-
8/2/2019 Application Form for Teaching Staff2
1/4
[Shree Swami Atmanand Saraswati Institute of Technology] Page 1
of 4
Shree Swami Atmanand Saraswati Institute Of Technology
Shree Swami Atmanand Saraswati Vidyasankul
Kapodra, Varachha Road, Surat-395006.
Visit us at: www.ssasit.org Email: [email protected]
Form For Teaching Staff
Advertisement No: 01/2012.
Post Applied for
:______________________________________________
Department :______________________________________________
Specialization
:_______________________________________________
1. (i) Full Name (In Block Letters)
:______________________________________________________________
(As in HSC Marksheet)
(ii) Fathers / Husband Name:
____________________________________________________________
2. Date of Birth : _________________ Age [(as on date) completed
years] ____________________3. Gender: Male / Female Marital Status:
Married / Unmarried4. Correspondence Address:
___________________________________________________________
_______________________________________________________________________________
_________________________________________________________Pin
___________________
Phone No. : Office: ________________ Res: _________________
Mobile: ___________________
E-mail ID : (i) _____________________________ (ii)
___________________________________
5. Do you belong to (Please tick ) : SC / ST / OBC / Person With
Disabilities (PWD)/ ExServiceman /Dependent of Defense personnel
killed/Disabled in war action):
____________________________________________________
6. Post held at present:Post held at
present *
Date of
Appointment
Nature of the Post
(Temporary /
Probation/ Permanent)
Name & Address of Employers
with present salary
*Copy of appointment order is attached: Yes / No
Type of organization (Government / Semi Government / Grant in
Aid) _____________________
Please affixduly signed
recentpassport sizephotograph
-
8/2/2019 Application Form for Teaching Staff2
2/4
-
8/2/2019 Application Form for Teaching Staff2
3/4
-
8/2/2019 Application Form for Teaching Staff2
4/4
[Shree Swami Atmanand Saraswati Institute of Technology] Page 4
of 4
(d) Other Activities:
(i) Number of Expert Lectures Delivered:
________________________________________________
(ii) Number of Summer / Winter schools / Training Programmes:
____________________Organized
(iii) Number of Seminar / Conference / Workshop / Networking:
___________Programme Organized
Administrative & Community Services:(e.g. Dean/
Vice-Principal/ Principal/ Hostel Warden/ HOD/ Dept.
Incharge/Chairman - Board of Studies/ Self Development
Programmes for community Services)
Sr.
No.Name of Assignment Duration
Name of Responsibility Shared/Service
Offered
11. Member of Technical Societies :
__________________________________________________________________________________________________________________________________
12. Please give details of two References:(i) Name:
_________________________ (ii) Name:
____________________________________
Designation: ____________________ Designation:
________________________________
Full Address: ____________________ Full Address:
________________________________
_______________________________
__________________________________________
Contact No. & Fax _________________ Contact No. & Fax
____________________________
E-mail: _________________________ E-mail:
____________________________________
13. Extra Curricular activities / Hobbies
:_________________________________________________________________________________________________________________________________
14. Any other relevant information :
_____________________________________________________
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 supplied may
lead to immediately rejection of
application/ appointment if found subsequently.
Date: _____________________
Place: (Signature of Applicant)
