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VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY, NAGPUR 440010
( Advt No. VNIT/ P-ASP-AP/01/2012)Application Proforma for the post of Professor/Associate Professor/Assistant Professor
(Candidates are advised to read general instructions and information, before filling up the Application form)
APPLICATION FOR THE POST OF
Assistant Professor / Associate Professor / Professor in _________________(Department)
Academic Grade pay ___________________
Area of Specialization(If any)_________________________________________________
Current Area of Research____________________________________________________
1.Name in Full: _____________________________________________ Gender: M / F
(In Block Letters)
2. a) Fathers Name: _________________________________
b) Mothers Name: ________________________________
3. i) Address for correspondence: _____________________________________________
_____________________________________________
_________________Phone No.____________________
Mobile No.___________________
E-mail address: ________________________________
ii) Permanent Address : _________________________________________________
_________________________________________________
_________________________________________________
4. Nationality: _____________________
Date of Birth : dd/mm/yy Age: Years Months
In case of OBC, whether belong to Non creamy layer Yes / No
(Applicable for the post of Assistant Professor only)
VNIT Nagpur, Faculty Advertisement February 2012
5. Category: SC ST OBC UR PWD
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6. Particulars of Educational Qualifications
Sl.
No.
Degree Obtained &
Branch / Specialization
(specify)
Name of the
University/Institute
Year of
Passing
% of
Marks/
CGPA
Class/
Division
1 Bachelors Degree2 Masters Degree
3 Ph.D. Degree
4 Others (if any)
7. JOB/RESEARCH EXPERIENCE
NATURE OF JOB DETAILS
(ORGANISATION, DESIGNATION)
YEAR
(DURATION)
PAY SCALE
&
LAST PAY DRAWN
TEACHING
RESEARCH
INDUSTRY
ADMINISTRATIVE
8. RESEARCH AND PUBLICATIONS: (Please provide details on separate sheet)
a) Number of Projects Supervised : (B. TECH/BE/BArch) (M.TECH/M Arch.) (M.E./MArch by Research / M.S.)
b) Number of Ph.D. Scholarssupervised
:
(Completed) (Ongoing)
c) Number of Publications
a) International :
(Refereed Journals) (Conferences/Seminars/Workshops)
b) National :
(Refereed Journals) (Conferences/Seminars/Workshops)
d) Number of Books Authored :
e) Number of Patents :
9 . (a) Minimum Pay expected: Basic and AGP: ...
(Should not be treated as accepted even if called for interview and selected)
(b) Time required joining the Institute, if selected: _________________________
10. REFERENCES:
Name and addresses of two professional referees (who are not related to the applicant) who are in aposition to testify from their personal knowledge as to the suitability of the applicant for the post
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applied for. Candidates have to arrange to send recommendations from these referees directly to
Dean(FW), VNIT Nagpur.
i) Name : __________________________________________________
Status : __________________________________________________
Address : __________________________________________________
__________________________________________________
e-mail and Phone : ______________________________Mobile______________
ii) Name : __________________________________________________
Status : __________________________________________________
Address : __________________________________________________
__________________________________________________
e-mail and Phone : _____________________________Mobile_______________
11. Any other information relevant to the Post applied for, such as:
i) Position of responsibility in Professional Societies:
a)
b)
ii) Attainments in sports and extra-curricular activities (including N.C.C.)
a)
b)
iii) Language fluency:
Language Read Write Speak
iv) Awards and Recognition including scholarship
v) Other Academic and Corporate Activities
vi) Any Other Relevant Information, You may like to furnish
12. DETAILS OF TESTIMONIALS / CERTIFICATES / DOCUMENTS ENCLOSED:
(N.B.:
Every application must be accompanied by photo copies of documents in support of claims made by thecandidate in respect of date of birth, academic qualifications, practical training, experience, caste,
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projects, publications, consultancy etc.
(Do attach attested copies of all documents/ certificates in support of the information furnished by you in
Annexure-XV.)
1. _________________________________ 2. _______________________________
3. _________________________________ 4. ________________________________
5. _________________________________ 6. ________________________________
7. _________________________________ 8. ________________________________
13. IF OFFERED, would you be willing to accept one step lower faculty position than the post you had
applied for? : YES/NO
14. If you are selected for this post at VNIT Nagpur, what would be your plan of action at VNIT Nagpurfor near future? Explain in brief in less than 100 words in your own handwriting.
List out three of your the best of Publications (Include one set of Xerox copy in Annexure-XII) :
1.
2.
3.
Name & Signature of the Candidate:
Date:
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DECLARATION BY THE APPLICANT
I, the undersigned, whose photograph appears on the page, hereby
declare that I have carefully read and understood the instructions and
particulars provided by the Institute and affirm that every informationthat I have furnished is true to the best of my knowledge and belief.
I understand that I alone will be responsible for any consequencesarising out of incorrect and / or incomplete information furnished in this
application.
