SAFI INSTITUTE OF ADVANCED STUDY

Vazhayoor East P.O., Malappuram – 673 633. Ph: +91-495-3246110

Email : siasmails@yahoo.com; www.safindia.org

Application for the Post of …………………………………………………..

Bank Draft No. …………….

Dated ………………………. Self attested
Amount Rs. 100/- photograph
(Application without DD for Rs. 100/- will not be accepted.
DD should be drawn in favour of “SAFI Institute of
Advanced Study” payable at Cherukavu)

1. Name: …………………………………………….
(Block letters, write in order : first name middle name, last name)

2. Gender : Male ( ) Female ( )

3. Date of Birth : ………………..….. In words ………………………………...…………..

4. Place of Birth ……………………………………………………………………...………

(Village, Taluk, District, State)

5. Religion : ………………………..…………. Caste : …………………………………….

6. Father’s name : ……………..……………………………………………………………..

Address, Occupation …….…………………………………………..……………….......

7. Address for correspondence : …………………………………………….………………

………………………………………………………………………………………………
………………………………………………………………………………………………
City : ……………………………State …….……………………. Pin ………….………
Phone: …………………………………………Fax ………………………………...……
Email :

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8. Are you employed; if Yes please furnish (a) Designation and official address :
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

9. Academic qualification

Name of the Name of the Year of Class/Rank/ Main

examination / Board/University passing Marks* Subjects/
degree Specialization

Higher Secondary

Bachelor’s Degree

Master’s Degree

Ph. D.

Thesis topic, and

the name of the
guide:

Any other Degree

or Diploma
obtained :
a)

b)

c)

Whether NET qualified Yes [ ] No [ ]

* Enclose certified copies of the mark list, degree certificate, etc.

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10. Summer schools / training programme as course director

Name of the course Institution Duration & year Organised /

Attended
a

11. Proficiency in languages (Indian & foreign languages)

Read only Speak only Read and Speak Read, Speak and Examination
Write passed

12. Employment record (Starting from the most recent one)

Sl. Name of the Institution Post held Teaching Experience (years)

No.
UG PG

Note : Enclose a separate sheet if necessary

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13. Research projects undertaken
(Note : enclose a separate sheet if necessary)

a. Title :

b. Your status (Coordinator, PI, Co-PI, Associate) :

c. Funding agency and amount sanctioned :

d. Organisation and Year of start and completion :

e. National / International Symposia/Seminar/ :

Congress/Workshop/Teachers Training
Programme, etc

Organised Attended

14. Please give a note regarding your activities related to teaching (graduate and post
graduate teaching, research) and significant contributions indicating your suitability
for the post applied for in 250 words – Enclose a separate sheet

15. List of Publications (Nos) National International

a. Original research papers in referred journals ( ) ( )

b. Book chapters ( ) ( )

c. Books published ( ) ( )

d. Papers in symposia/seminar/conference ( ) ( )

e. Popular articles ( ) ( )

f. Technical bulletins ( ) ( )

g. Others (specify) ( ) ( )

(Note : Enclose a list of all publications. Also give a list of 10 most important
publications starting with the most recent one in the categories)

16. Membership in professional bodies

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17. Awards and recognition
(Note : Enclose a separate sheet if necessary)

18. Academic visit to other laboratories/institutions in India and abroad

Period and Laboratory / Status Nature of work

Country Institution

19. Referees
(Please give the name(s)/address and contact numbers of three referees)

1. 2. 3.

Declaration

I certify that all the particulars given in the application are true to the best of my knowledge
and belief.

Place : Signature ……………………………………

Date : Name ………………………………………..

Note : Attested copies of all the relevant records should be submitted along with the
application.

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