AMITY UNIVERSITY, RAIPUR
APPLICATION FORM FOR FACULTY & MANAGEMENT POSITIONS
POST APPLIED FOR : ______ADVERTISMENT DATE: ______
NAME OF NEWSPAPER :______
ANY OTHER SOURCE: ______
(A) PERSONAL PARTICULARS OF CANDIDATE
1. Name : ______
2. Father’s/Husband’s Name : ______
3. Date of Birth :
Day Month Year
4. Sex :
Male Female
5. Marital Status
Married Un-married
6. Mailing Address : ______
______
______
______
Phone ______Fax ______
E-mail ______
7. Permanent Address : ______
______
______
______
Phone ______Fax ______
E-mail ______
(B) EDUCATIONAL/PROFESSIONAL QUALIFICATION
Degree / Institution attended / Board/University / Year / Marks/
Grade / Subjects
iMatriculation (Xth)
iHigher Secondary
(XIIth)
iGraduation
iPostgraduation
iM.Phil
iPh.D
iOthers
Title of Ph.D Thesis :
Whether NET/Equivalent Test qualified:
Yes No
(C) PROFESSIONAL DEVELOPMENT PROGRAMMES ATTENDED *
Programmes / Nature of Programmes(Seminar/ Workshop/ Training Programmes/ Short Courses etc.) / Date/
Duration / Papers presented
* Please enclose a separate sheet, if necessary
(D) RESEARCH CONTRIBUTIONS **
(i) Major research studies undertaken :
(ii) Research papers published :
(iii) Books authored :
(iv) Ph.D Scholars supervised :
** Please enclose details.
(E) INNOVATIONS IN CURRICULUM DEVELOPMENT/EDUCATION TECHNOLOGY ETC.
(F) HONOURS/FELLOWSHIPS/AWARDS RECEIVED
(G) JOB PROFILE
Organisation / Position held / PeriodFrom To / Pay Scale/ Salary Drawn
(H) ASSOCIATION WITH PROFESSIONAL BODIES
(I) PROFICIENCY IN LANGUAGES
Read Write Speak
(J) INTERESTS/HOBBIES
(K) ANY OTHER RELEVANT INFORMATION
(L) NAMES/ADDRESSES OF TWO REFEREES (OTHER THAN RELATIVES)
1. Name & Address ______
______
______
______
Phone ______Fax ______
E-mail ______
2. Name & Address ______
______
______
______
Phone ______Fax ______
E-mail ______
(M) UNDERTAKING
I hereby certify that the information provided in the Application is correct to the best of my knowledge. In case it is found to be otherwise at any stage, I shall be liable for summary dismissal.
Date : ______Signature : ______
Place : ______Name of candidate : ______