Application Form for the Appointment of Teachers in The

NORTH ORISSA UNIVERSITY

SRIRAM CHANDRA VIHAR, TAKATPUR, BARIPADA-757003, MAYURBHANJ

APPLICATION FORM FOR THE APPOINTMENT OF TEACHERS IN THE

P.G. TEACHING DEPARTMENTS

a) POSITION APPLIED FOR :…………………………….SUBJECT………………………..

b)Advertisement No. & Date: ………………………………………………………………

c)Category (SC/ST/GEN/SEBC/DA) : …………………………………………………….

d)Bank Draft Number and Date: …………………………………………………………..

Full Name of the Candidate

in Block letters (Surname underlined): …………………………………………………

3. / a) Date of Birth (In figure) / : ……………………………………………………
(In words) / ……………………………………………………….
b) Birth Place : …………………………………… c) Passport No:……………………….
d) Gender : ……………………………………….. e) Marital status: ……………………
f) Nationality : ………………………
4. / a) Mother’s Name / : ………………………………………………………………
b) Father’s name / : ………………………………………………………………
c) Mother Tongue / : ………………………………………………………………

d)Any other language he/she can :

Read ………………… Write …………….. Speak ………………

Whether the candidate is qualified at UGC/CSIR NET(give details)
Furnish details about Research Experience as JRF/SRF/PDF(Provide the proof from concerned Institution with official letter with letter number and date)

Mailing : Email ID: ……………………………………………………………………..

Present Address / Permanent Address
Mobile/Telephone No: / Mobile/Telephone No:

8. Qualification in ascending order (one copy of all documents)

Sl.
No. / Examinations/ Degree
from Matriculation or
equivalent onwards / Name of the
University or
other examining
body / Division
or
Class / Perce
ntage
of
marks / Subject
(Specify
Hons./
Distinction) / Year
of
Passing

9. Field of Specialization :

i)Masters Degree stage : ………………………………………………………………

ii)M. Phil Stage: ………………………………………………………………

iii)Doctoral Degree Stage : ………………………………………………………………

iv)Post-Doctoral Research Stage : ………………………………………………………

10. Publications/Research activities for Applicants of Reader & Professor positions (3 Copies of best 5 papers be attached)

a)Number of research paper published

I) National journals (Referred): ………………………………………………………

II) International journals (Referred): …………………………………………………

III) Chapter in books / Conference & Symposia Proceedings (With ISSN/ISBN Number):

………………………………………………………………………………………………

b)Numbers of books authored/Edited (With ISBN Number): ………………………

c)Number of candidates supervised for M.Phil./Ph.D./D.Sc./D.Litt.

(Provide the list of candidates with year of award of Degree)

Degree Awarded / Thesis Submitted
(With title of thesis) / (With title of thesis)
M.Phil / ………………………. … / ………………………………
Ph.D / ………………………….. / ……………………………….
D.Litt/D.Sc. / …………………………. / ……………………………….

d)Number of Major/Minor research project and amount of the grant Undertaken as PI/CO-PI(Provide a list of funding agencies): …………………………………..

e)Number of nature of seminar/conference attended and presented paper-Invited/oral/poster(Provide list/Certificate to be produced along with API Score pro-forma): …………………………………………………..

If appointed, when can the candidate join the Post : ……………………………………

Membership or fellowship of learned societies or accredited bodies

(Give details): ……………………………………………………………………………...

13. Present scale of pay / : Rs
Pay Band / AGP / D.A. / H.R.A / Any other allowances / Total Emoluments

Teaching Experience (Experience certificate to be attached)

Sl / Name of the / Design- / Nature of / Classes Taught / Period / Length of
No. / College / / ation / the Post / (Give / experience
University / (Tem./ / UG / PG / dates) / Years / months
Permanent / Level / Level
/ Ad-hoc) / (Pass /
Hons)

15. Other experiences / employments

Sl / Name of post / / Date of / Date / Salary (scale of pay / Name & address
No. / University / / joining / leaving / and present basic / of the employer
Institution / pay)

Have you ever been dismissed/suspended from service?

