Periyar Nagar, Vallam Thanjavur - 613 403, Tamil Nadu, India
Phone: +91 - 4362 - 264600
Fax: +91- 4362 - 264660
Email: registrar@pmu.edu
Web: www. pmu.edu
For office use only
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Date :
FACULTY APPLICATION FORM
(Application should be complete in all respects, Incomplete applications will not be considered)
Position applied for
Department
Specialization
Please affix recent
Passport size
Photograph
A) PERSONAL DATA
Email id: .
1.
Name in full (in block letters) Mr./Mrs./Ms/ Dr.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
Mailing Address (In block letters)
Mobil. No.
Tel. No
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
Permanent Address (in block letters)
Mobil. No.
Tel. No
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
3.
Date of Birth . . . . . . . . . . . . . . . . . 4. Religion . . . . . . . . . . . . . . . .5. Caste . . . . . . . . . . . . ..
OC/BC/MBC/SC/ST
(Certificate to be enclosed)
4.
Marital Status
Married / Single
B) ACADEMIC QUALIFICATIONS
5. Start with your highest qualification (Enclose copies of Certificate)
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Name and address of
Institution/College / School
* State whether
Part time (P)
University\Board
Full time (F)
Degree /
Diploma*
Specialisation
Correspondence (C)
Percentage/
Class / Rank /
Year of
Passing
C) PROFESSIONAL INFORMATION
6. PREVIOUS TEACHING EXPERIENCE (Enclose copies of Certificate)
Duration
Name of Institution &
Place
From
To
Designation
Reasons for
Leaving
Last pay drawn
with total
emoluments
7. PREVIOUS INDUSTRY WORKING EXPERIENCE (Enclose copies of Certificate)
Name of Organisation &
Place
Duration
From
To
Designation
Reasons for
Leaving
Last pay drawn
with total
emoluments
8. RESEARCH EXPERIENCE: ____________
a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
9. TOTAL EXPERIENCE: Research/Industry/ Teaching : ___________________
TEACHING: ____________
PG : _____________ UG
INDUSTRY: ____________
RESEARCH: _____________
: _____________
10. AWARDS AND RECOGNITIONS
a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
11. PUBLICATIONS
Kindly furnish list of Papers/Reports/Articles published by you. (Use additional sheets, if necessary)
a) ____________________________________________________________________________
b) ____________________________________________________________________________
12. Have you traveled abroad for training or studies? YES/NO (if yes furnish details)
_________________________________________________________________________________
_________________________________________________________________________________
13. Are you a member of any Professional Body / Institute / Society? YES/NO (if yes furnish details)
_________________________________________________________________________________
D) REFERENCES
14. Please give the names of three references acquainted with your attainments. If related give details of
relationship
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Name
Designation
E) Are You a Physically Challenged Person
Phone
Address
E- mail
Yes/NO
F) Any other information relevant to your application, which you may like to give in support of
your Application can be enclosed.
I hereby certify that the above information furnished by me is true and that I agree to appear for an
interview/test if required to do so.
Date:
SIGNATURE
(For official purposes only)
Remarks of the Selection Committee
Date of Interview
