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Pandit Deendayal Petroleum UniversityGandhinagar-382007

Date: _______________________________________________________________________________________________

Post Applied for __________________________Subject: ______________(Valid for single post only)Department /School: _____________________________________________

___________________________________________________________________

1. Name in Full: _____________________________________________________(Capital letters only) (Surname) (First Name) (Last Name)

2. Address:

For Correspondence:__________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

City: ______________________ District: _______________________ Country: __________________

Permanent: __________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Phone: ________________ Mobile No.: ________________ e-mail: ____________________________

3. Date of Birth: ___________________ 4. Nationality: _________________ 5. Sex: M / F

6. Present Status:Designation: __________________________________________________

Organization: _________________________________________________Total Emoluments: _________________________________________

7. Areas of Specialization: ________________________________________________

8. Current Areas of Research: __________________________________________

9. Academic Record (starting with Bachelor’s Degree)(Please attach photocopies of degree certificates and also brief synopsis of the Master’s & the Doctoral thesis)

Degree(Subjects)

Institution Year Marks &Division

Remarks

10. Title of Ph.D. Thesis: ______________________________________________________

Passport sizephotograph

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11. Category: Open/ ST/SC/ SEBC(Attach a certificate from the authority prescribed under government rules for ST/SC/ SEBC category)12. Previous Experience (Starting with the recent)A1. Teaching Experience:

Sr.No.

Organization Designation Pay-scale

Total Pay(pm)

Duration TotalExperienceFrom To

A2. Details of Academic Experience (in years and months):

(a) Teaching at Post Graduate Level:

Subjects taught at P.G. Level

From______________ to _____________

Name of Subjects:

_____________________________________________

_____________________________________________

_____________________________________________

(b) Teaching at Graduate Level:

Subjects taught at Graduate Level

Teaching at other Level(s), if any

From______________ to _____________

Name of Subjects:

____________________________________________

____________________________________________

____________________________________________

_____________________________________________

(c) Teaching at other Level(s), if any From______________ to _____________Name of Subjects:

____________________________________________

____________________________________________

B1. Research Experience: (Excluding Research during M. Tech./Ph.D.)Sr.No.

Organization Designation Pay-scale

TotalPay (pm)

Duration TotalExperienceFrom To

(a) Research Supervision: (i) Ph. D. level ________________________

(ii) P.G. level _________________________

(b) Other Research Experience, if any ____________________________________________________________________________________________________________________________________

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B2. Sponsored Projects:Duration Sponsoring

OrganizationTitle of Project Amount of

GrantCo-Investigators

(if any)

B3. Consultancy:Duration SponsoringOrganization

Area of Project Co-Investigators (if any)

C. Publications:No. of Research Papers published in journals.

(i) In Refereed Journals:

No. of Publication *Total Impact Factor

International

National

* Cumulative total of impact factor of all the publications in Referred journals

(ii) In Proceedings of Refereed (i) International: _______________________________

Conferences (ii) National: ________________________________

Note: Please attach the summary on separate sheets for publications in refereed journals and referred conferences papersincluding all details. (i.e. Title, Year, Vol., Page No. Name of the Publisher (may be mentioned) & Impact factor .) Alongwith this details also attach the Reprints of published best three research Papers, Journal/Proceedings of Conference in lastfive years.

(iii) Details of published Books / Review article: ______________________________________________

____________________________________________________________________________________

_____________________________________________________________________________________

D. Industrial Experience:Duration Organization Nature of Work

Total Pay (pm)

E. Contribution in institutional / departmental activities (administrative):Duration Organization Nature of Responsibility Designation

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Summary

Post Applied for:

Name of the Candidate:

Address:

Date of Birth: Nationality:

Qualification: Year Percentage/grade

Ph.D. Title:

Master Degree Title:

Bachelor Degree

Teaching Experience: Pre Ph.D. experience: Total No. of _______Years _______Months

Post Ph.D. experience: Total No. of ______Years _______Months

Present Position: Designation: __________________________________________________Organization: _________________________________________Total Emoluments (pm): ________________

Research Experience:(Excluding Research done for M.Tech /Ph.D.) Total No. of _______Years _______Months

No. Publications: In ReferredJournal

*Total ImpactFactor

Conference/ Seminar

Books

No. of Thesis/ Dissertationguided (Independently/Jointly)

M. Tech. Ph.D. Consultancy

No. of Sponsored projectsCompleted / continuing withbudget Funds

Title of the Projects FundingAgency

Budget Fund(Rs. Lakhs)

No. of Consultancy projectscompleted/ continuing withbudget Funds (Rs. Lakhs)

Title of the Projects (Rs. Lakhs) FundingAgency

Budget Fund(Rs. Lakhs)

Awards & Distinctions:

Any other information

For Use at PDPU

Remarks If any

• Cumulative total of impact factor of all the publications in Referred journals

SIGNATURE OF THE CANDIDATE