PSG INSTITUTE OF TECHNOLOGY AND

APPLIED RESEARCH
Neelambur, Coimbatore-641062
Affiliated to Anna University,
Approved by AICTE

Application for the post of Assistant Professor

1. Name (in block letters)

2. Address for Communication :

(a) Mobile Number

(b) E-mail ID

Recent
Photograph

3. Date of Birth

Age :

4. Marital Status

Name and Occupation of Spouse:

5. Mother Tongue

6. Religion

Caste :

Community :
Nationality :

7. Teaching / Industrial / Research Experience (Starting from Present Experience)

Name of the
post held

From
Date

To
Date

Months

Sl.
No

Monthly
Gross Pay
(Rs)

Years

Period of Employment
Name of the
Employer /
Institution

Teaching/
Industrial/
Research

_____years____months:Teaching

Total Experience

_____years____months:Industry

_____years____months:Research

Degree/
Diploma

a)Academic Qualifications: (Starting from Highest Qualification)

Branch/
Specialization

% of Marks/
CGPA

Class

Cleared all
the papers in
single
attempt (Say
Yes/ No)*

Name of the
Institution

F / P / D **

8.

University

Month &
Year of
Passing

* If No, please provide the details in the following format

** Note : - F / P / D State Whether Full-Time (F), Part-Time (P), D Distance Education

8. b) Details of Arrears (If any):

Sl.
No.

Degree

Name of the subject cleared as

an arrear subject

Semester in
which arrear
occurred

No. of attempts
to clear the
subject

Semester in which
it was cleared

9. Membership in Professional Bodies:

10. Present Salary Details
Basic

: Rs

Scale of Pay:

Total Gross Monthly Emoluments: Rs./ =pm.

11. Expected Salary
12. Joining Time Required :

: Rs./ =pm.
months

13. Name and addresses of persons to whom reference can be made about the applicant:
1.

2.

14. Publications (Attach separate sheets, if necessary):

15. Subjects taught/ Interested subject to teach:
Sl.No

Subjects Taught

No. of
times
taught

Sl.No

Subjects interested to teach

16. Any other information the applicant wishes to state:

Place :
Date :

Signature of the Applicant

Note : ATTESTED PHOTOCOPIES of degrees, service certificates, testimonials, community, salary proof
etc. are to be annexed to the application