. PDF
2. P. G. / P. G. Diploma

3. Any Other

11. Teaching Experience as on 01.06.2017

Classes No. of Years

U. G.

P. G.

12. Achievements in Teaching (Enclose details if Yes)

a) Contribution towards syllabus enrichment - Yes/No

b) Innovative teaching / learning methodology - Yes/No

13. Research Guidance (in numbers)

M. Phil. Ongoing Completed

Ph. D. Ongoing Completed

14. Research Projects

S. Title of the Major / Minor Funding Sanctioned Duration Ongoing /

2
No. Project Agency Amount Completed

15. Research Papers Published (in numbers)

Engineering / Agriculture / Veterinary Science / Faculty of Languages / Arts / Humanities

Medical Science / Social Sciences / Library/ Physical
Education/ Management
Non
Non Refereed Conference
Refereed Conference
Refereed Refereed Journals With Proceedings
Journals with Proceedings as
Journals Journals ISSN/ISBN as full
ISSN/ISBN full papers
Nos. papers
Nos.

Note: Science Citation Indexed / UGC Approved Journals only (Negative Marks for
other Journals listed here)

3
 16. Books Published

Publishers No. of books ISBN/ISSN Sole Co-Author Chapters

published Number Author

International
Level
National Level

Others/ Local

17. Paper Presentation in Seminar/Conference/Symposium/Workshop (in numbers)

State National Level International*

* Organized Abroad or atleast one foreign resource person if organized in India

18. Seminars / Events Organized (in numbers)

State National Level International*

* Organized Abroad or atleast one foreign resource person if organized in India

19. As Chairperson in Seminar/Conference/Symposium/Workshop (in numbers)

State National Level International

(Organized Abroad)

20. Visits Abroad

S. No. Country Dates of Visit Purpose

21. Research Activities (in numbers)

4
 Projects done in collaboration with

National Companies/ Industries/ Research Organizations

International Companies /Industries / Research Organizations

22. University Assignments / Representation

S. Period
University Bodies University
No. From To

1 Syndicate Member
2 Senate Member
3 Chairman - Board of Studies
4 Member - Board of Studies

5 Chairman Examination
6 Member AICTE / UGC / University
Inspection Commission / University
Standing Committee

23. Ph. D. Viva-Voce (in numbers)

As External Examiner

24. Awards/ Recognitions

25. Projects Outcome / Outputs

Patent / Technology Transfer / Product / Process
26. Any Other
Please Mention:

Are you a recipient of Best Faculty Award? If yes, furnish the details of Discipline, Category
and the Year.

Yes No

N. B.:

1. No documents are required to be attached with the application(except for Item 12)
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 2. Short listed candidates should attend the interview on 03.12.2017 at Nehru Arts and
Science College, Nehru Gardens, Thirumalayampalayam, Coimbatore 641 105 with the
following:
i. An attested copy for each supporting document
ii. All original documents
iii. Two photographs
iv. Power point presentation (for 15 minutes)
2. The score of the presentation and interview will be added to the score of the candidate as
per the application,
3. Marks will be awarded on the basis of verification of original documents.
4. The candidates with the best overall scores shall be presented with the Awards on
15.12.2017 at a prestigious and solemn function at P K Das Auditorium.
5. Invitation will be sent to all the winners.

Declaration

I hereby declare that the information furnished is true to the best of my knowledge.

Name :
Signature :
Date :

Certificate

Certified that I have verified the facts furnished above and found them to be true.

Forwarded for consideration

PRINCIPAL / REGISTRAR
(Name and Signature)

Note: Certificates (Originals and copies to be brought for interview if shortlisted)