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: ---------------------------------- ---------------------------------- ---------------------------------- (#) Permanent Address: ---------------------------------- ---------------------------------- ---------------------------------- .. '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