NATIONAL INSTITUTE OF TECHNOLOGY TIRUCHIRAPPALLI
TAMIL NADU - 620 015
PROFESSOR
ASSISTANT PROFESSOR
Recent passport
LECTURER size photograph to
be affixed
1. Advertisement No. NITT:06/2009
2. Department and Area
of Specialization
3. Name in Full (Capital Letters)
(as in SSLC Certificate)
Day Month Year
4. Date of Birth
Age …………. years
Citizen of India
5. Citizenship Status
(tick the appropriate box) by Birth by Domicile
OBC SC ST PC
6. Other Backward Caste/Scheduled
Caste/ Scheduled Tribe/Physically
Challenged please attach the attested copy of certificate
Mr./Mrs./Miss………………………………………………………...
7. Address to which Communications …………………………………………………………………………
Should be sent (also furnish email, fax,
telephone number, if any) …………………………………………………………………………
…………………………………………………………………………
Pin :
E-mail :
Mobile :
Fax :
Mr./Mrs./Miss………………………………………………………..
8. Permanent Home Address …………………………………………………………………………
…………………………………………………………………………
…………………………………………………………………………
Pin :
Phone :
9. Name and Address of Parent/
/Spouse
10. Details of payment
D.D.No. Bank : Date:
11. Details of University Education from SSLC onwards
Degree University Division % of marks Year of passing
Discipline *
12. Professional Experience in chronological order upto the present post
Organization Designation From To Scale of Pay Basic Pay
13. Academic Profile(Give details of the following in separate sheets)
Papers published in Journal
Books Authored/Co-authored
Papers published in Conferences
Sponsored Research projects: Title, Sponsoring, Agency, Sanctioned Amount and Duration
Awarded: Submitted: Ongoing:
M.S./Ph.D. thesis guided/co guided **
M.Tech. Projects guided
Workshop/Training Programmes/Summer/Winter Schools/Conferences Attended/Organized.
Awards, Patents, Prizes etc.
Any other relevant information on your academic standing in brief.
14. Professional Affiliation, Indian and Foreign (Membership of Societies, etc.)
Organization Year of Grade of Membership Remarks
induction
* Indicate the title of the Ph.D. thesis, if applicable.
** Title of thesis and name of guide/co-guide and year of submission/award.
15. Visits Abroad (for Professional Work or Training only)
Period of Visit
Country Purpose
From To
16. Present Basic Pay Minimum Basic Pay expected Time required to join if post is offered
17. Are you willing to be considered for the next lower post
18. Name of References (Preferably of your Professional background)
Name and Designation Current Address/Email/Phone
(i)
(ii)
(iii)
19. Please enclose the following
Attested copies of Degrees/Diplomas and Certificates Nos.:
Reprints/Xerox copies of front page of the papers published in Nos.:
journals/conferences
20.
I hereby declare that the information given above is correct and to the best of my knowledge
and belief. I fully understand that if it is found at a later date that any information given in the
application is incorrect/false or if I do not satisfy the eligibility criteria, my
candidature/appointment is liable to be cancelled/terminated.
Place :
Date : Signature of the Applicant
21. Endorsement of the Present Employer:
The application of _____________________________________________________________
(Name and Designation of application) for the post of Assistant Professor/Lecturer in NIT,
Tiruchirappalli-15 is forwarded to the Registrar, National Institute of Technology,
Tiruchirappalli-620 015.
Date : Signature of the Head of the Institution with Seal
