BANGALORE UNIVERSITY

A. Name & Address of the Applicant

Day Month Year

B. Age & Date of Birth Age

Whether you belong to SC/ST/OBC/Please Indicate

C.
Category
II Details of Employment at Present

A. Name of the Employer

From To
B. Date of Joining

III Academic Qualifications : (Copies of Certificates enclosed/Not Enclosed) Yes/No

IV Educational Career :
Length of
Year of
Examination Name of School/College with Course Marks
Passing/obtaining Percentage
Degree Passed University pursued obtained`
the Degree
From To
1 2 3 4 5 6 7
A. B.A./B.Sc./ I
B.Com/ B.E. II
(for all the
III
years)
IV
Total
B. M.A./M.Sc./ I
M.Com/ M.E.
II

Total
C. M.Phil Year of Passing Result Marks Obtained Percentage

D. Ph.D., Year of Obtaining the

Title of the Paper Enclosed
Degree

V. Teaching Courses taught

Name of the Number of Year or
Experience : Under Graduate/ Graduate/
Institution/Organisation Month
(if any) Advanced/ Post Graduate

VI. Any other examination passed : including NET Examination Yes/No

VII. Whether sent through proper Channel Yes/No

The above particulars furnished by me are true and actually correct to the best of my knowledge.

Date :

Place : Signature of the Candidate

 BANGALORE UNIVERSITY
Jnana Bharathi, Bangalore – 560 056

Please affix a signed

APPLICATION FOR THE POST OF
Passport size
Photograph here

IN THE DEPARTMENT

SPECIALISATION
(only when it is mentioned in the advertisement

1. Name in full (Block Letters)

Age & Date of Birth

Day / Month / Year

Place of Birth

State whether you belong to SC/ST/GM/OBC

(Please enclose Certificate)

Nationality

Married/Single

2. Address (Block Letters) (Please give your permanent address and the current address, if different)
(a) Permanent Address (b) Current Address

3. Employment (Please give your employment in sequence with the latest employment at the top.
Date of Date of Designation & Nature Pay & Scale (Basic
Name of the Employer
Joining leaving of Employment Pay to be specified)
4. Educational Carrer
Year of stay in Year of
Examination Length of Class/
Name of School/College the passing/ Subjects
Degree Course Grade/
with University School/College Obtaining Taken
Passed Pursued Division
(From-To) the Degree

5. Teaching Experience (if any)

Courses taught
Institution/Organisation Number of Year
Under Graduate/Graduate/Advanced

6. Research or Technical
a) If you have been engaged in research, please give the details. Attach a list of all papers published by you
giving proper reference to the journals, etc., It would be preferable if you enclose 7 copies of these papers
which you consider significant.
b) If you are engaged in Technical/Scientific activity, such as design or development of scientific equipment or
mathematical analysis/programming etc., please give a short account stressing your own contribution.
Enclose any publication/report which may have resulted from this work.

c) Research Projects / Sponsored Projects carried out / on going, consultancy Projects (Enclosed Details)
d) Research Guidance if any,
7. Professional Experience
Please include any specialised training. Industrial/Professional Experience/Service in the statutory
bodies/Government/Semi-Government/and other renowned Establishment/Corporation, etc., other than required
for your academic degrees.
Year of Stay Kind of Experience & Degree of
Organisation
(From - To) responsibility

8. Affiliation with Professional Bodies and Societies (India & Abroad)

Professional Organisation Year of Selection Grade of Membership

9. (a) Whether the applicant knows Kannada

Languages that you know including Second Language

(b)
(Indian & Foreign)
Read only Speak only Read & Speak Read, Write & Speak Exams. Passed, If any

If offered the Post, time required by you to join

10.
duty

Whether you are prepared to accept minimum

11.
salary of the Scale
12. References :
Please give names and address 1. Name, Occupation &
of two Scientists or Professional Position Address :
persons who are intimately
acquainted with your academic
and technical work

2. Name, Occupation &

Position Address :

13. List all Enclosures to this

application (including copies of
testimonials)
 14. Any additional information that you wish to give

15. Please give a brief statement about the Technical/Scientific activity you propose to pursue if you join the
University
This is an important statement of your objectives of work and should be carefully and succinctly written. Your
statement should be in technical terms and include a definition of your project, its technical importance and
your approach.

16. Whether the required application fee has been paid and the receipt
enclosed? If so, indicate the amount, receipt number and date Rs.

Receipt No.

Date :

Rs. 1000/- in case of Associate Professor/ Assistant

a) Rs. 500 for SC/ST
Professor / Professor (General)
1. I hereby declare that the entries in this form are true to the best of my knowledge and belief.

2. I have carefully read the University Grants Commission/All India Council for Technical Education/Council
of Architecture/Guidelines prescribing the minimum qualification/experience etc., in so far as they are
applicable to the post for which I am submitting my application and I declare that I fulfil the minimum
qualifications/experience etc., in this regard.

Date :

Place : Signature of the Candidate

 FOR OFFICE USE ONLY

The application with all the enclosures furnished by the candidate are forwarded to the Chairman/ Chairperson, of the
concerned Department of the University for verification of the documents and scrutiny of the application, with reference
to the University Notification and to submit the report to the Registrar, Bangalore University, Bangalore, along with a
covering letter.

Dated : Registrar

SCRUTINY AND VERIFICATION REPORT

No. Dated :

I have gone through the application and also the enclosures furnished by the candidate and on my scrutiny I am
satisfied that the candidate under reference fulfils all the requirements, as laid down in the University notification under
reference and the candidate may be invited for the interview.

If the candidate is not eligible, please furnish the details.

Bangalore Chairman/ Chairperson

Department of :

RECOMMENDATION OF THE CONCERNED OFFICER

The scrutiny report furnished by the Chairman/Chairperson of the concerned department is accepted and the candidate
concerned may / may not be invited for Interview.

Bangalore : Registrar

W.D.1288-BUP-3000x8 sets-Feb 2006