NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING Application form_new.pdf5.Educational Qualifications - Copies of marksheets and certificates from X to Ph.D. 6.Caste Certificate, as applicable

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 :


dd/mm/yyyy

dd/mm/yyyy

%mark

f) Area of Specialization : (Ph.D./Fellow Research Area and Current Research Interests)

(1)

(2)

(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)


(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


(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


Publisher and Indexing



(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


(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


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


(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.


3. Enter your details, and Click Confirm buttom at the last page of application form.

NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING Application form_new.pdf5.Educational Qualifications - Copies of marksheets and certificates from X to Ph.D. 6.Caste Certificate, as applicable

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