FOR OFFICE USE ONLY
Application Received on:
Registration No.: _________________
GOVT. MAHILA ENGINEERING COLLEGE, AJMER
(An Autonomous Inst. of Govt. of Rajasthan)
Nasirabad Road, Makhupura, Ajmer- 305001
Tel.No. 0145-2695535, Fax No. 2695102
www.gweca.ac.in
website:
APPLICATION FORM FOR THE TECHING POSTS
Name of the Post applied for:
_______________________
Department/Field of
Specialization:__________________
Advertisement No.
______________________________
DD No._________
Amount__________Dated:_________
Name of Bank: _____________________________________
Affix your
photograph
here
(Self
attested)
1.
Name :( IN BLOCK LETTERS):
2.
Father's/Husband's Name:
3.
Date of Birth:
Place of Birth:
(Proof Enclosure No.
)
Present Age (As on last date of submission of application) : ____
4.
_
_
5.
Sex
(Male/Female):
7.
6. Marital Status:
Nationality:
8. Religion:
9. (a) Category (UR/SC/ST/OBC):
_____
(Proof of category- Enclosure No.
*The OBC Certificate should not be older than 6 months.
(b) Do you belong to Physically Handicapped category):
YES/NO
(If yes, enclose relevant certificate - Enclosure No. )
10. Address:
For Correspondence:
Permanent Address:
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
PIN Code: ___________________________
Tel. No: _____________________________
PIN Code: __________________________
Tel. No: _____________________________
1
Mobile No. ___________________________
Mobile No. ___________________________
11. Academic Qualifications (Secondary School Examination Onwards):
Exami
Board/
nation/
University
Degre
High
School/
Secondary
Sr. Secondary
Subject Year CGPA/ Divisi
of
s/
%Mar on
Specializa Passin ks
Proo
f
Encl.
B.E. / B.Tech/
M.E. / M.Tech
Ph.D.
Others
12. Details of Experience in academic institution/research organizations
(chronological order):
Period
S.
No.
Post Held
Organization
From
To
Total
Perio
d
Pay
Scale
Basic
Proof
Pay or
Encl.
AGP/GP No.
13. Details of Industrial/Field Experience (chronological order)
Period
S.
No.
Post Held
Organization
From
To
Total
Perio
d
Pay
Scale
Basic
Proof
Pay or
Encl.
AGP/GP No.
14. Details of Scholarships/ Rewards/ Honour with Proof (Enclose
separate sheet, if necessary):
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
15. Details of Academic achievements with Proof (Enclose separate
sheet, if necessary):
________________________________________________________________________________
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
16.
Developed / Participation in production of educational programs with
proof (Enclose separate sheet, if necessary):
______________________________________________________________________________
17.
Conducted Short Term/ Continuing Education Program/ Other
Courses with proof (Enclose separate sheet, if necessary):
______________________________________________________________________________
18. Attended STTP/Conference/Workshop/Symposium etc. (Enclose
separate sheet, if necessary):
______________________________________________________________________________
19. Special
necessary):
Training/
Assignments
(Enclose
separate
sheet,
if
20. Publications (in numbers): (Enclose separate sheet, if
necessary):
(A)
S.
No.
PAPERS
1 Papers in Refereed
International Journals:
2 Papers in Refereed National
Journals:
Publishe Accepted
d (Nos.)
(Nos.)
Communica
ted
Remarks
(Nos.)
3 Papers in
Conferences /Symposia :
4 Books :(Enclose Detailed List)
5 Review/ Research/ Feasibility
Reports :
(Enclose Detailed List)
(B) List of Publications in Journals (Enclose separate sheet, if
necessary):
S.No
.
Details (Author(s)/Title/Volume/Page/Year)
Cumulative
Impact INDEX
(with proof)
(C) List of Publications in Conference Proceedings:
S.No
.
Details
(D) Details of IPRs/ Patents etc. (Enclose separate sheet, if necessary)
_____________________________________________________________________________
_
_____________________________________________________________________________
_
_____________________________________________________________________________
_
21. Thesis Supervision (in numbers): (Enclose separate sheet, if
necessary)
S.No
.
1
2
Description
Ph.D.
M.E./ M.Tech./ M.Sc.
Awarde
d
Submitte
d
In
Progress
Remarks
Others
22. Sponsored Research/ Consultancy Projects: (Enclose separate sheet,
if necessary)
S.
No
.
Name of Project
Funding Agency
Status
(Complete
d/
In
Amou
nt
Remar
ks
Progress)
23. Membership/Fellowship of Professional Societies/ Bodies:
24. Administrative Responsibilities Held in chronological order (Enclose
separate sheet, if necessary):
S.
No
.
Period
Position Held
Organization
From
To
Nature of
Responsibi
lity
25. Give names, designations and addresses of two referees, not
related to you but well acquainted with your academic and
administrative performance and conduct:
(a) ________________________________
_______________________________
_
(b) ___________________________________
___________________________________
Email___________________________
Mobile
No.______________________
Email______________________________
Mobile No._________________________
26. Details of Present Employer
Name &
Address
of Present
Contact
No.
Nature of
Present
Post
Scale
Present Pay Details
AGP/G
Other
Total
P
Allowanc
Emolume
es
[Mark()
]
Permanen
t
Temporar
y
Ad-hoc
Contractu
al
Employer
nts
27
If appointed, the minimum time you will require to join the post?
____________________
28. Have you been punished during your service or, convicted by court of Law? If
so, give details:
29. Were you, at any time, declared medically unfit or discharged/dismissed from
service? If so, give details:
31.
Any
other
information
sheet)___________________________
you
wish
to
give?
(Attach
extra
that
the
DECLARATION BY THE CANDIDATE
I,
hereby
declare
information given by me in this application form is true to the best of
my knowledge and belief. If, at any time, I am found to have concealed
any
material/information
or
given
any
false i n f o r m a t i o n ,
my
candidature/ appointment may be summarily rejected /terminated
without any notice or compensation and I am liable for legal action
against me.
Place:
______________________
Date:
(Signature of the
Applicant)
The certificate to be given in the institute/organization/Industry's
official letter pad
CERTIFICATE FROM THE PRESENT EMPLOYER
(This certificate must be signed by the Employer in case of the candidate already in
service whether in Permanent/ Ad-hoc/ Temporary capacity)
No.
Dated:
___
Forwarded, Shri/Smt./Dr. ________________________________bearing the designation
of _____________________________________ holds the post in our Institution/
Organization i n Permanent /Temporary/ Ad-hoc/contractual capacity.
He / She, is dra wing the pay in the pay band/ scale
______________
w it h AG P/GP ___________ . This
no objection to
Institution/Organization has
the candidature of the applicant being considered for appointment to the post
of ..................... in Govt. Mahila Engineering College, Ajmer.
(Signature of the
Employer)
Place:
Date:
Name
Designation
Seal of the Institution / Organization
10
