Application format for the position of Vice-Chancellorof Dr. BabasahebAmbedkar Open University

Application / NominationForm

  1. Personal Details:

Name:

Father’s/Husband’s Name :

Date of Birth :

Marital Status :

Nationality :

Languages Known:

Languages / Read(Yes/No) / Write(Yes/No) / Speak(Yes/No)
English
Hindi
Gujarati
Other (______)

Present Position Held :

Present Emoluments and :

Pay Scale

Contact Details :

(a)Postal Address :

(with PIN Code )

(b)Contact Numbers : Phone -

(With STD Code)

Fax-

Mobile –

(c)E-mail :

  1. Educational Qualification :

Degree/Examination / Year of Passing / Subject(s) / University /College / Grade/Percentage of Marks obtained
  1. Work Experience :

(Teaching/ Research/Administration and others)

No. / Position held / Name of Institute/University / Particular of Experience
(Duties Performed) / Duration
(From –To)
  1. Research Experience (Including Research guidance to PG Students, Research Publication; International, State Level, Research Project(Completed/on going),Books authored, Conferences attended/organized etc.) : (Attach separate sheet, if required)

Sr. No. / Particulars / Details
  1. Details of Research and Publication :

Sr. No. /

Name/Title of the Research and Publication

/ Publisher / ISBN / ISSN No. / Month, Year of publication
  1. International Exposure (InternationalConferences Organized/attended, Academic Collaboration):
  1. Membership of Academic Bodies/Professional bodies/Association/University/

Institutions/Member of Government Committee:

  1. Your Vision for The Dr. BabasahebAmbedakar Open University .

(Not More than 300 words )(If required separate sheet may be attached):-

  1. Names and Contact details of three distinguished individuals well acquainted with Candidate’s work. Reference for the position applied.(Name and Contact details)

Sl. No. / Name / Contact details including Present Postal Address /Phone number/Mobile number /E-mail
  1. Any other information:-

I hereby declare that the information given above is true, correct and is based on documentary evidence.

Place :Signature of Candidate

Date : Name of Candidate