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Application for Academic Appointment

Indian Institute of Technology Gandhinagar


Instructions: Complete this application form and email this form along with all necessary annexures as a
single PDF file to faculty.recruitment@iitgn.ac.in . See detailed instructions at the end of this form.
Date of Application:
Post applied for:
Discipline(s) (max 2):
1. Name:
First Name Middle Name Last Name/Srname
2. Personal Details:
a) Date of !irt" (dd/mm/yyyy):
#) A$e (in years):
c) %ender:
d) Marital Stats:
e) Nationalit& ('iti(ens"ip):
f) S'/S)/*!' 'ate$or&+ :
(Please attach appropriate certificates is
answered yes)
,. (a) Mailin$ Address:
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(#) Permanent Address:
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.. 'ontact Details (with STD/ISD code)
a. P"one (Mo#ile):
#. P"one (Landline):
c. Fax:
d. /0mail 1D:
2. Academic record startin$ 3it" !ac"elor4s de$ree (Please attach unofficial transcripts/ mar
sheets/ grade cards for all your degrees)!
5. 'ore Areas of Speciali(ation: --------------------------------------------------------
-------------------------------------------------------------------------------------
6. 'rrent 7esearc" 1nterests: ----------------------------------------------------------
-------------------------------------------------------------------------------------
8. /mplo&ment 9istor& (in re"erse chronological order starting with present employment):
:. A3ards and 7eco$nitions:
De$ree
Speciali(ation /
Discipline
'olle$e/;ni<ersit&/1nstitte
=ear of
>oinin$
=ear of
lea<in$
Percenta$e
/ '%PA
No. Desi$nation *r$ani(ation/1nstittion
Date of
>oinin$
Date of
lea<in$
Dration
Afx a
passport size
color
photograph
1?. List *f P#lications
List t"ose P;!L1S9/D@ A''/P)/D@ and 1N P7/PA7A)1*N separatel&
a. Books & Book Chapters
b. Papers in refereed ournals (Please also include the #ournal impact factor)
c. Papers in conference proceedings
d. Papers presented in conferences but not published
Please enclose reprints of t"e #est papers (a#ot t"ree) in &or >d$ment
11. Please 3rite #riefl& !ma"imum # page$ 3"& &o 3is" to #e considered for a faclt&
position at 11)%N and "o3 do &or lon$0term career o#>ecti<es tie in 3it" a position at
11)%N+ !riefl&@ also 3rite a#ot "o3 &o propose to contri#te to 11)%N@ and "o3 t"e
1nstitte can "elp for &or #est possi#le professional $ro3t".
12. Please attac" a #rief statement !ma"imum % pages$ on &or immediate s"ort0term
researc" plans (20, &ear time frame). Additionall&@ please also inclde t"e researc"
facilities (eAipment@ space@ fnds@ manpo3er) t"at &o 3ill need for t"e same.
1,. Please list t"e t&pe of nder$radate and post$radate corses t"at &o 3ill liBe to
de<elop and/or teac" at 11) %and"ina$ar.
1.. )eac"in$ /xperience@ Ne3 'orses or La#oratories
Sl. No. )itle of corse ta$"t Post$radate/ ;nder$radate Sole instrctor or 3it" ot"ers =ear
1ndicate an& special 3orB done to3ards de<elopin$ ne3 corse or la#oratories
12. S"ort0term 'orse/CorBs"op/Seminars etc. *r$ani(ed
15. Post %radate )"esis Sper<ision
16.
Sponsored Pro>ects ;ndertaBen
18.
'onsltanc& CorB Done
No. *r$ani(ation )itle of Pro>ect Amont of $rant Period 7ole
(P1/co0P1/Senior
1n<esti$ator)
No. Sponsorin$
A$enc&
)itle of Pro>ect Amont of
$rant
Period 7ole
(P1/'o0P1/ot"er)
No.
Name of stdent/
researc" sc"olar
)itle of )"esis
Doctorate/
Master4s
=ear of
'ompletion
'o0$ide
(1f an&)
1:. 1nformation of )"ree 7eferees (It is prefera$le that you include your PhD ad"isor and someone who
is familiar with your recent wor)!
7eferee 1 7eferee 2 7eferee ,
Name
Desi$nation
*r$ani(ation/1nstitte
Mailin$ Address
)elep"one
Alternate )elep"one
Fax
/mail
2?. An& *t"er 7ele<ant 1nformation =o Ma& LiBe )o Frnis"
(e.$. Mem#ers"ip of Professional #odies@ /ditorial/7e<ie3 3orB@ Additional Professional )rainin$@ etc.)
21. 1 "ere#& declare t"at 1 "a<e carefll& read and nderstood t"e instrctions@ and t"at t"e entries in
t"is form as 3ell as in attac"ed s"eets are tre to t"e #est of m& Bno3led$e and #elief.
Date: ------------------------------
Place: (Signature of %pplicant)
&Digital signature or scanned signature is accepta$le'
Instructions:
Please email t"e completed application form alon$ 3it" all annexres as
a single P&' file to faculty.recruitment(iitgn.ac.in
Please name t"e PDF file )our*ame+IITG*+'ac+App.pdf 3it"
D=orName4 replaced #& &or name.
,ail one hard copy to:
Professor 1n0'"ar$e@ Faclt& Affairs
1ndian 1nstitte of )ec"nolo$& %and"ina$ar
E%/' 'omplex@
'"andB"eda@ Eisat0%and"ina$ar 9i$"3a&@
A"meda#ad@ %>arat
1ndia 0 ,82.2.
'"ecBlist of Annexres (Please arran$e in this order in a single P&' file):
7eprints of t"ree #est papers
'ertificate of S'/S)/*!' if applica#le

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