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Contact Us: 0180-2569700, 2569699, 2569799, 3059200, 3059201, 3059202, 3059203 WWW - Piet.co - In, Info@piet - Co.in

This document contains an application form for a teaching position at Panipat Institute of Engineering & Technology. It requests information such as contact details, personal details, family details, educational qualifications, work experience, publications, extracurricular activities, references, and a declaration signed by the applicant. The form has 16 sections to capture all relevant information for evaluating the applicant.

Uploaded by

Raj Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
44 views

Contact Us: 0180-2569700, 2569699, 2569799, 3059200, 3059201, 3059202, 3059203 WWW - Piet.co - In, Info@piet - Co.in

This document contains an application form for a teaching position at Panipat Institute of Engineering & Technology. It requests information such as contact details, personal details, family details, educational qualifications, work experience, publications, extracurricular activities, references, and a declaration signed by the applicant. The form has 16 sections to capture all relevant information for evaluating the applicant.

Uploaded by

Raj Singh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Contact us : 0180-2569700, 2569699, 2569799, 3059200, 3059201, 3059202, 3059203

www.piet.co.in,[email protected]

(To be filled by the applicant in his/her own handwriting clearly and completely)
(Information from point 1 to 7 be filled in Block Letters)

Post Applied for ……..…………………………………..Discipline…………………


PHOTOGRAPH
1. Name in Block letters………….………………………………………………………..
(a) Date of Birth………………………………………………………………..
(b) Place of Birth ……………………………………………………………….
(c) Nationality…………………………………Sex.……………M/F…………...
(d) Blood Group ………… (e) Identification Marks ……………………………
(f) PAN No…………………………Driving License No………………………
Passport No……………………Aadhar Card No……………………………..
(g) Bank Account No (HDFC Bank Only)……..…………………………………
(h) IFSC Code (HDFC Bank Only)……………..………………………………...
Candidate must enclose I.D. Proof: (A Copy of Aadhar/Ration Card /Voter
Card/Driving License/PAN card/Passport)

2. Present Postal Address (in block letters) ……………………………….…………


………..………………………………………………………………….…………
………..………………………………………Pin Code….……………..…………
Phone……………Mobile No.……………..………E-mail…………….………….
3. Permanent Home Address (in block letters)………………………………………..
………..………………………………………………………………….…………
………..…………………………………………PinCode……………………………
Phone………………..Mobile No.……………..………E-mail …….…….……………..
4. (a) Father’s Name …………………………Mother’s Name……………………….
(b) Name of Husband/wife (if married) ……………………………………………
(c) Details of Family…………………………………………………………………
……………………………………………………………………………………
5. Whether belongs to GEN/SC/ST/BC/OBC/PH/ESM……………………………..…
6. a) Present designation & name of employer (if employed)………………..……..….
……………………………………………..………………………………………….
b) Grade and consolidated salary being drawn .……………………………………...
7. Have you ever been prosecuted, kept under detention, fined, convicted by a Court of Law
for any offence or debarred/disqualified by any University, Public Service Commission
from appearing at its examinations/selection? Is any case pending against you in any
Court of law at the time of filling up of this application form? If the answer is ‘Yes’ full
particulars of the case, detention, fine conviction, sentence etc. should be given.

8. Educational Qualification (from Matriculation onwards):


Sr. Exam. Passed University/ Name of the Institute Year of % age of Regular/Cor
No. Board Passing Marks& respondence
Division /Part time
1. Matric

2. 10+2/Diploma

3. B.A./B.Sc./ B.Com.
B.Tech. (Branch)
4. M.A./M.Sc./M.Com/
MBA/MCA/
M.Tech. (Branch)
5. M.Phil/Ph.D.

6. Any other Exam.

(Please attach the copies of certificates duplicate)


9. Topic of M. Tech./ M.Phil Dissertation……………………………………………………

10. Topic of research for Ph.D…...………………………………………………………………


Field of specialization………………………………………………………………………
11. Experience A: Academic

Reaso Total
Employers Name & Institute/ Duration Nature of Emoluments n Experie
Address Industry From To Total Duties & Scale etc. For nce
Leavi
Period ng
11.Experience B: Academic (After M.Tech)

Total
Duratio Experie
Employers Name & Institute/ n Nature of Emoluments Reason nce
Address Industry From To Total Duties & Scale etc. For
Period Leaving

11. Experience C: Discipline and Moral

Sr. No. Moral Explanation


Sr. No Discipline Explanation

1 Self Discipline 1 Honesty

2 Student 2 Commitment
Discipline
3 Department’s 3 Service to
Discipline Humanity
4 General
4 Social Awareness
Discipline

Scales A – 80% and Above

B -- 60% T0 79%

C – 35% TO 59%

Note: Attach Extra page for 11(B), if necessary

Please specify whether you have ever worked in Panipat Institute of Engg. & Technology.
…………………………………………………………………………………………………………
Total experience: Under Graduate Classes……………..Yrs. Post graduate Classes ………Yrs.

Results of classes taught by you:-

Sr. No Subject/Paper Pass %age Sr. No. Subject/Paper Pass %age

12 A. Paper published in Journals………………………………………………………………..


Nos. ISSN No. Impact
factor/references if any
National Free
Paid
International Free
Paid

(Attach extra sheets if required)


B. No. of Conferences attended (National/International)

C. Papers presented/published in Conferences (National/International).

Nos. ISSN No. of proceedings


National

International

Attach a list of publications is respect of each category mentioned above.


D. No. of books published…………………………………………………………………..
Detail of publishers………………………………………. ISSN No………………………...
E. Detail of Patents (if any)……………………………………………………………………
………………………………………………………………………………………………
13. Extra Curricular Activities (Sports, Social, Literary Activities, N.C.C./N.S.S.) etc.

Name of Level/Name of the Competition Year Position Achieved


Activity
14. Conference/Seminar organized by you: (Attach list)
Conference Name of Place Date Sponsored/Faculty
Conference
National

International

15. Any other achievement you would like to mention:


………………………………………………………………………………………………..
…………………………………………………………………………………………………
…………………………………………………………………………………………………

16 Have you ever been connected with any political party? If so give details

Do you have any contract/ bond with your present employer? If yes, give details

Do you consume liquor? : Yes/No

Are you used to gambling? : Yes/No

Do you have any relative working in PIET or any relation with any member of the Managing
Committee (if yes, furnish details)
……………………………………..………………………………………………………………
……………………………………………………………………………………………………..

Please state whether you are pursuing any course of studies at present? If yes, give details
…………….……………………………………………………………………………………

Please note that:


(a) You will not be allowed to undertake any further studies during your employment without
prior written permission of the competent authority.
(b) You will not undertake any part-time job including coaching/tuition etc.
If selected, when can you join? :
Salary Acceptable :

Name & Addresses of two references, not relatives:

I declare that the information given above is true and correct to the best of my knowledge and belief
& nothing has been concealed therein. I am aware that any false or incorrect information given by
me may result in termination of my services ipsofacto.

Place:

Date: (APPLICANT’S SIGNATURE)

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