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 / Period
From 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 : ______