national institute of industrial engineering application form.pdf · 1.no objection certificate...
TRANSCRIPT
Application No.: (to be entered by the Office)
NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING (NITIE)
VIHAR LAKE, MUMBAI 400 087
FORM TO BE FILLED IN BY THE APPLICANT
APPLIED FOR THE POST OF (Please select) :
Whether willing to be considered
for a lower post:
Area of Specialization applied for(Please select) :
Yes No
Present (or Last) Post / Designation:
Pay Band Basic Pay Grade Pay Details of Present (or Last) Pay (For Govt. & Autonomous Govt. only)
Total Emoluments (in present post or last drawn) : as on MMM,YYYY:
Per month Rs.
(1) PERSONAL INFORMATION Full Name :
Gender :
Date of Birth (dd/mm/yyyy)
Nationality Indian
Category :
Religion :
Marital Status
Mailing Address
Permanent Address
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Age as on 01-07-2019
Others (Specify)
Please read instructions given at the bottom of this form
(Proof to be attached with hard copy)
City
State
Pin Code
Country
City Pin Code
State Country
Knowledge of Languages : English Hindi Others ( Specify)
(2) EDUCATIONAL QUALIFICATIONS *In chronological order from X Std onwards other than Ph.D.
Period of Study Class / Exam passed Year of
passing From To
University /
Board
Subject of specialization
*Please indicate your position in University / Board meritlist (if any)
Whether Ph.D. or Fellow :
(3) DETAILS OF Ph.D/ FELLOW
b)
c)
Ph.D./Fellow Award Status
Ph.D./Fellow Submission Status
Date of Awarddd/mm/yyyy
Date of Submission
d) Ph.D./Fellow Joining Date of Joining
e) Ph.D./Fellow Instituteand University Name :
f) Ph.D./FellowTopic in Full :
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dd/mm/yyyy
dd/mm/yyyy
Speaking
Reading
Writing
MobileTelephone No(prefix STD)
Email-Id :
a)
%mark
g) Area of Specialization : (Ph.D./Fellow Research Area and Current Research Interests)
(4) PROFESSIONAL MEMBERSHIPS
Sl. Name of Organization (Specify Indian or International)
Period (Year) Category of Membership From To
(5) SUMMARY OF PUBLICATIONS Filling the details in the below mentioned format is compulsory
Total number of publications(mention period)
1. Papers in International Journals
2. Papers in National Journals
4. Books / Chapters Edited
5. Conference Papers presented (National) (International)
6. Conferences Attended (National) (International)
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1.
2.
3.
4.
(1)
(2)
(3)
3. Papers Published in Conference Proceedings
(6) LIST OF RECENT/ BEST PUBLICATIONS
I. JOURNALS:
Sl. Author Name
with Co-Authors
Year of Publication
Title of Paper Name of Journal
1
2
3
4
5
6
II. CONFERENCES/SEMINARS:
Sl. Author Name
with Co-Authors
Year of
Publication Title of Paper, Proceedings Name of Conference/
Seminar
1
2
3
4
5
6
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* If required, attach additional sheet with the hard copy of the application and send by post.
(7) WORK EXPERIENCE (OTHER THAN TEACHING EXPERIENCE)
From To Designation in chronological order(Post and Organization)
Nature of experience
Industry Research
(8) TEACHING EXPERIENCE
From To Designation in chronological order (Post and Organization)
Faculty - 2019 Page 5
* If required, attach additional sheet with the hard copy of the application and send by post.
Details of Work *
Total Work Experience (Years): Industry : Research :
Total Teaching Experience (Years) :
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* If required, attach additional sheet with the hard copy of the application and send by post.
(9) SUBJECTS TAUGHT * One Row for each Subject
Sl. Subject Title UG/PG Class Size
1.
2.
3.
4.
5.
6.
7.
(10) TEACHING INTERESTS (IF SELECTED)
Sl. List of Subjects that you are interested to teach in preference order
1.
2.
3.
4.
5.
6.
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(11) RESEARCH PROJECTS / CENTRES (provide names of co-investigators if any)
Sl. Sponsor Title of Project / Center Duration Amount
(12) DOCTORAL STUDENT GUIDANCE COMPLETED
Name
Sl. Student Thesis Title University/
Institute
Award Date / Status
Co-Guide
Name
DOCTORAL STUDENT GUIDANCE IN PROGRESS with progress status
(13) CONTRIBUTIONS TO INSTITUTE ADMINISTRATION
Sl. Position Description From To
* If required, attach additional sheet with the hard copy of the application and send by post.
1
2
3
4
1
2
3
4
5
1
2
3
4
1
2
3
4
(15) ANY OTHER INFORMATION Please provide details that you would like, example Books, Patents, Awards, Recognitions, etc.
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* If required, attach additional sheet with the hard copy of the application and send by post.
(14) OUTREACH ACTIVITIES (Executive Training, Consultancy to Industry)
Sl. Clients Title of Assignment Duration Amount
1
2
3
4
(16) REFERENCES Please provide contact details of two persons holding responsible
positions and FULLY acquainted with the applicant and not related to the applicant.
1
Institute/ Organization
Address
2
Designation
Institute/ Organization
Address
LIST OF TESTIMONIALS
Original Testimonials are to be produced only at the time of interview.
1. No Objection Certificate from the present employer, if applicable
2.
3.
Work Experience Certificates
4. List of Publications & full printout of 3 best publications
5. Educational Qualifications
6. Caste Certificate, as applicable for reserved posts
8. Others (Specify)
I hereby declare that the above information is correct and complete to the best of my knowledge and belief.
Place:
Date: Signature of the Applicant
Instructions (for filling the Application Form) :1. Download this blank PDF application form and save it in your computer.2. Open this PDF Application form in Adobe. Please do not make changes to the form.3. Enter your details, and save it in your name (your_full_name.pdf) in your computer.4. Email this filled and saved PDF form to email-id: [email protected]
Please note: Please do not send the certificates, photo, etc. by email. The hard copy of the application form along with the copies of certificates, etc. should be sent by post as mentioned in the Advertisement. List of Certificates required: Date of Birth, Photograph, Educational Qualifications, Experience, and Caste Certificate for reserved post.
Faculty - 2019 Page 9
Designation
Name
Telephone No. with STD
Mobile No.
Name
Telephone No. with STD
Mobile No.
Teaching Experience
7. Proof of Date of birth