INDIAN INSTITUTE OF TECHNOLOGY (BANARAS HINDU UNIVERSITY), VARANASI

APPLICATION FORM FOR FACULTY POSITION

(Applicants after 13th August 2016 are required to use this updated form)

Advertisement No. Affix your

recent
Post Applied for
passport
Department /School size
photograph
If interested in joint appointment, indicate Main
and Second Department/School

A. Personal Details
1. Name in Full (In Capital letters)

First Name Middle Name Last Name

2. Address

Present (Address for Communication) Permanent

Phone Phone
Fax Fax
Email Email

3. Date of Birth (DD/MM/YYYY):

(Enclose copy of 10th/matriculation certificate as proof of age)

4. Nationality: Indian/Others (Specify)

5. Sex: Male/Female

6. Marital Status: Married/Unmarried

7. Category: Gen/OBC/SC/ST
(In case of OBC/SC/ST, enclose certificate issued from the authority prescribed under Govt rules)

8. Whether Differently Abled: Yes/No

 (If yes, enclose certificate issued from the authority prescribed under Govt rules)

B. Educational Details
9. Academic Record
(Please attach copies of degree certificates and also brief synopsis of the Master’s & Doctoral thesis)

i. From Matriculation up to Graduation Level

% of
Board/Institution/ Subjects/Area of
Degree Year Marks/Division Remarks
University Specialization
/Grade

Matric/High
School/10th

Intermediate/
10+2

BSc/BTech/B
E

ii. From Post Graduation onwards

University/ % of Marks/ Name of

Degree Year Department Thesis Title
Institution Division/Grade Supervisor/ Advisor

MSc/MS/
MTech

PhD

10. Broad Area of Specialization:

11. Current Area(s) of Research:

C. Professional Details

12. Present Employment Details:

Scale/Pay Band
& Grade
Pay/Pay Matrix Emoluments/
Roles and
Organization Designation From To Total Salary
responsibilities
Basic Pay (Pay in hand
in Pay Band +
Grade Pay)
13.Previous Employment Details (in reverse chronological order)
(Please attach copies of relevant certificates. Research experience should exclude research done for
PhD Degree or any other lower degree)
Scale/Pay
Band &
Grade
Emoluments/
Pay/Pay
Reason Total Salary
Sl. Roles and Matrix
Organization Designation From To of in hand at
No. responsibilities
Leaving the time of
Basic Pay
leaving
(Pay in Pay
Band +
Grade Pay)

D. Teaching and Research Details

14. Courses Taught
Sole Instructor Developer of course
Sl. No. Course Title Level (UG/PG)
or with others (Yes/No)

15. Post Graduate & Doctoral Thesis Supervision (at all the organizations where you have worked)
(i) Master’s Level
Year of Title of Thesis Guide or Co-guide
Name of the Name of
Sl. No. completion or
Student(s) Institution
in Progress

(ii) Doctoral Level

Year of Title of Thesis Guide or Co-guide
Name of the Name of
Sl. No. completion or
Student(s) Institution
in Progress

16. Details of Administrative Experience, if any

Sl. No. Organization Designation From To Roles and Responsibilities

17. Sponsored Projects

Sponsoring Amount of Grant Co-Investigator(s),if any
Sl. No. Period Title of Project
Organization
 18. Consultancy
Sl. No. Period Organization Nature of Work Co-Investigator(s),if any

19. Patents
Sl. No. Year Title International/National Status

20. Publications:

i. Mention here five best papers (in your judgment) published in Professional Peer Reviewed Journals:
Complete Reference Impact Citation of
Sl. No. Author (s) Year Title of Journal Factor of paper
Journal

ii. Give complete list of publications (List SCI and Non-SCI journal publications separately) in the following
format as Enclosure-I):
Complete Reference Impact Citation of
Sl. No. Author (s) Year Title of Journal Factor of paper
Journal

iii. Give complete list of Full Papers (not abstracts) in the following format as Enclosure-II
published in Conference Proceedings:

Sl. No. Author (s) Year Title Complete Reference of Conference

iv. Give complete list of Papers presented in Conferences and not Published (in the following format as
Enclosure-III):

Sl. No. Author (s) Year Title Complete Reference of Conference

v. Books (List those published and in press separately):

Sl. No. Name Year of Publication Title Author or Co- author

21. Membership of Professional Bodies

Sl. No. Name of Body Status of Membership: for Life / Annual
 22. Give details of Important Seminars/Workshops/Schools attended and not covered under 19 (iii)
& 20 (iv) in the following format as Enclosure-IV:

Sl. No. Year Place Seminars/Workshops/Schools Title of paper read, if any

E. Other Important Details

23. Awards and Recognitions:

24. Any Other Relevant Information:

25. Salary/Total Emoluments Expected at IIT (BHU):

26. Details of Five Referees (at least two of them should be familiar with your research work):
(Applicants for Assistant Professor position should include PhD Supervisor and PDF Advisor, if any)

Referee-1 (PhD Supervisor, in Name

case of Assistant Professor) Address
Contact Phone/Mobile No.
Fax No.
E-mail id
Referee-2 (PDF Advisor, in Name
case of Assistant Professor) Address
Contact Phone/Mobile No.
Fax No.
E-mail id
Referee-3 Name
Address
Contact Phone/Mobile No.
Fax No.
E-mail id
Referee-4 Name
Address
Contact Phone/Mobile No.
Fax No.
E-mail id
Referee-5 Name
Address
Contact Phone/Mobile No.
Fax No.
E-mail id

27. Statement of Objective:

i. Please indicate as to why you wish to join IIT (BHU) (not more than 500 words)
 ii. How, in your opinion, do you meet the job requirements as advertised? (not more than 250 words)
iii. A short note (not more than 500 words) about the research and development projects you would like to
undertake.

iv. A short note (not more than 250 words) about the courses that you would like to teach at UG and PG
levels. Select courses from the approved syllabus of the concerned Department/School.

I hereby declare that I have carefully read and understood the instructions and particulars for
the post I am applying. Further, I also declare that all entries in this form as well as the attached
sheets are true to the best of my knowledge and belief.

Date:

Place: Signature of Applicant

Enclosures:
(I) Complete list of publications (List SCI and Non-SCI journal publications separately) as per the format given at Item
No. 20 (ii)

(II) Complete list of Full Papers (not abstracts) published in Conference proceedings as per the format given at Item
No. 20 (iii)

(III) Complete list of Papers presented in Conferences which are not published as per the format given at Item No. 20
(iv)

(IV) Details of Important Seminars/Workshops/Schools attended as per the format given at Item No. 22

(V) Copies of Five best published papers as mentioned at Item No. 20 (i)

Note:

(i) All the information asked for should be provided in the application form itself and not
as enclosures except when asked specifically.

(ii) The candidates will be required to show all certificates in ORIGINAL at the time of
interview, if called for.