Application Form

Name of Candidate: - ___________________________________________________________________

( Surname First Name Middle Name) Photo

Post applied: - _____________________________________________________________

Department:-_______________________________ Area of Specialization:- ______________________________________

Date of Birth (DD/MM/YYYY)____________ ______ Caste :- _________________ Category______________________

A) Educational Qualification:-

Month &
Sr. University/ Class
Particular Subject Year of Percentage
No. Board Obtained
Passing
1 S.S.C.

2 H.S.C.

U.G.-
3
P.G.-
4
Ph.D.
5

NET/SET/
6
Other

B) Academic Experience:-

Total Academic experience in Years____________

Period of Last Pay

Appointment With Drawn in
Sr. Subjects Name of the Nature of
Designation Date the
No. Taught Organization Appointment
Institutio
From TO
ns
1

5
 C) Industrial Experience :

Period of Appointment
Sr. Name of the
Designation
Area of Work With Date
No. Organization
From To
1

Total Industrial Experience in Years : ____________________

D) Administrative Experience : ______________________

E) Research Experience:- ________________________________________________________________________________
F) Students Guided:- PG-________________________ PhD ___________________________________________________
G) Publications - i) International Journals:- ________________ ii) National Journals: ___________________

iii) Conferences: _______________________ iv) Books: _________________ ______________

H) Projects Carried Out & Funds Received in Rs. :- ____________________________________________________

I) Patents: - i) Filed _______________________________ ii) Accepted _____________________________________

J) Technology Transfer: ___________________________________________________________________________________

K) Membership of Various Bodies -______________________________________________________________________

M) Workshops Attended: _____________ Workshops/STTP Arranged:_______________________________

L) Your plans and Vision at SGU: Attach Separate page.

O) References:-

1) Name/Designation/Institute ___________________________________________Contact No________________________

2) Name/Designation/Institute ___________________________________________Contact No________________________

3) Name/Designation/Institute __________________________________________Contact No _____________ __________

Address for Communication: ________________________________________________________________________________

____________________________________________________________________________________________________________________
Tal._____________________________ Dist.-_____________________________________ Pin Code __________________________
Contact Details: - Land Line With STD Code-( )_________________________________________________
Mobile: - _________________________________________ Email ID ___________________________________________________

Date: - Applicant’s Signature