Kadaganchi, Aland Road
Kalaburagi - 585 367
CENTRAL UNIVERSITY OF Phone (08477) – 226743
KARNATAKA Telefax : 226703/709
(Established by an Act of the Parliament in 2009)
Website: www.cuk.ac.in
Email: registrar@cuk.ac.in
EMPLOYMENT NOTIFICATION FOR
RECRUITMENT OF TEACHING POSITIONS
(NOTIFICATION No. 23/2019)
APPLICATION FORM
KALABURAGI
January 2019
CENTRAL UNIVERSITY OF KARNATAKA
(A Central University established by an Act of the Parliament in 2009)
FOR OFFICE USE ONLY
Sl.No. REGN. NO.
Application Form for Teaching Posts
Advertisement No…………................................Dated .........…………
Post Applied for ……………..................................................…………
Fix your latest photograph
School of ........................................................................................ and sign across
Department of ...............................................................................
Particulars of Demand Draft:
Draft No. Dated Amount
Name of the Issuing Branch and name of the Bank
Name of the Bank on which drawn
1. Personal details: Use CAPITAL LETTERS and write clearly
Name:
Date of Birth: Day Month Year Age as on date Year Month
of advertisement
Place of Birth: City / Village: State : Country :
Father’s Name : English
Mother’s name: English
Religion: (for statistical purpose only):
Nationality : Gender Category Marital Status
Male SC ST Single
Female OBC General Married
If physical challenged, Type of Disability Percentage of disability
indicate relevant
particulars:
2. Contact Details of the Applicant:
Address for Correspondence Permanent address
Name Name House
House No: No: Street:
Street: City: State:
City: Pin Code:
State:
Pin Code:
Email: Phone No. Mobile No. Fax No.
(With STD Code)
3. Educational Qualifications: Attach self-attested photocopies of documents
Name of Year Marks Maximum %age of Division Subjects studied
the Board / Obtained marks marks /
University CGPA with
%age
marks
Matriculation (10th)
Higher Secondary/
Intermediate(10+2)
Bachelor’s degree
……………………………
( Name of degree)
Master's degree
……………………………_
( Name of degree)
M.Phil. in
.....................................
Topic of the M.Phil. Dissertation:
Ph.D. Topic of the Thesis:
....................................
Any other
Details of JRF/NET/SLET Year Qualified Subject
JRF
NET
SLET
4. Present Assignment
Designation Employer Date of Joining Nature of Appointment
(Name of the Organisation) Date/Month/Year (Adhoc/ Temporary/
Permanent/ Contractual
Basic Pay p.m. (Rs.) Pay Band (Rs.) GP/AGP (Rs) Gross Salary p.m. Increment
(Rs.) Date (Date/Month)
• What has been your important/unique contribution(s) in the present assignment:
5. Past Work Experience ( Please start from first appointment to the present position).
Add additional rows, if needed.
Post held Pay Basic Pay Gross Employer Experience Nature of
Scale/ p.m. (Rs) Salary (Name & From To Total assignment
Band p.m. address of the Experience
Organisation) in Years/
Months
• Total Teaching Experience in years Years of Teaching Years of Teaching Years of Teaching
on the date of advertisement Experience of PG Experience of UG Experience of UG and PG
classes only classes only classes Together
• What have been your important/unique contribution(s) in the previous assignment:
6. Research Experience after obtaining Ph.D.:
Position held Emoluments Name of the Period of work
(per month) University/Institution
From To No. of
years
7. Details of Publications: (Number of Publications) Attach copies
Sr. Type of Publications Published Accepted Communicated
No.
1 Reference Books with ISBN No.
2 Text Books with ISBN No.
3 Edited Books with ISBN No.
4 Research Papers in refereed international journals
with ISSN NO.
5 Research Papers in refereed national journals with
ISSN NO.
6 Papers in other international journals with ISSN
NO.