Any of the information in your support :

List of documents submitted with the applications :

………………………………………………….

………………………………………………….

………………………………………………….

4. . ………………………………………………….

…………………………………………………..

……………………………………………………

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Declaration

I, solemnly declare that the entries made in this form are true to the best of my knowledge and belief.

Date : …………………………………….

Place : …………………………………...

Signature of the Candidate (in full)

CATEGORY III: RESEARCH, PUBLICATIONS AND ACADEMIC CONTRIBUTIONS

A) (i) Published papers in journals ( Referred *& Non–referred)

API Score: / Category I-Refereed / -15
Category II- / Non- Refereed / -10

Refereed Journal :Wherever relevant to any specific discipline, the API score for paper in refereed Journal would be augmented as follows:- (i) indexed Journals – by 5 points; (ii) papers with impact factor between 1 and 2 by 10 points; (iii) papers with impact factor between 2 and 5 by 15 points; (iv) papers with impact factor between 5 and 10 by 25 points.

API for joint publications: Of the total score for the relevant category of publication, the first author and the corresponding author / supervisor would share equally 60 % of the total points and remaining 40% shared equally by other authors.

A)(i)

Sl. / Title / with / Journal / ISBN /
ISSN/CategorizationRefereed
/Non referred / Whether
peer-
reviewed/
Impact / No. / of / Whether
Youare
themainauthor / API
No. / page / Name / Co- / Score
number / authors
A) (ii) / Full papers in Conference Proceedings / API Score-10
Sl.
No. / Title
with page
number / Details of
Conference
Publication / ISBN/ ISSN no/
categorization / Whether
peer-
reviewed/
Impact / No. of
Co-authors
(Points to
Be shared) / Whether
you are
the main
author
(Full
points) / API
Score
B) (i) / Articles / Chapters published in Books
API Score ( per Art / Chap) Category 1 : International Publication / - / 10
Category 2 / : National / State / Central / Societies Publisher / - / 5
Category 3 / : Subject books by Other / Local Publisher / - / 3
Category 4 / : Chapters in Knowledge- based Volumes / - / 5
Sl. No. / Art/Chapter
Title with
page
numbers / Book title,
Editor &
Publisher / ISBN/
ISSN No
/(Or,
Renowned
publishers)
See Cat 1-4
As above
for scores / Whether
peer-
reviewed/
Impact / No. of Co-
authors
(Points to
Be shared) / Whether
You are
the main
author
(Full
points) / API
Score

B) (ii) Books Published as a Single Author / Editor

API Score - Category I Text/ Reference Books by International Publisher / -50
Category II Text / Reference Books by National/Soc/Univ Publ / -25
Category III Subject Books by Other / Local Recognized Publ / -15
Sl. / Title with / Type / of / Publisher & / Whether / No. / of / Whether / API
No. / page / Book / and / ISBN / ISSN / / peer- / Co- / you / are / Score
number / Authorship / Categorization / reviewed/ / authors / the / main
Impact / (To / be / author
shared)
C) Ongoing and Completed Research Projects and Consultancies
(I & ii) Ongoing Projects / Consultancies API Score forProjects –
Cat I: (Sc-Rs 30 lakhs + Non-Sc: Rs 5 lakhs+): / 20
Cat II: (Sc-Rs 5 lakhs + Non-Sc: Rs 3 lakhs+): / 15
Cat III: (Sc-Rs 0.5 lakhs + Non-Sc: Rs 0.25 lakhs+): / 10
Other approved projects of Univ/Other agencies : / 5
API Sore for Consultancies-
(Sc – For every Rs 10 lakhs + Non-Sc: For every Rs 2 lakhs + ) : 10
API Score for Quality Evaluation-
Major (Completed) Project Eval: / 20
Minor (Completed) Project Eval: / 10
Sl. / Title / Agency / Period / Output/ Impact, i.e. / Grants(s)/Amou / Whether Principal / API
No. / (Funding, / Book/Paper / nt mobilized (so / Investigator / / Co- / Score
Commissioning / /technology /Process / far)inRs. / investigator / or
and / / / or / (Lakhs) / Consultant / /
Collaborating) / Quality evaluator
(iii & iv) Completed Projects / Consultancies
API Score for Projects :
Cat I: (Sc-Rs 30 lakhs + Non-Sc: Rs 5 lakhs+): / 20
Cat II: (Sc-Rs 5 lakhs + Non-Sc: Rs 3 lakhs+): / 15
Cat III: (Sc-Rs 0.5 lakhs + Non-Sc: Rs 0.25 lakhs+): / 10
Other approved projects of Univ/Other agencies : / 5
API Sore for Consultancies:
(Sc –Rs 10 lakhs + Non-Sc: Rs 2 lakhs + ) : / 10
API Score for Quality Evaluation:
Major (Completed) Project Eval: / 20
Minor (Completed) Project Eval: / 10

