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Indian Institute of Information Technology

The document appears to be an application form for a faculty position at the Indian Institute of Information Technology in Kalyani, West Bengal. It requests information such as the applicant's personal details, educational qualifications, employment history, research experience, publications, teaching experience, and references. It contains 19 sections requesting details like name, address, citizenship, category, date of birth, educational qualifications with marks/percentages, work experience, research projects, publications, teaching experience, areas of interest, and a list of references. The applicant is asked to sign a declaration that the information provided is true to the best of their knowledge.

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49 views

Indian Institute of Information Technology

The document appears to be an application form for a faculty position at the Indian Institute of Information Technology in Kalyani, West Bengal. It requests information such as the applicant's personal details, educational qualifications, employment history, research experience, publications, teaching experience, and references. It contains 19 sections requesting details like name, address, citizenship, category, date of birth, educational qualifications with marks/percentages, work experience, research projects, publications, teaching experience, areas of interest, and a list of references. The applicant is asked to sign a declaration that the information provided is true to the best of their knowledge.

Uploaded by

Aircc Airccse
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 6

INDIAN INSTITUTE OF INFORMATION TECHNOLOGY

(Autonomous institution under MHRD, Govt. Of India & Department of


Information Technology & Electronics, Govt. of West Bengal)
JIS College of Engineering Campus
Block-A, Phase-III, Kalyani-741235,West Bengal
--------------------------------------------------------------------------------------------------------------------------------------------------

FORM OF APPLICATION FOR FACULTY APPOINTMENT BY SELECTION


(Please read carefully the general condition /instruction of the advertisement before filling the form)

To be sent to

Recent passport size


(3.5cm x 3.5 cm)
photograph of the
Applicant with his/her full
signature thereon

The Registrar
Indian Institute of Information Technology,
JIS College of Engineering Campus.
Block-A, Phase-III, P.O Kalyani, Dist.
Nadia-741235,West Bengal

1.

Name in full as you write (in capital


letters)(Underline Surname)

2.

Father`s/Husband`s Name

3.
4.

a. Marital Status (married/unmarried)


a. Permanent address
b. Address for
correspondence (if
different from 4(a) )
c. Mobile No

5.

b. Male/Female :

d. Email ID

a) Post applied for


b) Advt. No. & date
c) Discipline (CSE/IT/Maths/
Physics)
d) Field (s) of Specification

6.
7.
8.
9.
10.

Date of birth (please attach true


copy of certificate )
Are you a citizen of India by
birth or by domicile?
Please state your category (Gen/SC/ST/OBC) :
If appointed, what notice would you
require before joining the post?
If you are employed, please state
your present pay band indicating
Grade pay/ Pay package
1

11. Details of educational qualification: Please give particulars of all examinations passed and degrees obtained beginning with the most recent.
Give details of Ph. D, even if it is not completed. Please attach copies of certificate and mark sheets/testimonials (self attested).
Sl.
No.

School/
College/Institute

Date of
entry

Date of
completion/
Ph. D thesis
submission

Name of the
Board/
University/Institution

Examination
/Degree /Diploma
passed

Distinction
/ Class /
Division

Subjects (Please
mention field of
Specialization, honours,
etc. where applicable)

Percentage
of marks or
C.P.I

Date of award

12. Details of Employments: Please give particulars of your present and past employments in chronological order, beginning with the most recent:
Sl.
No

Organization/Institute

Position
held

Date of
joining

Nature of duties/work

Date of
leaving

Last pay (Pay Band


and Grade Pay/Pay
package)

Additional remarks about


experience, if any*

*Please specify, if the position is: (i) Pre-Ph. D, (ii) Post-Ph. D, or (iii) Concurrently with Ph. D

13.

Research & Development, Training, Project, Publication :

(a) Please attach a list of your Sponsored Research & Development/Industrial/Training Experience
(b) Please state the following in the format below (give details in a separate sheet):
No. of Projects involved in

No. of Ph. D thesis


guided

No. of Projects involved


in

Completed

Sponsored

On going

No. of
Patents

Consultancy

(c) Please state the number of publications in different categories


In Journals
National

14.

