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Application Form: Hamirpur-177 005 (Himachal Pradesh), India

1. The document is an application form for a faculty position at the National Institute of Technology in Hamirpur, India. 2. It requests information on the applicant's personal details, educational qualifications, experience, subjects taught/willing to teach, references, and vision statement. 3. The applicant must provide all required documents and certificates and understands the application will be rejected if any information is incorrect or incomplete.

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AMIT KUMAR
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45 views4 pages

Application Form: Hamirpur-177 005 (Himachal Pradesh), India

1. The document is an application form for a faculty position at the National Institute of Technology in Hamirpur, India. 2. It requests information on the applicant's personal details, educational qualifications, experience, subjects taught/willing to teach, references, and vision statement. 3. The applicant must provide all required documents and certificates and understands the application will be rejected if any information is incorrect or incomplete.

Uploaded by

AMIT KUMAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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हमी रपुर- 177 005 (हिमा चल प्रदेश), —ȡš

Hamirpur- 177 005 (Himachal Pradesh), India

APPLICATION FORM
(Advertisement No: ……../2019, Date: …………., 2019)

Post Applied for* : Passport


Department : size Colored
Signed
Specialization :
Photograph
Area of Specialization(s) :

(as listed in the advertisement)

Category :

Genera EWS SC ST OBC


l

[Please tick (√) the Sub Category (PWD) [yes/no] appropriate one]

Number of unsuccessful attempts in the Interview for the same post at NIT Hamirpur:
Adv. No. 07/2018, 11/2018, Admn-02/2019,
dated 08th Aug., 2018 dated 23 Aug., 2018 dated 04th June, 2019
rd

Please tick (√) the


appropriate one

Fee Details (except SC/ST/PWD and Women Candidates):


Amount & Date:
SB Collect Reference Number:
Exempted case for the post of Professor subject to
production of proof for the same :
Amount and Date of fee deposited in previous
Advertisements No.09/2018, Dated 13/08/2018, 06/2017,
Dated 22/12/2017.
* Candidates who wish to apply for more than one department or more than one post in the same department, he/she should apply
separately for each department / post and separate application must be submitted for each department / post along with requisite fee.

I. PERSONAL INFORMATION:
1. Name of the Candidate :
2. Father’s Name :
3. Date of Birth :
4. Gender :
5. Marital Status :
6. Permanent Address :

7. Correspondence Address :

Mobile No.:……………………………. Email ID:………………………………….


II. EDUCATIONAL QUALIFICATION:
(Please attach self attested photocopies of various Degrees, Certificates and Mark sheets):-

S. No. Qualification Stream % Marks/ Division Date, Month University/ Remarks


Degree/ CGPA & Year of Institution/ Board (if any)
Certificate passing
1. Ph.D.
2. PG
3. UG
4. HSSC (12th)/

Diploma
5. SSC (10th)

Details of Ph.D.:

Ph.D. Title:
Field of Specialization :
University/Institution :
Date, Month & Year of award of Ph.D. Degree:

III. EXPERIENCE (As on the last date of receiving hard copy):


(Please attach self attested photocopies of all experiences):-

(a) Teaching Experience:


Position/Designatio Name of Institution From To Total Grade Pay,
Pay Level, (b)
n Till date
Basic Pay
Years Months
(b)
(b)
(b)
(b)
(b)
Research Experience:
Position/Designatio Name of Institution/ From To Total Grade Pay,
Industry/Research Pay Level,
n Till date
Lab Basic Pay
Years Month
s

(c) Industrial Experience:


Position/Designatio Name of Industry/ From To Total Grade Pay,
Research Lab Pay Level,
n Till date
Basic Pay
Years Month
s

IV. Subject Taught / Willing to Teach:


(Please attach self attested photocopies of all proofs of subject taught issued by concerned HODs):-

S. No. Subject taught Willing to teach


A At UG Level: 1. 1.
Core Courses 2. 2.
3. 3.
B At UG Level: 1. 1.
Elective Courses 2. 2.
3. 3.
C At PG Level: 1. 1.
Core Courses 2. 2.
3. 3.
D At PG Level: 1. 1.
Elective Courses 2. 2.
3. 3.

V. List of Two Referees:


(The referees should be residents of India and holders of responsible positions. They should be
intimately acquainted with the character and work of the applicant but must not be in relation).
Sr. Name of the Referee Designation Complete Address with Mobile /
No. Landline No. & Email ID.

1
2

VI. VISION STATEMENT: Write a note on your short term (next 5 years) and long term (career)
vision / goals for (a) Teaching, and (b) Research
Short Term

Long Term

UNDERTAKING
I hereby undertake that, I have read all the information and instructions given in
Advertisement on the website i.e. www.nith.ac.in and the above information given by me is
correct. I understand that my application shall be rejected if i) the information is not correct or ii) all
the required certificates and documents are not attached or iii) application is incomplete.
I am not arrested, prosecuted, kept under detention, or bound down/fined/convicted by a
court of law for any offence or debarred/disqualified by any Public Service Commission from
appearing in its Exam/Selections or debarred from taking any Exam/rusticated by any University
or any other Educational authority/Institution or no case is pending against me in any court of law,
University or any other educational authority/Institution.

Signature of Applicant

Place :

Date :

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