NATIONAL INSTITUTE OF TECHNOLOGY

WARANGAL 506 004 (T.S.) INDIA

Advt. No. Admn. 01/2015

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.

DD No.

Date

Amount

Recent passport size

color photograph to
be affixed

Name of issuing Bank

APPLICATION FOR THE POST OF _______________________ in ________________

(Department)
SPECIALIZATION _________________________________________________________
1. Name in Full: _____________________________________________
(In Block Letters)

Gender:_______

2. a) Fathers Name: _________________________________ Occupation: ______________

b) Mothers Name: ________________________________ Occupation: ______________
3. Nationality: _____________________

Place of Birth : ____________________

Date of Birth: _____________ Age: __________

Marital Status: __________________

4. Category:

SC
ST
OBC
UR
PWD
In case of OBC, whether belong to creamy layer Yes / No
(If No, enclose OBC Certificate issued after 01.04.2015 based on income of 2014-15.)
5. Particulars of Educational Qualifications:
Sl.
No.
1

Degree Obtained &

Branch / Specialization
(specify)
Bachelors Degree

Masters Degree

Ph.D. Degree

Others (if any)

N.B.:

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 Ph.D. Thesis with name and address of Ph.D. Guide. (Enclose Abstract of Thesis)
Degree
Ph.D.

Title of Thesis

Guide

University

Year of Award

7. Details of Experience:
i) Teaching Experience :
Sl.
No.

Name of the
organization where
employed

years Post Ph.D. Experience:

Designation

years

Date of
Joining

Date of
leaving

Last Pay
Band and
Grade Pay

Service
Regular/Contract

Date of
Joining

Date of
leaving

Last Pay
Band and
Grade Pay

Service
Regular/Contract

Date of
Joining

Date of
leaving

Salary
Drawn

Service
Regular/Contract

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

Name of the
organization where
employed

years
Designation

1.
2.
3.
4.
iii) Industrial Experience:
Sl.
No.
1.
2.
3.

Name of Industry

years
Designation

8. i) Total Research Publications / Presentations

Sl.
No.
1.
2.
3.
4.

Nature
Books
Chapters
Refereed
Journals#
Presentations#
(Proceedings)

Published

Accepted

National
International
National
International

# Attach a separate sheet with list of all publications / presentations as per Annexure - I.

8. ii) Research Projects:

Sl.
Title of the Project
No.
1.
2.
3.
4.

Amount
in Rs.

Funding
Agency

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.
4.
10. Consultancy
Sl. No.
1.
2.
3.
4.

P.G.

Period

Remarks
(Completed/ Ongoing)

Ph.D.

Name of the patent

Year

Organisation

Name of Organisation

Year

Amount (Rs.)

11. Administrative Responsibilities held

Sl. No.
1.
2.
3.
4.

Responsibility held

duration

12. (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: _________________________
13. Honours / Awards / Distinctions, if any:
3

14. Name and addresses of three 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

: __________________________________________________

Address

: __________________________________________________
__________________________________________________

e-mail and Phone

: ______________________________Mobile______________

ii) Name

: __________________________________________________

Status

: __________________________________________________

Address

: __________________________________________________
__________________________________________________

e-mail and Phone

: _____________________________Mobile_______________

iii) Name

: __________________________________________________

Status

: __________________________________________________

Address

: __________________________________________________
__________________________________________________

e-mail and Phone

: _____________________________Mobile_______________

Candidates shall enclose at least three reference letters (Sealed and Stamped).

15. i) Address for correspondence: _____________________________________________

_____________________________________________
_________________Phone No.____________________
Mobile No.___________________
E-mail address: ________________________________
ii) Permanent Address

: _________________________________________________
4

_________________________________________________
_________________________________________________

16. Any other information relevant to the Post applied for, such as:
i) Memberships/Fellowship and position of responsibility in Professional Societies:
a)
b)
c)
d)
ii) Attainments in sports and extra-curricular activities (including N.C.C.)
a)
b)
c)
d)
iii) Language fluency:
Language

Read

Write

Speak

17. 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 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. 01/2015/___________

Signature of the Receiving Officer

ANNEXURE I
Attach a separate sheet indicating the list of publications as per the format given
below:
Journal publications:
Sl.No
.

Title and the Authors of

the paper

Name of the
Journal

National/
International

Year / Vol./
Page No.

SCI
Yes/No

List of Journal Publications outside Ph.D. Thesis:

Sl.No
.

Title and the Authors of

the paper

Name of the
Journal

National/
International

Year / Vol./
Page No.

SCI
Yes/No

Conference Publications:
Sl.No.

Title and the Authors of the

paper

Name of the
Conference

National/
International

Year and Place

The above information submitted by me is true and I am responsible for the veracity
of the same.

Signature of the Applicant