Pandit Deendayal Petroleum University
Gandhinagar-382007
Date: __________________
_____________________________________________________________________________
Post Applied for
__________________________Subject: ______________
(Valid for single post only)
Department /School: _____________________________________________
Passport size
photograph
___________________________________________________________________
1. Name in Full:
_____________________________________________________
(Capital letters only)
(Surname)
(First Name)
(Last Name)
2. Address:
For Correspondence:__________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
City: ______________________ District: _______________________ Country: __________________
Permanent: __________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Phone: ________________ Mobile No.: ________________ e-mail: ____________________________
3. Date of Birth: ___________________ 4. Nationality: _________________ 5. Sex:
M/F
6. Present Status:
Designation: __________________________________________________
Organization: _________________________________________________
Total Emoluments:_________________________________________
7. Areas of Specialization: ________________________________________________
8. Current Areas of Research: __________________________________________
9. Academic Record (starting with Bachelors Degree)
(Please attach photocopies of degree certificates and also brief synopsis of the Masters & the Doctoral thesis)
Degree
(Subjects)
Institution
Year
Marks &
Division
Remarks
10. Title of Ph.D. Thesis: ______________________________________________________
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11. Category:
Open/ ST/SC/ SEBC
(Attach a certificate from the authority prescribed under government rules for ST/SC/ SEBC category)
12. Previous Experience (Starting with the recent)
A1. Teaching Experience:
Sr.
Organization
Designation
PayNo.
scale
Total Pay
(pm)
Duration
From
To
Total
Experience
A2. Details of Academic Experience (in years and months):
(a) Teaching at Post Graduate Level:
From______________ to _____________
Subjects taught at P.G. Level
Name of Subjects:
_____________________________________________
_____________________________________________
_____________________________________________
(b) Teaching at Graduate Level:
From______________ to _____________
Subjects taught at Graduate Level
Name of Subjects:
Teaching at other Level(s), if any
____________________________________________
____________________________________________
____________________________________________
_____________________________________________
(c) Teaching at other Level(s), if any
From______________ to _____________
Name of Subjects:
____________________________________________
____________________________________________
B1. Research Experience: (Excluding Research during M. Tech./Ph.D.)
Sr.
Organization
Designation
PayTotal
Duration
No.
scale
Pay (pm) From
To
(a) Research Supervision:
(i)
Total
Experience
Ph. D. level ________________________
(ii) P.G. level _________________________
(b) Other Research Experience, if any
____________________________________________
____________________________________________
____________________________________________
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B2. Sponsored Projects:
Duration
Sponsoring
Organization
B3. Consultancy:
Duration
Sponsoring
Organization
Title of Project
Amount of
Grant
Area of Project
Co-Investigators
(if any)
Co-Investigators (if any)
C. Publications:
No. of Research Papers published in journals.
(i) In Refereed Journals:
No. of Publication
*Total Impact Factor
International
National
* Cumulative total of impact factor of all the publications in Referred journals
(ii) In Proceedings of Refereed (i) International: _______________________________
Conferences
(ii) National: ________________________________
Note: Please attach the summary on separate sheets for publications in refereed journals and referred conferences papers
including all details. (i.e. Title, Year, Vol., Page No. Name of the Publisher (may be mentioned) & Impact factor.) Along
with this details also attach the Reprints of published best three research Papers, Journal/Proceedings of Conference in last
five years.
(iii) Details of published Books / Review article: ______________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
D. Industrial Experience:
Duration
Organization
Nature of Work
Total Pay (pm)
E. Contribution in institutional / departmental activities (administrative):
Duration
Organization
Nature of Responsibility
Designation
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13. Professional distinctions/Awards/Medals if any:
___________________________________________________________________________________
___________________________________________________________________________________
14. Details of any other innovation/activity involved during professional career.
a. Innovation / Contribution in teaching:
(i) Design of curriculum:
________________________________________________
(ii) Teaching methods:
________________________________________________
(iii) Laboratory Development:
________________________________________________
(iv) Evaluation Method:
________________________________________________
(v) Preparation of Resource Material:
________________________________________________
(vi) Remedial teaching:
________________________________________________
b. Extension work (Community service / ________________________________________________
Corporate life)
________________________________________________
15. Membership of Professional Bodies: (i) _____________________________________________
(ii) _____________________________________________
(iii) _____________________________________________
16. Give Names, designation and addresses of three persons (not related to you), to whom
reference may be made about your work, conduct & performance.
(i) _________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Email: ____________________________________________ Contact No.: ______________________________
(ii) _______________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Email: ____________________________________________ Contact No.: ______________________________
17. If not found eligible, as per university norms for the position you have applied for, would you
like your candidature to be considered for lower position: . Yes / No
18. State any other information not covered elsewhere (Please attach a sheet, if required)
___________________________________________________________________________________
___________________________________________________________________________________
19. Minimum time duration for joining: ________________________________________________
DECLARATION TO BE SIGNED BY THE CANDIDATE
I hereby declare that the details given above are correct to the best of my knowledge and belief. I
understand that if any information provided above is found to be false or inaccurate my candidature shall be
treated as cancelled at any point of time.
Date:
(Signature)
Name:.......................
Page 4 of 6
General Instruction
(For candidates interested in a faculty position)
1. Candidates applying for a position to more than one department are required to use separate application
forms.
2. (a) On the first page of the Application Form (column 1 to 11), the desired particulars are to be filled
in by the candidates supported by certificates and documentary proofs (where necessary)
(b) On the second page (column 12) separate sheet (s) for each sub-heading in the format is/are
indicated to be used indicating cross references in the columns provided and the annexures attached
(c) All annexure and the application form must bear full name and signature of the candidate on each
page at the bottom.
3. Applicants who are employed in Government, Semi-Government Organizations/ Grant in Aid
Institutions should send their applications THROUGH PROPER CIIANNEL else they will
be required to produce a NO OBJECTION CERTIFICATE from their employer at the
time of interview.
4. Dully filled form should be sent to following address within prescribed time limit:
To
The Registrar,
Pandit Deendayal Petroleum University,
Raisan, Gandhinagar -382007
Gujarat, India
Note: Please mention the post Applied for: ___________ on the envelope.
Page 5 of 6
Summary
Post Applied for:
Name of the Candidate:
Address:
Date of Birth:
Qualification:
Nationality:
Year
Percentage/grade
Ph.D.
Title:
Master Degree
Title:
Bachelor Degree
Teaching Experience:
Pre Ph.D. experience: Total No. of _______Years _______Months
Post Ph.D. experience: Total No. of ______Years _______Months
Present Position:
Designation: __________________________________________________
Organization: _________________________________________Total Emoluments (pm):________________
Research Experience:
(Excluding Research done for M.Tech /Ph.D.)
Total No. of _______Years _______Months
No. Publications:
In Referred
Journal
No. of Thesis/ Dissertation
guided (Independently/Jointly)
*Total Impact
Factor
M. Tech.
Conference/
Seminar
Ph.D.
No. of Sponsored projects
Completed / continuing with
budget Funds
Title of the Projects
No. of Consultancy projects
completed/ continuing with
budget Funds (Rs. Lakhs)
Title of the Projects (Rs. Lakhs)
Books
Consultancy
Funding
Agency
Budget Fund
Funding
Agency
Budget Fund
(Rs. Lakhs)
(Rs. Lakhs)
Awards & Distinctions:
Any other information
For Use at PDPU
Remarks If any
Cumulative total of impact factor of all the publications in Referred journals
SIGNATURE OF THE CANDIDATE
Page 6 of 6