Place : _______________________ Signature of applicant : _______________________
Date : _______________________ Name : ___________________________________
____________________________________________________________________________________
ENDORSEMENT BY FORWARDING AUTHORITY
(Only for applicants who are in service of Govt./ semi Govt. /PSUs/Universities/ Academic Institutions)(To be filled in by the present employer)
Forwarded / Not Forwarded the application of Shri / Dr________________________
_____________________________.
Place: Signature of the Forwarding Authority:
Date: Designation:
Office Seal:
___________________________________________________________________________________
FOR OFFICE USE ONLY
1. Application received on: __________________________________________________________
2. Remarks __________________________________________________________________
VNIT Nagpur, Faculty Advertisement February 2012
Attesting officer to sign across the ph
Affix recent
coloured photo
here
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VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY, NAGPUR 440010
( Advt No. VNIT/ P-ASP-AP/01/2012)Self Appraisal SUMMARY SHEET (To be written legibly or typed neatly)
Name : Mr./Ms. Date of Birth:
Category:(SC/ST/OBC/UR): PWD:Yes/No. If OBC, belong to non creamy layer:Yes/No.
(Applicable for the post of Assistant Professor only)
Post applied for: Department:
Qualifications: Degree Division Year University
UG
PG
PhD
Others
Total Experience: Years Post Ph.D. Experience: Years
Teaching:
Position Basic Pay AGP From To
Professor
Assoc. Prof.
Asst. Prof.
Industry/Research:
Position Basic Pay AGP From To
Publications National International
Journal Papers
Proceedings/PapersBooks / Chapters
Patents
Ph.D. thesis Guided
M Tech Thesis guided
ProjectsTotal value (Rs. in Lakhs)
2 Lakhs 2 to 5 Lakhs 5 to 30 Lakhs > 30 Lakhs
Research
Consultancy
Awards / Distinctions, if any:
Short term courses organized Conference / workshop organised
Present Employment (if applicable) and Basic Pay:
Date: Signature of the Applicant:Office use only
Remarks of Scrutiny committee: Eligible/ Not-Eligible
Signatures of Scrutiny Committee members HoD/Chairman
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Annexure-I Details of Experience
i) Teaching Experience : years Post Ph.D. Experience years
Sl.
No.
Name of the
organization where
employed
Designation Date of
Joining
Date of
leaving
Last Pay Band
and Grade Pay*
1.
2.
3.
4.
ii) Research Experience: years
Sl.
No.
Name of the
organization where
employed
Designation Date of
Joining
Date of
leaving
Last Pay Band
and Grade Pay*
1.
2.
3.
4.
iii) Industrial Experience: years
Sl.
No.
Name of Industry Designation Date of
Joining
Date of
leaving
Salary Drawn
1.
2.3.
* Prior to 6th CPC indicate the Basic Pay.
Annexure-II TEACHING EXPERIENCE
SerialNo.
Title of course taught Postgraduate or Undergraduate
Sole instructor or withothers
Year
Annexure-III POST GRADUATE / Ph.D THESIS SUPERVISION
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SerialNo.
Name of the Student /research scholar
Title of thesis Doctorate or Masters level
Year ofcompletion (orin progress)
Co-guide(s)(if any)
Annexure- IV Developing / Developed new courses
SN Details of new courses
NB: Include the new courses you would like to develop if selected in VNIT.
Annexure-V Developing / Developed laboratories.
SN Details of Laboratory / Experiments
NB: Include the new laboratories / experiments you would like to develop if selected in VNIT.
Annexure-VI SPONSORED/ RESEARCH PROJECTS UNDERTAKEN
Sponsoring Agency Title of project Amount of grant Period Co-investigators (if any)
NB: Include the new sponsored / Research project you would like to undertake if selected in VNIT.
Annexure-VII CONSULTANCY WORK DONE
Organization Title of project Amount of grant Period Co-investigators (if any)
NB: Include the type of consultancy work you are planning if selected in VNIT.
Annexure-VIII INDUSTRIAL EXPERIENCE/INTERACTION
Organization Nature of work Period
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Annexure-IX CONTINUING EDUCATION PROGRAMMES CONDUCTED
Organization Title of the program Period
NB: Include the continuing educational programmes you would like to conduct / organize if selected inVNIT.
Annexure-X SHORT TERM COURSES/WORKSHOPS/SEMINARS ORGANIZED
Organization Title of the program Period
NB: Include Short term courses/ workshops/ seminars you would like to conduct / organize if selected inVNIT.
Annexure-XI LIST OF PUBLICATIONS
SN Papers in refereed journals
SN Papers in conference proceedings
SN Papers in Seminar / Workshops
NB: Enclose reprints of the best papers (about three) in your judgement. List those PUBLISHED andACCEPTED separately
Annexure-XII SHORT TERM COURSES/WORKSHOPS/SEMINARS CONFERENCES ATTENDED
Organization Title of the program Period
Annexure-XIII MEMBERSHIP OF PROFESSIONAL BODIES
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Professional Body Member no./ID Remarks
NB: Include names of professional bodies whose membership you would like to opt if selected in VNIT.
Annexure-XIV PROFESSIONAL TRAINING RECEIVEDProfessional Body Brief on training Period
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Annexure-XV Attested Xerox Copy of Certificates
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