In Conference

International

Referred

(a) Teaching Experience


Please give a list of course taught
on a separate sheet with course
titles, levels (UG/PG)

Technical
Reports

Un-Referred

No. of different courses taught:


No. of. Years :

No. of. courses as teaching assistant:

(b) Areas of specialization in your


thesis
(c) Title of your Ph. D Thesis
(d) Please describe briefly on a separate sheet
regarding your Ph. D. Work.
(e) Mention your areas of interest with work
done in each case (if any).
(f) Laboratory Experience: Please describe, in brief on a separate sheet, your experience in (i) Setting up
of teaching and research laboratories (ii) Conducting laboratory courses & (iii) Using different types of
instruments, systems, computers etc.
15.

Additional Remarks :
(applicant may mention here any
other qualifications or experiences,
which have not been included under
the heads given above)

16.

Give a list of all publications in chronological order (beginning with the most recent). Give full details
of each paper including the names of all authors in order of appearance in the paper (as you would refer
in a paper) (use more pages if required).

17.

Please give a list of at least three referees below, along with their addresses and E-mail IDs. Your
Ph. D supervisor is expected to be one of the referees. Please request your referees to send their letter
of reference directly to The Registrar IIIT-Kalyani, [email protected] with the subject: letter
of reference for <your Name>.

18.

Enclosures to be 1. Sponsored Research & Development/Industrial/Training experience, list


included with the
of courses taught/assisted, details of laboratory experience, and details
application (if there is
of Ph. D work.
no information for
some items, specify 2. Details of Work Experience.
that this enclosure is
not included).
3. Attested Copies of all degree certificates and mark sheets.
4. Others.

I hereby declare that I have carefully read and understood the instruction and particulars provided to
me and that all the entries in this form are true to the best of my knowledge and belief.

Date:.........................
_____________________________
Signature of the Applicant

19. Endorsement of the present Employer:


The application of Shri/Ms. ...................................................... (Name and designation
of the applicant) for the post of ....................................................................................... at
IIIT- Kalyani is forwarded herewith. It is certified that no enquiry/disciplinary action is
pending or contemplated against him/her.

Date:

Signature of the head of the institution/Forwarding authority with seal

INDIAN INSTITUTE OF INFORMATION TECHNOLOGY, KALYANI


HIGHLIGHTS OF CURRICULUM VITAE
(To be filled in by the Candidate)
Application No._____________

Name of the
____________
Candidate
(in block letters)(First Name)

___________

______________

(Middle Name)

(Last Name/Surname)

Advertisement No.

Post applied for


Designation : _______________

Academic Record (Starting from Madhyamik or equivalent )


Examination

Year

Class/Division %Marks

Board/Univ.

Rank if Known

Department : _______________

Category of Candidature
(Please put tick mark ( ) in
the appropriate box )
General
Scheduled Caste
Scheduled Tribe
Other Backward Classes
Physically Handicapped
Others
Date of Birth
Date

Month

Year

Address for Communication


___________________________
___________________________
___________________________

Experience in Years
Undergraduate teaching
Postgraduate teaching
Research experience
Industrial experience
Administrative experience
No. of Research Projects

Telephone Number

__________________________
E-mail Address (if any)

___________________________

Completed
Under implementation
Under preparation

No. of Publications
Papers in Indian Journals
Papers in Foreign Journals
Papers in Conference
Proceedings ( National)
Papers in Conference
Proceedings ( International)
Books, Monograph andOthers

No. of thesis/dissertations
guided by the candidate

Masters ( Completed )

Masters ( Ongoing )
Ph. D ( Completed )
Ph. D ( Ongoing )

Any other matter in support of the Candidature

Certified that the statements recorded here are to the best of my knowledge.

Date :

( Signature of the candidate in full )


6

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