NATIONAL INSTITUTE OF TECHNOLOGY

(An Institution of National Importance)

WARANGAL 506 004 (A.P.) INDIA

Advt. No. Admn. 01/2013

Application Form for Faculty Position

Application Fee: (DD should be drawn in favour of the Director, NIT, Warangal payable at Warangal on SBH, NIT Branch (IFSC Code: SBHY0020149) or any other Nationalised Bank payable at Warangal.

Recent passport size color photograph to be affixed

DD No.

Date

Amount

Name of issuing Bank

APPLICATION FOR THE POST OF _______________________ in ________________ (Department) SPECIALIZATION _________________________________________________________ 1. Name in Full: _____________________________________________ Gender:_______ (In Block Letters) 2. a) Fathers Name: _________________________________ Occupation: ______________ b) Mothers Name: ________________________________ Occupation: ______________ 3. Nationality: _____________________ Place of Birth : ____________________ Marital Status: __________________ PWD

Date of Birth: _____________ Age: __________ 4. Category: SC ST OBC UR

In case of OBC, whether belong to creamy layer Yes / No (If yes, enclose OBC Certificate issued after 01.01.2013 based on income of 2011-12.) 5. Particulars of Educational Qualifications: Sl. No. 1 2 3 4
N.B.:

Degree Obtained & Branch / Specialization (specify) Bachelors Degree Masters Degree Ph.D. Degree Others (if any)

Name of the University/Institute

Year of Passing

% of Marks/ CGPA

Class/ Division

Every application must be accompanied by photo copies of documents in support of claims made by the candidate in respect of date of birth, academic qualifications, practical training, experience, caste, projects, publications, consultancy etc.

6. Title of PG/Ph.D. Thesis with name and address of Ph.D. Guide. (Enclosed Abstract of Thesis) Degree i) P.G. Title of Thesis Guide University

ii) Ph.D.

7. Details of Experience: i) Teaching Experience : years Sl. No. 1. 2. 3. 4. Name of the organization where employed Designation Post Ph.D. Experience years Date of Joining Date of leaving Last Pay Band and Grade Pay*

ii) Research Experience: Sl. No. 1. 2. 3. 4.

years Designation Date of Joining Date of leaving Last Pay Band and Grade Pay*

Name of the organization where employed

iii) Industrial Experience:

years Date of Joining Date of leaving Salary Drawn

Sl. Name of Industry Designation No. 1. 2. 3. * Prior to 6th CPC indicate the Basic Pay.

8. i) Total Research Publications / Presentations (Attach reprints of best 5 recent publications) Sl. No. 1. 2. 3. 4. Nature Books Chapters Refereed Journals# Presentations# (Proceedings) Published Accepted

National International National International

# Attach a separate sheet with the list of all publications / presentations classified as National/ International alongwith science citation Index (SCI) for the total career.

8. ii) Research Projects: Sl. Title of the Project No. 1. 2. 3. 4.

Amount in Rs.

Funding Agency

Period

Remarks (Completed/
Ongoing)

8. iii) No. of PG dissertations / Ph.D. thesis guided: (Attach the titles of the Ph.Ds guided) 9. Patents Sl. No. 1. 2. 3. 10. Consultancy Sl. No. 1. 2. 3. Name of the patent

P.G.

Ph.D.

Year

Organisation

Name of Organisation

Year

Amount (Rs.)

11. (a) Minimum Pay expected: Basic and AGP: ... (Should not be treated as agreed even if called for Interview and selected) (b) Time required to join the Institute, if selected: _________________________ 12. Honours / Awards / Distinctions, if any:

13. Name and addresses of two professional referees (who are not related to the applicant) who are in a position to testify from their personal knowledge as to the fitness of the applicant for the post applied for: i) Name Status : __________________________________________________ : __________________________________________________ 3

Address e-mail and Phone ii) Name Status Address e-mail and Phone

: __________________________________________________ __________________________________________________ : ______________________________Mobile______________ : __________________________________________________ : __________________________________________________ : __________________________________________________ __________________________________________________ : _____________________________Mobile_______________

14. i) Address for correspondence: _____________________________________________ _____________________________________________ _________________Phone No.____________________ Mobile No.___________________ E-mail address: ________________________________ ii) Permanent Address : _________________________________________________ _________________________________________________ _________________________________________________ 15. Any other information relevant to the Post applied for, such as: i) Memberships/Fellowship and position of responsibility in Professional Societies: a) b) c) ii) Attainments in sports and extra-curricular activities (including N.C.C.) a) b) c) iii) Language fluency: Language Read Write Speak

16. Copies of documents enclosed: i) ii) iii) iv) v) vi) vii) Declaration: I hereby solemnly declare that the information furnished above is true and correct and I am responsible for the veracity of the same. Place: Date:
N.B.

Signature of the Applicant

Every application must be accompanied by self-attested photo copies of documents in support of claims made by the candidate in respect of date of birth, academic qualifications, practical training, experience, caste, projects, publications, consultancy etc.

(To be filled in by the present employer) FORWARDED / NOT FORWARDED

Place: Date:

Signature of the Forwarding Authority: Designation: Office Seal:

(TO BE USED BY THE INSTITUTE OFFICE ONLY) Date of Receipt: Registration No. 01/2013/___________ Signature of the Receiving Officer

NATIONAL INSTITUTE OF TECHNOLOGY

WARANGAL 506 004, (A.P)
Advt. No. Admn. 01/2013

SUMMARY SHEET (To be written legibly or typed neatly) DD No.

Name : Mr./Ms. Category: (SC/ST/OBC/UR): Post applied for: Qualifications: Degree UG PG PhD Others Total Experience: Years Teaching: Position Professor Associate Professor Assistant Professor Industry: Research: Present Employer (if applicable) and Basic Pay & AGP: No. of Publications Journal Papers Papers in Conference Proceedings Books Chapters in Books Patents Ph.D. thesis Guided Projects Research Consultancy Awards / Distinctions, if any: Place : Date: Signature of the Applicant 2 Lakhs National International Basic Pay

Date:

Amount:

Date of Birth: PWD: Yes / No. Department: Division Year University

Post Ph.D. Experience: Years AGP From To

Total value (Rs. in Lakhs) 2 to 5 Lakhs 5 to 30 Lakhs

> 30 Lakhs

10

11

NATIONAL INSTITUTE OF TECHNOLOGY

WARANGAL 506 004 (A.P.) INDIA
Advt. No. Admn. 03/2011

ACKNOWLEDGEMENT Registration No. 01/2013/__________________ Sub: Acknowledgement for application received Reg. 12

-.Received an application from Dr./Mr./Ms. ________________________________________

(Candidate to write his/her name above in capital letters)

for the post of ______________________ in the Department of _______________________ For any correspondence in future, candidate must quote the registration number given above.

Office Superintendent (Administration) Date: _______________

UNDER CERTIFICATE OF POSTING

(U.C.P.)

To ___________________________________________ ___________________________________________ ___________________________________________

From: National Institute of Technology, Warangal 506 004 (A.P.)

__________________________PIN _________________ (Address to be filled by the candidate)

13