ANNEXURE-I

APPLICATION FORM FOR FACULTY POSTS

ADVERTISEMENT No.: 03/ 2024, dated 01/10/2024

Post applied for: __________________________

Department with _______________________
Field of Specialization (if any):
Paste your
Applied under category __________________ latest photo
UR/PWD/SC/OBC/EWS
(Attach reserve category certificate)

Website: www.nerist.ac.in

NORTH EASTERN REGIONAL INSTITUTE OF SCIENCE AND TECHNOLOGY

(DEEMED TO BE UNIVERSITY)
(Under section-3 of the UGC Act, 1956, vide Notification No. f.9-15/2002-U.3, Dated 31st May, 2005, MoE, Govt. of India)
Nirjuli ::: Itanagar ::: Arunachal Pradesh
(Under Ministry of Education, Govt. of India)

ADVERTISEMENT No.: 03/ 2024, dated 01/10/2024

Particulars of fee Remitted:

Amount: Bank Draft No. Dt. Issue in Bank: (Branch Code

1. Full Name (in Block Letters) SUMIT SINGH RAJPUT

2. Father's Name Deepak Singh Rajput

3. (a) Address for Correspondence (b) Permanent Address

House no. 50 Peeli Amman koil street House no. 256 Ward no.1 Kejurice mill road,
Tharamani Chennai, T.N. Bajrang Nagar chowk Durg. C.G.
Pin code- 600113 Pin code- 491001

Phone No: 9074795260 Phone No: 9074795260

email: email:
dr.s.s.rajput07@gmail.com dr.s.s.rajput07@gmail.com

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 4. Date and Place of Birth: 14/09/1990 5. (a) Sex: Male

Age on the last date of this application (b) Category: General

Years:

Months:

Days:

5. Marital Status: Married 7. (a) Nationality: Indian

(b) Religion: Hindu

8. Academic Qualification (Commencing with the High School or an equivalent examination):

Examination Year Div. % Marks Subjects Specialization University/ Distinctions/
at PG level
/Grade College/ Scholarship
Board

Research Degree(s):
Degree University Specific date Specific Title of the work
of submission date of
of Ph. D. thesis award
M. Phil

D. Sc./D. Lit.
(i) Whether Ph. D. awarded as per UGC Regulation 2009 or 2016 (if yes, please give documentary
proof).

(i) Whether NET qualified (Conducted by UGC/CSIR/ICAR), if yes, Please Indicate the date with
documentary proof)

9. Teaching/Professional/Research Employment (Give particulars in descending order starting with

the present post):
Employer *Status of Post Held Scale/Pay Basic Period of Employment Nature of
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Institute/ Band Pay Duties/Work
and
University From
ACP

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10. Summary of experience/performance

A. Teaching Experience From Total years & Months

Under Graduate

ii Post Graduate
iii Total Teaching
Experience :
Participation in
production of
Educational TV
programme:
Short term/ Continuing
Education/ Specialist
Courses conducted
B. Course developed (No.)

c. * Research and academic contributions

i. Research papers published in Refereed Scopus/SCI indexed Journals/Non-refereed but

reputed journals having IISBN/ISSN (please give the details in Annexure — A)

Research Publications (Other than refereed journal articles):

ii. Books [Chapters in books (Please give the details in Annexure — B):

a. Book:
b. Book Chapters:
*Note: List of publications with details and reprints of five best research papers and acceptance
letters (in case of accepted papers) must be enclosed with hard copy of application.

Research Projects (Please give the details in Annexure — C):

a) Completed:
b) In Progress:

E. Research Guidance:
Number of Thesis Awarded Submitted In progress
Supervised (Please give the
details in Annexure — D):
i. Ph.D.
ii. M. Phil 4
iii. M. Tech./M.Sc.
F. Prizes Medals/Awards/Honors:

G. Extra-curricular activities - give details, if any, of proficiency acquired in games, sports and
part taken in other extra-curricular or social activities such as NCC, Public Lectures, Debates,
Social Service etc.
As a student:

After entering into service:

11. Training Courses and conference/seminar/workshop (Please give the details in Annexure — E):

(a) Organized
(b) Attended
(c) Papers presented

12. (a) Membership/Fellowship of professional societies:

(b) Other activities/Responsibilities:

Academic:
Administrative

(c) Are you willing to accept the initial salary of the grade?
(If no, state what is the minimum salary expectable or expected with justification thereof).

