Application No.

(For Office Use only)

A.N. Sinha Institute of Social Studies

Patna – 800001

Application Form for Faculty Position

(Please read advertisement on website carefully before filling)

Post Applied for:

Subject:

Area of Specialization:

1. Personal Details (in Capital Letters)

Sl. No. of
Proof Enclosed
Name / Age(in years)
Mother’s Name / Marital Status
Father’s Name / Religion
Date of Birth
(DD/MM/YY) / Gender
Category
Nationality

2. Address (In Capital Letters)

Mailing Address / Permanent Address
E-mail Address
Mobile No.
Phone No.

3. Educational Qualification (Matriculation Onwards)

Name of the Degree/Exam / Board/Institution/University / Year of Passing / Percentage of Marks / Division/Class /GPA / Subjects / Sl. No. of Proof Enclosed

4. Details of Ph. D as per UGC Regulation 2010

University / Subject / Sl. No. of Proof Enclosed
Mode of Admission
Date of Registration
Details of Fellowship (if any)
Funding Agency
Title of Thesis
Status / Degree Awarded / Thesis Submitted
Date:
Courses work completed during Ph.D Programme:

If yes, list of Courses

Courses / Duration / Grade / Sl. No. of Proof Enclosed

Details of Research Paper published before thesis submission:

5. Title of Thesis

Sl. No. of
Proof Enclosed
Master
Ph. D

6. Academic Distinctions (Award/Scholarship/Rank etc.):

7. Membership/Fellowship of Learned Accredited Bodies:

8. Present Position:

9. Experience

Designation Basic Pay, PB with Grade Pay / Organization / Period / No. of Years/Months / Sl. No. of Proof Enclosed
From / To
Nature of Work

10. Your Competence in application of Computer/IT in Education and Research

Sl. No. of Proof Enclosed

11. Additional Information, if any

SN / Name of Training / Organized At / Sponsors, if any / Duration / Sl. No. of Proof Enclosed
From / To

12. Name and Complete Postal Address of 3 Referees (In Capital Letters)

Referee 1 / Referee 2 / Referee 3
E-mail:
Mobile No.:

Note: Request any of your two referees to send recommendation directly. Recommendations received after the last date of application will not be considered.

13. Title of publishable research paper for seminar presentation before selection committee (Attach Full Paper):

14. Details of current academic work engaged with (attached separate sheets for details)

15. Detailed proposal of work plan for next two year, if you are given opportunity to work in this Institute.

16. Declaration

I hereby declare that all the entries made by me in this Application Form are true to the best of my knowledge and belief. If anything is found false at any stage, my candidature may be cancelled without assigning any reason thereof.
Date: Signature of the Applicant

17. Endorsement by the employer (for in service candidate holding a substantive post only):

To be Forwarded by the Present Employer
Forwarded to:
The applicant Prof./Dr./Mr./Mrs./Ms. …………………………………………………………………………………...
who has submitted this application for the post of …………………………………………………………………….. in the ANSISS, has been working in ……………………………………………………………………………………
as ………………………………………………. on a substantive post with effect from ……………………………...
In the Pay Scale/Pay Band of Rs. ……………………………… She/he is drawing a Basic Pay/Pay of Rs. ………….
…………………………………………………………. His/her next increment is due on ……………………………Further, it is certified that no disciplinary/vigilance case has ever been held or contemplated or is pending against the said applicant. There is no objection for his/her application being considered by ANSISS.
------(Signature of the forwarding authority)
Name: ………………………………………………………..
Designation …………………………………………………..
Place: ………………………………………………………… Office Seal
Date: …………………………………………………………..

Application Form for Faculty Position

Page 5 of 8

(Please read the advertisement on website carefully before filling it)

RESEARCH AND ACADEMIC CONTRIBUTION

(Only for the Assistant Professor/Associate Professor and Professor)

A. Published Paper in Journals

Sl. No. / Title with Page No. / Journal with full reference and ISSN/ISBN. Whether peer reviewed. Impact Factor, if any / No. of Coauthors / Whether you are the main author / API Score / API Score verified by screening committee

B. Articles/Chapters published in Books

Sl. No. / Title with Page No. / Book Title, Editor & Publisher (with ISSN/ISBN) / No. of Coauthors / Whether you are the main author / API Score / API Score verified by screening committee

C. Full Paper in Conference Proceedings

Sl. No. / Title with Page No. / Details of Conference Publication (with ISSN/ISBN) / No. of Coauthors / Whether you are the main author / API Score / API Score verified by screening committee

D. Books published as single author or as editor

Sl. No. / Title with Page No. / Type of Book & Authorship(with ISSN/ISBN) / No. of Coauthors / Whether you are the main author / API Score / API Score verified by screening committee

E. Ongoing and Completed Research Project and Consultancies

Sl. No. / Title / Agency / Period / Grant/Amount Mobilized (Rs. Lakh) / API Score / API Score verified by screening committee

F. Completed Projected/Consultancies

Sl. No. / Title / Agency / Period / Grant/Amount Mobilized (Rs. Lakh) / API Score / API Score verified by screening committee

G. Research Guidance

Sl. No. / Number / Thesis / Degree / API / API Score

H. Training Courses, Teaching-Learning-Evaluation Technology Programme, Faculty Development Programme (not less than one week duration)

Sl. No. / Programme / Duration / Organized By / API Score / API Score verified by screening committee

I. Paper presented in Conferences, Workshops, Symposia

Sl. No. / Title of the Paper / Conference/Seminar / Organized By / API Score / API Score verified by screening committee

J. Invited Lectures and Chairmanships at National and International conference/Seminar, etc.

Sl. No. / Title of Lecture/Academic Session / Title of Conference/Seminar / Organized By / API Score / API Score verified by screening committee

Date:

Place:Signature of Applicant