ANIL NEERUKONDA INSTITUTE OF TECHNOLOGY & SCIENCES

(Affiliated to AU, Approved by AICTE & Accredited by NBA)

SANGIVALASA-531 162, Bheemunipatnam Mandal, Visakhapatnam District
Phone: 08933-225083/84/87 Fax: 226395
website: www.anits.edu.in Email: principal@anits.edu.in

APPLICATION FORM FOR …………………………………...……. POSITION

(For Office Use only)

(Photo)

(To be filled by the Candidates

1 Post Applied for :

Name of the Candidate in Capitals

2 :
(As per Academic Records)

3 (a) Sex : Male / Female

(b) Blood Group & Category :

4 Category (OC, BC, SC & ST) :

5 Date of Birth (As per Academic Records) :

6 Name of the Father / Husband :

Address for Correspondence (in Capital letter with

7 :
PIN Code

8 Telephone No. with STD Code :

9 Email Address :

10 Marital Status : Married / Single

11 Nationality :
 Academic Qualification (Give particulars commencing from 10th Class)
Board / Aggrega
S. Year of School/College specialization, if Division
Examination University to te % of
No. Passing attended any obtained
which affiliated Marks

12

Particulars of higher academic qualification for which

working, if any, (Give the title of Program, Institution
13 :
where registered, duration and probable date of
completion)

14 Title of Under-Graduation Project, if any :

Title of Dissertation / Thesis at Post-Graduate level, if

15 :
any

16 Title of Ph.D. Thesis, if any :

17 Particulars of Prizes won, if any :

18 Particulars of Academic Scholarships received, if any :

Particulars of Academic Publications, if any, (if necessary use separate sheet)

19 Name of Journal or Proceeding of Conference together with
S. No. Title of Publications
Month & Year of Publication
 Work experience after obtaining the recruitment, qualification for the post of Professor, Associate Professor,
Assistant Professor, (if necessary, use separate sheet)
Period of
S. No. Designation Employer Nature of Duties
Employment

20

If you have teaching experience during the last 3 years, indicate:

a) Courses taught
i)
ii)
III)
iv)
v)
vi)
21 b) Laboratory Work conducted

i)

ii)

III)

iv)

v)

vi)
 c) Projects guided: Under-Graduate / Post Graduate
i)
ii)
III)
iv)
v)
vi)

d) Particulars of Experience in Institutional Administration, if any:

i)

ii)

III)

iv)

v)

vi)

If employed, Details of last pay drawn:

a) Scale of Pay : Rs.
22
b) Basic Pay : Rs.
c) Gross Salary : Rs.

23 If selected, Joining time required :

Any other Relevant Information (if needed, use separate Sheet) :

24

Station :
Date : Signature of the Applicatant