7 Papers in other national journals with ISSN NO.
8 Chapters in edited books with ISBN No.
9 Articles in national magazines/newspapers
10 Articles in regional/local magazines/newspapers
11 Papers presented in International
Seminars/conferences
12 Papers published in proceedings of international
seminars/conference
13 Papers presented in national seminars/conferences
14 Papers published in proceedings of national
seminars/conference
Important Note:
Please furnish details of each publication clearly mentioning the title, co-authors, publisher, journal, volume,
issue, impact factor of the articles/papers and year of publication
8. Research Projects Completed ( Insert additional rows, if necessary):
Name of the Funding Duration
Title of the Project Amount
Agency From To
9. Research Projects Ongoing ( Insert additional rows, if necessary):
Name of the Funding Duration
Title of the Project Amount
Agency From To
10. Details of the Orientation Programmes /Refresher Courses/ Summer Schools
attended ( Insert additional rows, if necessary)
Name of the Programme Year Duration (in days) Organising Institution
11. Details of Conferences/Seminars/Workshops attended:
( Insert additional rows if necessary)
Name of the Name of the Year Duration in Presented Key Note Speaker/
Seminar/Conference/Symposia,etc. Organiser Days Paper Chaired Session
12. Details of the Lectures Delivered
Topic Year Event Place
13. Consultancy Work undertaken ( Attach additional sheet if needed):
Duration
Name of the Organisation Nature of Consultancy Amount
From To
14. Proficiency in Computing: (on a scale of 1 -10, where 10 =the most proficient)
Statistical/
Windows based Others
Proficiency Mathematical Proficiency Proficiency
Packages Packages (Pl. specify)
Words SPSS
Excel MatLab
Power Point e-View
Access
Outlook
15. Languages Known Spoken Written
16. Details of Foreign Visits:
Duration
Countries visited Purpose of visit Period
From To Total
17. Membership of Professional Bodies, Societies, etc. ( Insert additional rows, if
necessary)
18. Awards /Honours/any other academic distinction
( Insert additional Rows if necessary)
19. Participation in Extension work/community services
( Attach additional sheet if needed):
20. Participation in Corporate Life (Contribution to the institution you served in the
matter of co-curricular activities, enrichment of campus life, students’ welfare, etc.
21. Any other Experience/Achievements/ Qualifications relevant to the post applied
for :
22. References: Please provide names of three persons who are not related and
are familiar with the work/professional experience/accomplishments
1 2 3
Name and address
Contact Address
Email:
Phone (landline)
With STD Code:
Mobile Phone no.
Fax with STD code
23. Declaration
I, son/daughter of
hereby declare that all the entries made by me in this application are true and correct to the best of my
knowledge. If anything is found false or incorrect at any stage, my candidature / appointment may be cancelled
by the university without assigning any reason thereof.
Signature of the applicant
Name in Capital letters
Date: Place_
(Unsigned application is liable to rejection)
24. Endorsement by the EMPLOYER
(In case of in-service candidates, whether in permanent/contract/temporary capacity, the application must be
endorsed/forwarded by the Head of the Department/Employer. Otherwise the application is liable to be
rejected.)
Forwarded to the Central University of Karnataka, Gulbarga – 585106
The applicant Dr./Mr./Mrs/Ms. , who has submitted this
application for the post of in the Central University of K a r n a t a k a , has been
working in this organization namely in the post of
in a temporary / contract/ permanent capacity with effect from
in the Scale of Pay/Pay Band of `. _. He /She is drawing a
basic pay of ` His / Her next increment is due on .
Further, it is certified that no disciplinary/vigilance case has ever been held or contemplated or is pending
against the said applicant. There is no objection for his/her application being considered by the Central
University of K a r n a t a k a ,
(Signature of the forwarding officer)
Name:
Designation:
Place:
Date:
(Seal)
25. Checklist of Documents Enclosed
Sl. No Documents
1. Matric/ Secondary/High School (10th Class) Marks Sheet
2. Matric/Secondary/High School (10th Class) Certificate
3. Sr. Secondary/Intermediate (12th Class) Marks Sheet
4. Sr. Secondary/Intermediate (12th Class) High School Certificate
5. Bachelor's Degree Marks Sheet
6. Bachelors' Degree
7. Master's Degree Marks Sheet
8. Master's Degree
9. M. Phil. Marks Sheet
10. M. Phil Degree
11. Ph. D. Degree
12. NET/SET
13. Category certificate (OBC category certificate not older than six months)
14. Experience Certificate(s) from previous employers
15. Endorsement from the present employer
16. DD for the application fees (in original)
17. API Score Sheet
18. Any other
List of Documents be checked & ticked properly. Any lapse on this account is liable for rejection of
your form.
