APPLICATION FORM FOR TEACHING STAFF

(To be filled by the Candidate)

Advertisement Dated: Click here to enter a date. Department Applied for: Choose an item.

Position Applied for: Choose an item. Specialization Code:

SECTION – A: GENERAL

1. Name in full MR. Click here to enter text.

2. Date of Birth Click here to enter a date.

3. Father’s /
MR. Click here to enter text.
Mother’s Name
4. Mailing Address Click here to enter text.

Pin Code
5. Tel. No.
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(with STD code)
6. E-mail ID Click here to enter text.
7. Permanent Address Click here to enter text.
Pin Code

8.Nationality Click here to enter text.

9. Marital Status Choose an item.

10. Name of the Choose
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Spouse an item.
11. Occupation Click here to enter text. Designation Click here to enter text.
Any Other
12.Languages known English☐ Kannada☐ Hindi☐ Tamil☐ Telugu☐
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13.State of Domicile Click here to enter text.

14.Present Employer Click here to enter text.

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 SECTION B: CATEGORY I: TEACHING, LEARNING AND EVALUATION RELATION ACTIVITIES

EDUCATIONAL QUALIFICATIONS (Starting with highest degree obtained )

Percentage
Year of
Sl. Name of Board/ of Class/Division
Examination/Degree Specialization/subjects Passing/
No. College/University Marks/Final /Grade
Awarding
Grade
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1 to enter
a date.
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2 to enter
a date.
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3 to enter
a date.
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4 to enter
a date.
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to enter a
date.
Whether Ph.D. awarded:Choose an item. If Yes, please indicate below

Date of
Ph.D/ M.Tech Degree University Title & Area of Work Done
Awarding

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Additional Credentials, (NET/SLET/GATE etc..)
DETAILS OF EMPLOYMENT EXPERIENCE (In chronological order starting with the most recent)
Name of Period of employment
Sl. Post held/ Basic/ Gross Nature of
Employer/Status of
No. Designation From To last drawn duties
Institute/University
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1
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2
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 TOTAL :Click here to enter text.
TEACHING EXPERIENCE
Years Months
i. Under Graduate
ii. Post Graduate
iii Total Teaching Experience
iv.Short term/Continuing Education / Specialist courses /any other
courses conductedClick here to enter text.

SUBJECTS TAUGHT
Number of times this subject Course materials prepared if any, for
Subject UG/PG
has been taught the subjects taught

SUBJECTS you can teach other than the above listed Subjects
Sl No. Subject
1

TOTAL : Click here to enter text.

RESEARCH EXPERIENCE
Years Months
Research Experience other than the period spent for obtaining
Ph.D Research Degree

SECTION B: CATEGORY II: CO-CURRICULAR, AND PROFESSIONAL DEVELOPMENT RELATED ACTIVITIES

1. Student related co-curricular, and field based activities(such as e NSS/NCC and other channels, cultural activities,
subject related events).
Sl No. Description
1

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 2. Departmental\Academic\Administrative Responsibilities

Institute Year Responsibility Important Contribution

SECTION B: CATEGORY III: RESEARCH AND ACADEMIC CONTNRIBUTION

RESEARCH PUBLICATIONS
1. Books- Self authored/co-authored/edited

Whether
Sl. Title of the Book (s) Name of Publisher Month&Year of
Sole Author/
No. (with City/ Country) Publication
Co-author
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enter a date.
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date.
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date.
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date.

2. Research Articles/Papers published in Journals /Periodicals /Conference proceedings/Newspapers

Name of Month & year of

Whether
Sl. Title of research article / journal Publication, Level Impact
Sole Author/
No. paper(s) (with city/ Volume no. Factor
Co-author
country) & pageno.
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item.
enter text.
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Note: Ignore, if other than National or International

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 RESEARCH PROJECTS UNDERTAKEN (other than that for a research degree)

Whether
Total Outcome / Whether
Whether Name of
Title/Subject Grants / Outputs final report
Sl. major or Date of Date of Sponsoring/
of Research Funding sent to published as
No. minor Commencement Completion Funding
Project(s) received Sponsoring monograph
project Agency
(Rs.) Govt. book
Agency
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an item. enter a date. enter a date. item. item.

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an item. enter a date. enter a date. item. item.

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RESEARCH GUIDANCE:
Number of scholars who have been awardedPh.D. degree Click here to enter text.
under yoursupervision both as Guide and/or Co-Guide:

Name of Degree Submitted Awarded

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PROJECTS/THESIS SUPERVISED / FACULTY GUIDANCE

Level of Students/No of
Title Year Institute/Organization
students

Instructional Materials prepared, if any (give details)

Type of Instructional
Sl No. Title Subject
Material
1

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 IIISECTION B: CATEGORY IV: TRAINING COURSES AND CONFERENCE/SEMINAR/WORKSHOP
Refresher Course, Methodology, Workshops, Training, Faculty Development Programs,etc. attended.

Duration
Sl. No. Name of Course attended Sponsoring Institution
From To
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Lecture/Special Lecture in Institutions of repute other colleges

Sl. Name and Place of
Title/Subject of Lecture delivered Date of Lecture Duration
No. Institution

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Invited Lectures & Chairmanships at International /Seminars/ Workshops/ Conferences Organized

Sl. Particulars
Date
No. Seminars/ Workshops/ Conferences Organized
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SECTION C: OTHER MISCELLANEOUS INFORMATION

Membership/Fellowship of other institutions/professional societies

Name of the Society/Body Designation National/International

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Other activities/Responsibilities:
Details of Scholarships/Awards/Honours/ Patent awarded
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 Any other relevant information, if not given above: NA
Has there been any break in your academic career? If so, give details.

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.

Do you have any case pending against you in any court of law? If yes, give details

Do you suffer from any major ailment /medical problem? Yes/No, If yes, give details:

Are you willing to accept the minimum initial pay in the grade? If not, state reasons for claiming higherStarting pay
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If selected for appointment, what notice would you require for joining the post?

Do you intend to work for minimum 3 years in MVJCE?

Have you ever applied to / worked for MVJCE before? If yes, give details

Is any member of your family employed in the past or the present in any MVJ group of institutions?If yes, Give details

Expected salary

Names and Addresses of Two Referees*:

1) Name: NA 2) Name: NA

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Mobile No.: Click here to enter text. Mobile No.: Click here to enter text.

Email-Id: Click here to enter text. ` Email-Id: Click here to enter text.
*Recommendations from two Referees, not related to the applicants, who are scholars closely acquainted with the
applicant’s academic training, accomplishment and capabilities.
(NOTE: The College reserves the right to contact the persons referred for ascertaining the credentials of the candidate)

To the applicant:
Any additional information which you have not been able to include elsewhere in the application
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ANNEXURE 1: List of Scanned Copies of Documents to be enclosed with the Application Form :
Option provided in the last page of this document for attaching of enclosures
Nos. Enclosed / Not Applicable
SSLC Marks Card or Age Proof Document Enclosed
Latest Pay Slip or Bank Statement Choose an item.
Bachelor’s Degree Certificate Not Applicable
Bachelor’s Degree Marks Cards Enclosed
Master’s Degree Certificate Choose an item.
Master’s Degree Marks Cards Enclosed
Ph.D Degree Certificate Choose an item.
Research Experience Certificate Choose an item.

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 Teaching Experience Certificate Choose an item.
Industrial Experience Certificate Choose an item.
Research Publications / Papers Choose an item.
Professional Membership Certificates Choose an item.
Reference Letters Choose an item.
Note: Kindly ensure you carry the original copy of the above listed documents for the Interview Process. Availability of
complete documentation will assist in speedy closure of offers.

DECLARATION BY THE APPLICANT

I hereby certify that the information presented in this form and the documents enclosed as mentioned in ANNEXURE
1isAuthentic, Accurate and Complete. Any deviation will be sufficient cause for disqualification or dismissal.

Signature of Candidate_____________________ Date:Click here to enter a date. Place:Click here to enter text.

Copyright to MVJ College of Engineering, Bangalore Page 8 of 8