INDIAN INSTITUTE OF ENGINEERING SCIENCE AND TECHNOLOGY, SHIBPUR

HOWRAH, WEST BENGAL - 711103

FOR OFFICE USE
ONLY

(Application form for Faculty Position)

Application Serial No.

Self attested Stamp Size photograph

to be pasted here

Advertisement No............................... Dated ................

Application ID

with

Post applied for :

DD Number :

AGP

Department :

Amount : Rs.

Specialization :

Name of Issuing Bank :

FIRST NAME

Name in Full (BLOCK Letter) :

Father's /Husband's Name :

Mother's Name :

Date of Birth :

Marital Status : (please )

DD / MM / YYYY

Age (as on the date of Advertisement) :

Single

Married

Permanent Address (in BLOCK Letter) :

Gender :

P.O.

Dist.

Dist.
PIN

State

Country

PIN

Mobile no.

STD Code

Email Id

/F

Country

Residence Phone No.

Address for Communication (in BLOCK Letter) :

P.O.

State

dd /mm /yyyy

MIDDLE NAME
LAST NAME

Date :

ISD Code

Office Telephone

Nationality :

Religion :

Category (under which you are seeking reservation /

SC

relaxation) : (Please )

ST

PWD

OBC

UR

th

Details of Education Qualification (from 10 Standard onwards)

Examination Passed

Subject / Specialization/Title of Thesis

Board / Univ.

PhD Degree Faculty

Title of Thesis

Obtain from

Year of Passing

Date of
Regn.

DD/MM/YY

Divn / Cls.

% of Marks

Date of
DD / MM / YYYY
Completion

Signature of the Applicant

Designed by Arindam Banerjee, Jr. Assistant

Page 1 of 7

Experience of employment(s) in detail

10
(a)

TEACHING :

Sl. No.

Name & Address of the

employer

(b)

INDUSTRY :

Sl. No.

Name & Address of the

employer

(c)

RESEARCH :

Sl. No.

Name & Address of the

employer

11

POST PhD :

TOTAL :
Designation

Pay Pand with AGP /

consolidated Pay

From

To

Duration

Type of Organization

From

To

Duration

Type of Organization

From

To

Duration

Type of Organization

TOTAL :
Designation

Pay Pand with AGP /

consolidated Pay

TOTAL :
Designation

Pay Pand with AGP /

consolidated Pay

Other Information (Experiments/computational Projects added to teaching Laboratories/ Courses offered through application
of ICT/E-learning packages prepared) :

Signature of the Applicant

Designed by Arindam Banerjee, Jr. Assistant

Page 2 of 7

12

RESEARCH ACTIVITIES (Specify total number and attach list of publication in the each category as per format given)

(a)
(i)

Paper Publication in National / International Journal(s): [attach photocopy of 1 st

IN SCI

Sl. No.

Title of Paper(s)

Name of the Co-Author(s)

page ]

Name of the
Journal(s)

Page(s)

Volume & Year

Name of the
Journal(s)

Page(s)

Volume & Year

(ii) OTHER THAN SCI [attach photocopy of 1 st page ]

Sl. No.

(b)
Sl. No.

Title of Paper(s)

Name of the Co-Author(s)

Paper(s) Publication in National / International Conference(s) [attach photocopy of 1 st page ]

Title of Paper(s)

Name of the Co-Author(s, if any

Name of the
Journal(s)

Page(s)

Volume & Year

Signature of the Applicant

Designed by Arindam Banerjee, Jr. Assistant

Page 3 of 7

Number of UG and PG Student(s) Guided or Ongoing

(c)

UG Student(s)
Guided

PG Student(s)
Ongoing

Name of Student(s)

Name of Book/Monograph/Book
Chapter(s)

Name of the Co-Author(s), if any

Year of Publication

Publisher with address

Seminar(s) / Short Term Course(s) / Summer School(s) / Winter School(s) organized

14
Sl.
No.

Status
(Completed / Ongoing)

Title of the Dissertation(s)

Year

Books / Monographs / Book Chapter(s) written

13
Sl.
No.

Ongoing

Details of PhD students (Guided and Ongoing)

(d)
Sl.
No.