(d) If appointed, what period would you require before joining the post?

(e) Any other relevant information, not given above:

13. (a) Has there been any break in your academic career?

(b) Have you been punished during your studies at college/University? If so, give
details.
(c) Have you been punished during your services or convicted by a court of law? If so, give
details.

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 (d) Were you at any time declared medically unfit or asked to submit your resignation or
discharged or dismissed? If yes, give details in a separate sheet.
(e) Do you have any court cases pending as one of the parties? If yes, give details.

14. Give names, designations and addresses (Phone/Fax No./e-mail) of three referees not
related to you. Referees should be persons with or under whom you have worked, or
who have intimate knowledge of your work.
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2.
3.

15- List of Enclosures:

(a) Bank Draft and Photograph

(b) Copies of Mark-sheets and Certificates of educational qualifications including
NET.

(c) Copies of certificates of experience.

(d) List of publications with details, reprints of papers and acceptance letters (in
case of accepted papers).

(e) Copies of other relevant certificates and documents.

16. Declaration to be signed by the candidate
hereby declare that the entire information furnished in
this form are true to the best of my knowledge. If at any time, I am found to have
declared any material/information or given any false details, my appointment shall be
liable to be summarily terminated without any notice or compensation.
Signature of Applicant

Dated: Name:

17. Forwarded with the remarks that the institutions/organizations has no objections to the candidature
of the applicant being considered for the post applied for, as above.
(Candidate already employed should forward through their employer)

Place: Signature
Date:
Phone No.: Seal

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email:

ANNEXURE – II

NORTH EASTERN REGIONAL INSTITUTE OF SCIENCE AND TECHNOLOGY

(DEEMED TO BE UNIVERSITY)
(Under section-3 of the UGC Act, 1956, vide Notification No. f.9-15/2002-U.3, Dated 31st May, 2005, MoE, Govt. of India)
Nirjuli ::: Itanagar ::: Arunachal Pradesh
(Under Ministry of Education, Govt. of India)

APPLICATION FOR THE POST OF ………………………………………

Advertisement No. & Date: …………………………………………………….

1. (i) Full Name (in block letters) : .......………………………………………… Please affix recent
passport size
photograph
(ii) Father’s/Husband’s Name: ………………………………………………..

2. (a) Date of Birth: …………..……

(b) Age (as on ………………): ……..………………………………………………………

3. (a) Nationality: ……………………… (b) Gender: Male/Female

(c)Marital Status: Married/Unmarried/Divorced (d) Category: GEN/SC/ST/OBC/EWS
4. Postal Address for correspondence: ………………………………………………………................................

…………………………………………………………………………...……….………………...……………...

……………………………………………………… Pin Code: ………….………

Mobile No. (i): …………...………....... (ii)…………………………

e-mail ID: (i)…………………………………………………(ii)………………………………………………..

5. Permanent Address: ……..………..………………….…………………………...…….……………………..

……………………………………………………………...…………………………...Pin Code ……………....

6. Educational Qualifications (from matriculation onwards):

Sl. Examination Name of the Year of % of Marks/ Division /

Passed Passing Class
No. University/ Board Grade (CGPA)

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7. (a) Professional Experience:

Sl. Name of Employer Post held Period of Employment

No. From To

(b) Type of organization (Government/Semi Government/Govt.: ……………………………………………

Sponsored/Autonomous Body/ Private etc.)
8. Any other relevant information: ………………………………………………………………………

9. List of enclosures: …………………………….

DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief. I understand
that misleading or wrong information furnished may lead to summary rejection of application/ appointment (if
found subsequently).

Date: ------------------------------------
(Full Signature of Applicant)
Place: