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Application No.: (to be entered by the Office)
NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING (NITIE)
VIHAR LAKE, MUMBAI 400 087
FORM TO BE FILLED IN BY THE APPLICANT
POST APPLIED FOR:(Please select)
Whether willing to be considered
for a lower post:
Primary Area of Specialization:
Yes No
Present (or Last) Post /
Designation:
Pay Band Basic Pay Grade Pay Details of Present (or Last) Pay (For Govt. & Autonomous Govt. only)
Total Emoluments (in present post or last drawn) : as on MMM,YYYY:
Per month Rs.
(1) PERSONAL INFORMATION
Full Name :
Gender :
Date of Birth (dd/mm/yyyy)
Nationality Indian
Category :
Faculty - 2019 Page 1
Others (Specify)
(Proof to be attached with hard copy)
Secondary Area of Specialization:
Age as on 17-01-2020
Marital Status
(2) EDUCATIONAL QUALIFICATIONS *In chronological order from X Std onwards.
Period of Study Class / Exam passed Year of
passing From To
University /
Board
Subject of specialization
*Please indicate your position in University / Board meritlist (if any)
(3) DETAILS OF Ph.D/ FELLOW
a)
b)
Date of Awarddd/mm/yyyy
Date of Submission
c) Date of Joining
d) Ph.D./Fellow Instituteand University Name :
e) Ph.D./FellowTitle :
Faculty - 2019 Page 2
dd/mm/yyyy
dd/mm/yyyy
%mark
f) Area of Specialization : (Ph.D./Fellow Research Area and Current Research Interests)
(1)
(2)
(3)
Faculty - 2019 Page 3
(4) AWARDS, PATENTS AND RECOGNITIONS ( BEST 3)
Sl. Name Organisation Year
1
2
3
* If required, attach additional sheet with the hard copy of the application and send by post.
Total Teaching Experience (Years) :
From To Post Organisation
(5) TEACHING EXPERIENCE
In chronological order
(6) WORK EXPERIENCE (OTHER THAN TEACHING EXPERIENCE)
Nature of experience
Research
Total Work Experience (Years): Industry :
Details of Work *
Research :
From To
Designation in chronological order )Post Organization Industry
(In chronological order)
* If required, attach additional sheet with the hard copy of the application and send by post.
(7) SUMMARY OF PUBLICATIONS Filling the details in the below mentioned format is compulsory
Total number of publications(mention period)
1. Papers in International Journals
2. Papers in National Journals
5. Books / Chapters Edited/published
3. Papers in International Conferences
4. Papers in National Conferences
Faculty - 2019 Page 4
(8) LIST OF RECENT/ BEST PUBLICATIONS
I. JOURNALS:
Sl. Author Name
with Co-Authors Year of
Publication Title of Paper Name of Journal
1
2
3
4
5
6
II. CONFERENCES/SEMINARS:
Sl. Author Name
with Co-Authors
Year of
Publication Title of Paper, Proceedings Name of Conference/
Seminar
1
2
3
4
5
6
Faculty - 2019 Page 5
Publisher and Indexing
Faculty - 2019 Page 6
* If required, attach additional sheet with the hard copy of the application and send by post.
(9) SUBJECTS TAUGHT * One Row for each Subject
Sl. Subject Title UG/PG Class Size
1.
2.
3.
4.
5.
(10) TEACHING INTERESTS (IF SELECTED)
Sl. List of Subjects that you are interested to teach in preference order
1.
2.
3.
4.
5.
6.
(11) RESEARCH PROJECTS / CENTRES (provide names of co-investigators if any)
Sl. Sponsor Title of Project / Center Duration Amount
1
2
3
4
Faculty - 2019 Page 7
(12) DOCTORAL STUDENT GUIDANCE COMPLETED
Name
Sl. Student Thesis Title University/
Institute
Award Date / Status
Co-Guide
Name
DOCTORAL STUDENT GUIDANCE IN PROGRESS with progress status
(13) CONTRIBUTIONS TO INSTITUTE ADMINISTRATION
Sl. Position Description From To
* If required, attach additional sheet with the hard copy of the application and send by post.
1
2
3
4
5
1
2
3
4
1
2
3
4
(14) OUTREACH ACTIVITIES (Executive Training, Consultancy to Industry sponsored Research)
Sl. Clients Title of Assignment Duration Amount
1
2
3
4
Faculty - 2019 Page 8
(15) PROFESSIONAL MEMBERSHIPS
Sl. Name of Organization (Specify Indian or International)
Period (Year) Category of Membership From To
1.
2.
3.
4.
Please provide details that you would like, example Books, Patents, Awards, Recognitions, etc. (16) ANY OTHER INFORMATION
(17) REFERENCES Please provide contact details of two persons holding responsible
positions and FULLY acquainted with the applicant and not related to the applicant.
1
Institute/ Organization
Address
2
Designation
Institute/ Organization
Address
Designation
Name
Telephone No. with STD
Mobile No.
Name
Telephone No. with STD
Mobile No.
City
State
Pin Code
Country
MobileTelephone No(prefix STD)
Email-Id :
(18) ADDRESS
Mailing Address
Permanent Address
City
State Pin Code
Country
(19 )LIST OF TESTIMONIALS ATTACHED WITH APPLICATION
(Original Testimonials are to be produced only at the time of interview.) Please Tick ( )
1.
2.
3.
4. Full printouts of 3 best publications
5. Educational Qualifications - Copies of marksheets and certificatesfrom X to Ph.D.
6. Caste Certificate, as applicable for reserved posts
8. Others (Specify)
No Objection Certificate from the present employer, if applicable
Work/Teaching Experience Certificates
Salary Statement
7. Proof of Date of birth
I hereby declare that the above information is correct and complete to the best of my knowledge and belief.
Place:
Date: Signature of the Applicant
Instructions (for filling the Application Form) :1. Download this blank PDF application form and save it in your computer.2. Open this PDF Application form in Adobe. Please do not make changes to the form.
4. Save the file in your name (your_full_name.pdf) in your computer.5. Email this filled and saved PDF form to email-id: [email protected]
Please note: Please do not send certificates, photo, etc. by email. The hard copy of the application form along with the copies of marsheets and certificates, etc. should be sent by post as mentioned in the Advertisement.
Faculty - 2019 Page 9
3. Enter your details, and Click Confirm buttom at the last page of application form.