Guided

From

To

Name of the Course(s)

Sponsored by / Self Financed

Number of
Participants

Signature of the Applicant

Designed by Arindam Banerjee, Jr. Assistant

Page 4 of 7

15
Sl.
No.

Seminar(s) / Short Term Course(s) / Summer School(s) / Winter School(s) attended, if any
From

Sponsoring Agency

Title of the Project(s)

Name of the Professional Body/Bodies

19

Amount

Status

Grade of the Body/Bodies

Membership Number

Valid upto

Administrative / Institute Support Work

18
Sl.
No.

Period

Membership of Professional Body/Bodies

17
Sl.
No.

Name of the
Course(s)

Sponsored by

Research Project(s) / Sponsored Project(s) / Consultancy Activities

16
Sl.
No.

Institute / Industry

To

Section/ Office/ Institute level

Committee

From

Post Held

To

Responsibilitie(s)

Any Other Relevant Information [Separate Sheet(s) may added, if require ]

Total Number of Sheet(s) added

Marking of the Sheet(s) with Serial be mentioned

Signature of the Applicant

Designed by Arindam Banerjee, Jr. Assistant

Page 5 of 7

Name and Address of Two References

20
1

st

Referee

Name :

Name :

Position :

Position :

Address :

Address :

e-mail Id :

e-mail Id :

Contact No. :

Contact No. :

nd

Referee

Did you previously apply for any post in this Institute ? If yes, please give particulars:

21
Advt. No.

Department

Post
Did you called for
Interview ? (please )

Year

YES

NO

Appeared in the
Interview ?

NA

Declaration
"I hereby declare that the statements made by me in / above form are true, complete and correct to the best of my
knowlegde and belief."

Place: ......................

Signature of the Applicant

Date: .......................

*
*
*
*
*
NO OBJECTION CERTIFICATE TO BE FURNISHED BY THE APPLICANT WHO IS ALREADY IN EMPLOYMENT
(REGULAR/TEMPORARY BASIS)

Certified

that

Dr./Mr./Ms.

..........................................................................................................................

son/daughter of Dr./Mr./Ms. .................................................................................................................... is a

permanent/temporary/adhoc

employee

of

the

Department/School/Center/Institution/Organization

since......./........./........... The Department/School/Center/Institution/Organization has no objection, if he/she is

appointed in Indian Institute of Engineering Science & Technolgy, Shibpur (IIESTS) against the post(s) advertised by
the IIEST, Shibpur vide advertisement no....................................

Place ....................
Date ......................

Signature & Seal of the Forwarding Authority

Designed by Arindam Banerjee, Jr. Assistant

Page 6 of 7

INDIAN INSTITUTE OF ENGINEERING SCIENCE AND TECHNOLOGY, SHIBPUR

HOWRAH, WEST BENGAL - 711103
FOR OFFICE USE ONLY

Self attested Stamp Size photograph to be

pasted here

Application Serial No.

BIODATA SHEET
Application ID

Name

Address

(To be filled by the applicant)

PIN
Contact No.

Email Id

Date of Birth

DD / MM / YYYY

Educational Qualifications :

Examination Passed

Category

SC

(Pl. )

Subject / Specialization/Title of thesis

Board / Univ.

Title of the Thesis

Obtain from

ST

OBC

Year of Passing

PWD

UR

Divn/Cls.

% of Marks

Date of
Completion

DD/ MM /YYYY

Secondary / 10th Standard

H.S. / 10+2 standard
Graduation
Master Degree
Others, if any

PhD Degree Faculty

5
6
7

9
10
11

12

Date of
Regn.

DD/MM/YY

Post Doctoral Speciallization, if any :

Present Position with Salary

Position

Details

Pay Band / Consolidated Pay

Academic Grade Pay

Total Experience :

Year(s)

Post PhD

Teaching Experience :

Year(s)

Post PhD

Research Experience :

Year(s)

Post PhD

Industrial Experience :

Year(s)

Post PhD

Publication Details (give numbers) : INTERNATIONAL

NATIONAL

Journal Papers : INTERNATIONAL

NATIONAL

Conference Publications : INTERNATIONAL

NATIONAL

Number of Thesis Guided : UG

PG
Number of PhD Thesis : Completed / Guided

Ongoing

Number of Book(s) and or Chapter(s) Authored / Co-authored :

Paten(s) :

Name

Research / Project / Consultancy :

13

Award(s)/Distiction(s), if any :

14

Any other relavant Information :

Year

Name

Organization

Year

Name of Award
Name of Award

Amount

Year
Year

Place : ..................
Date : ....................
Designed by Arindam Banerjee, Jr. Assistant

Signature of the Applicant

Page 7 of 7