For patent / technology transfer / product / process:

International - / 50
National / - / 30
Title / Agency / Period / Output/ Impact, / Grants(s)/Amount / Whether Principal / API
Sl. / (Funding, / i.e. / Patent / mobilized & Utilized / Investigator/ / Co- / Score
No. / Commissioning / /Process / in Rs. (Lakhs) / investigator / or
and / / / or / Consultant / /
Collaborating) / Quality evaluator

D) Research Guidance / Supervision

API Score – Ph.D awarded – 10; Ph.D. Submitted – 7;

M.Phil. awarded – 3;

Sl. No. / Number / Thesis Submitted / Degree / API Score
Enrolled / awarded
M.Phil / or
equivalent
Ph. D. or
equivalent

(E) (i) Training Courses, Refresher Courses, Orientation Courses, Teaching-Learning- Evaluation Technology Programmes, Soft-Skill Development & Faculty Development Programmes

Cat I : (Not less than two week duration) : 20

Cat II : (Not less than one week duration) : 10

Sl. No. / Programme / Duration / Organized by / API Score

E (ii) Papers presented in Conferences, Seminars, Workshops, Symposia:-

If a paper is presented in Conference / Seminar is published in form of proceedings, the points would accrue for publication under Category III (A-ii) and not under presentation under Category III (E-ii). The same publication / presentation cannot be claimed for score in both.

API Score – Category 1 International - / 10
Category 2 / National / - / 7.5
Category 3 / Regional / - / 5
Category 4 Local / - / 3
Sl. No. / Title / of / Title / of / Organized by / Whether
International/
National / State/
Regional/
University / College
level / API Score
the / Paper / Conference / /
presented / Seminar

E (iii) Invited Lectures and Chairmanships at national / International Conference / Seminar etc

API Score – Category 1 International - / 10
Category 2 National / - / 5
Sl. No. / Title / of / Title / of / Organized by / Whether / API Score
Lecture / / / Conference / / / International /
Academic / Seminar etc. / National
Session

IV. API SCORES under Category III (with application of capping)

Sub-Category / Total API
Score under
categories / Capping as % of total API scorein application / Score claimed in
Subcategory after
capping
A. / Research / papers / 30
(Journals, etc)
B. / Research publications / 25
( Books, etc)
C. / Research Projects / 20
D. / Research Guidance / 10
E. / Training / Courses and / 15
Conf / Seminar, etc
Total

LIST OF ENCLOSURES: (Please attach copies of certificates, sanction orders, papers,book title-& content pages etc. wherever necessary)

1 / 6
2 / 7
3 / 8
4 / 9
5 / 10

Signature of the candidate with

Date:-

Address:-

Forwarded by HOD / Head of Institute