Shree Swami Atmanand Saraswati Institute Of Technology

(Approved by AICTE and Affiliated to GTU)

Shree Swami Atmanand Saraswati Vidyasankul
Kapodra, Varachha Road, Surat-395006.
Visit us at: www.ssasit.ac.in Email: ssasit@yahoo.in

Application Form For Teaching Staff

For Office Use Only Advertisement Date: 29/03/2018 Inward No with Date:
Department :

Post Applied :

Candidate : Eligible / Not Eligible

Remark :

Post Applied for :______________________________________________

Please affix
Department :______________________________________________ duly signed
recent
Specialization :_______________________________________________ passport size
photograph
1. (i) Full Name (In Block Letters as in HSC Marksheet):

_____________________________________________________________________________________

(ii) Father’s / Husband Name: ____________________________________________________________

(iii) Mother’s Name: ___________________________________________________________________

2. Date of Birth : _________________ Age [(as on date) completed years]: ____________________

3. Gender: Male / Female Marital Status: Married / Unmarried
4. Correspondence Address: _______________________________________________________________
_____________________________________________________________________________________
_________________________________________________________Pin ____________________

Phone No. : Office: ________________ Res: _________________ Mobile: ___________________

E-mail ID: (i) _____________________________ Pan Card Number: ________________________

5. Do you belong to (Please tick ) : OPEN/ SC/ ST/ OBC/ Person With Disabilities (PWD)/ Ex–Serviceman /
Dependent of Defense personnel killed/ Disabled in war action/ Other:_________________________

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6. Post held at present:
Nature of the Post
Date of Name & Address of Employer with
Post held at present* (Temporary /
Appointment present salary
Probation/ Permanent)

*Copy of appointment order is attached: Yes / No

Type of organization (Government / Semi Government / Grant in Aid): _____________________
7. Educational Qualifications: (From S.S.C. Onwards)

Name of Name of Class/ *Equivalent

Sr. Examination Year of No. of
the the Percentage Percentage in
No. Passed Passing attempts
Institute University / CGPA case of CGPA

* Proof of Conversion from CGPA to percentage is a must.

8. Prizes, Awards, etc. :_______________________________________________________________

____________________________________________________________________________________

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9. Professional / Educational Experience: (From Present Post)

Length of Service
Sr. Employer’s Post Total (date)
Pay Scale Nature of work
No. Name held Emolument
From To

10. (a) Total Experience : _______________ Year(s) _______________ Month(s)

(i) Teaching – Under graduate : _______________ Year(s) _______________ Month(s)
– Post graduate : _______________ Year(s) _______________ Month(s)
(ii) Research : _______________ Year(s) _______________ Month(s)
(iii) Industrial : _______________ Year(s) _______________ Month(s)
Any Break in Service : Yes / No
If Yes state the period of break : _______________ Year(s) _______________ Month(s)
& reason_______________________________________________________________________

(b) Research Activities: (Excluding M.Tech. Dissertation & Ph.D. Work)

Duration (Date) University /

Sr. Degree Registered / Funds
Sponsoring Present Status
No. Project undertaken From To Sanction
Authority

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(c) Publication:
 National Journal
Sr. Month /
Name of Journal Volume No. Title
No. Year

 International Journal
Sr. Volume Month /
Name of Journal Venue Title
No. No. Year

 Conference / Seminar
Sr. Month /
Name of Conference/ Seminar Venue Title
No. Year
International Conference/
Seminar

National Conference/ Seminar

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 (d) Other Activities:
(i) Number of Expert Lectures Delivered: ________________________________________________

(ii) Number of Summer / Winter Schools / Training Programs Organized/Attended: _____________

(iii) Number of Seminar / Conference / Workshop / Networking Program Organized: ____________

Administrative & Community Services: (e.g. Dean/ Vice-Principal/ Principal/ Hostel Warden/ HOD/
Dept. Incharge/ Chairman - Board of Studies/ Self Development Programs for community Services)

Sr. Name of Responsibility Shared / Service

Name of Assignment Duration
No. Offered

11. Member of Technical Societies : _________________________________________________________

_____________________________________________________________________________________

12. Please give details of two References:

(i) Name: _________________________ (ii) Name: ____________________________________

Designation: ____________________ Designation: ________________________________

Full Address: ____________________ Full Address: ________________________________

_______________________________ __________________________________________

Contact No. & Fax _________________ Contact No. & Fax ____________________________

E-mail: _________________________ E-mail: ____________________________________

13. Extra Curricular Activities / Hobbies:___________________________________________________

_____________________________________________________________________________________

14. Any other relevant information : _____________________________________________________

DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief. I
understand that misleading or wrong information supplied may lead to immediately rejection of
application/appointment if found subsequently.

Date: _____________________
Place: (Signature of Applicant)

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