The Maharaja Sayajirao University of Baroda

Vadodara
Passport size
Photograph

APPLICATION FORM FOR

DIRECT RECRUITMENT
(As per UGC Notification No. F.3-1/2009 Dated June 30, 2010)

Notification No. & Date ______ ___________________________________________________

Application Form for:
Assistant Professor,
Lecturer & Pradhyapak
Name of the Post applied for _________________________________________________
Faculty/Institute/College_____________________________________________________
Department ________ ______________________________________________________
Demand Draft/Challan Details:
Number__________________________Dated___________________
Name of the Bank__________________________________________
*In case of Offline Challan payment through Bank of Baroda branch; the bank will retain one copy of the challan and give you back
the remaining two copies: one of which (original + one copy) you are required to send along with this application form, while the other
is for your record.

PART A: GENERAL INFORMATION AND ACADEMIC BACKGROUND

Name (in block letters)

Fathers / Mothers Name

Date and Place of Birth

Gender

Marital Status

Nationality

Indicate

whether

belongs

to
1

SC

ST

OBC

PH

SC/ST/OBC/PH category (Please tick Certificate from competent authority to be

in the relevant box)
attached.
8

Address for correspondence (with Pin

code)

Permanent Address (with Pin code)

10

Contact Number

11

E-Mail

12

Department

13

Current Designation & Grade Pay

14.

Academic Qualifications (Matriculation onwards):

Examination

Board/University

Year

% of marks
obtained

Division &
Distinction

Matric / SSC
Intermediate/HSC (10+2)
Graduate degree
Post graduate degree
M.Phil.
Ph.D./D.Phil.
D.Sc./D.Litt.
Other Exams (if any)

In case of M.Phil/Ph.D. Examination, an attested copy of the degree and/or the result notification for
the same be attached.

15. A. Record of academic service other than The M.S. University (please attach relevant certificates
of service experience)
2

Essential
qualification
Institution Designation s for the post
at the time of
appointment

Nature of
appointment
(Regular/
Fixed term/
Temporary/
Adhoc)

Nature
of
Duties

Pay Date of Date of

Scale Joining Leaving

Reasons
for
Leaving

Please indicate, whether in previous service:

i)
The essential qualifications of the post held were lower than the qualifications prescribed by the UGC?
ii) The minimum qualifications as prescribed by the UGC for appointment to the post were the same?
iii)
The post is/was in an equivalent grade or of the pre-revised scale of pay?
iv) The post was filled in accordance with the prescribed selection procedure as laid down in the
Regulations of University/State Government/Central Government/Concerned Institution, for such
appointments?
v)
The previous appointment was as guest lecturer for any duration or an ad-hoc or in a leave vacancy of
less than one year duration?
15. B. Present Assignment:
Designation

Employer

Date of Joining
Date/Month/Year

Nature of Appointment
(Adhoc/Temporary/Permanent/
Contractual

Basic Pay p.m

(Rs.)

Pay Band (Rs.)

GP/AGP (Rs)

Gross Salary
p.m(Rs)

Important/unique contributions(s) in the present assignment:

Increment
Date(Date/Month)

16.

Period of teaching experience:

P.G. Classes (in Years)

U.G. Classes (in Years)

17.

Research experience
i.

Total Number of years

: ______________________________

ii.

Years spent in M. Phil. / Ph.D.

: ______________________________

iii.

Years of Guiding Ph.D. / M. Phil.

: ______________________________

iv.

Total No. of papers published in

i.

International Journals .

ii.

National Journals

iii.

Conference Proceedings

(Not abstract but full paper)

v.

Total No. of Conferences/Seminars/Workshops attended

i.

International

ii.

National

iii.

State Level

..

18.

Awards /Prizes/ Honours / Recognitions :

19.

Fields of specialization under the Subject/Discipline

a)
b)

20.

Academic Staff College Orientation/Refresher Course/QIP attended (Attach certificates) :

4

Nature of the
Course/Summer
School

21.

Sponsoring Agency

Name of the Journal, Vol.

No.,Year (ISSN/ISBN No.)

Title

Main/
co-author

Proficiency of the Languages

S.
No.

23.

Duration

List of publications (Attach copies for the purpose of evaluation):

(Full list can be attached as appendix)
S.No.

22.

Place

Language

a)

English

b)

Gujarati

c)

Any Other Language

Read & Write

only

Read, Write
and Speak

Examination Passed, if any

FUTURE PLANS:

23(a). Your vision for the Department:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________

23(b). Your contribution in the Department, Faculty and University:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________
23(c). Future academic development plan for self as well as department:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
24.

Any other relevant information:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
DECLARATION

I hereby solemnly affirm that the information given in this form is true and correct. If found
incorrect, my candidature will be liable for cancellation at any stage. I shall abide by the decision of
the University.
Date__________________

Signature of the Candidate

6

Place __________________
Forwarded through:

For employees of M S University of Baroda:

I herewith forward the application of _________________________________________________ for the post

of ___________________________________________ at the M. S. University of Baroda. He/she is working
as a ________________________. I have "No Objection" to his/her application being considered and,
if selected, for his/her appointment to the concerned post in the University.

____________________________________________
Name and Signature of the Head of the Department

____________________________
Name and Signature of the Dean /
Principal / Head of the Institution

Date and Place:

For candidates employed outside of the M. S. University of Baroda:

I herewith forward the application of Mr./Ms./ _________________________________________________

for the post of ___________________________________________ at the M. S. University of Baroda. He/she
is working as a __________________________________ in our organization on a temporary / permanent /
ad hoc / contractual basis. We have "No Objection" to his/her application being considered and, if
selected, for his/her appointment to the concerned post in your University.

__________________________________________________________
Name and signature of the authority competent to forward with seal
Place and date:
______________________________________________________________________________________
List of Enclosures:
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