An Autonomous Institution

APPLICATION FORM FOR TEACHING STAFF

(To be filled by the Candidate)

Advertisement Dated: Department Applied for:

Position Applied for: Specialization Code:

SECTION – A: GENERAL

1. Name in full Mr.

2. Date of Birth
3. Father’s / Mr.
Mother’s Name
4. Mailing Address

Pin Code
5. Tel. No.
Mobile No.
(with STD code)
6. E-mail ID
7. Permanent Address
Pin Code

8.Nationality

9. Marital Status Married

10. Name of the Mr.

Spouse
11. Occupation Designation
Any Other
12.Languages known English☐ Kannada☐ Hindi☐ Tamil☐ Telugu☐

13.State of Domicile

14.Present Employer

Copyright to MVJ College of Engineering, Bangalore Page 1 of 8

 SECTION B: CATEGORY I: TEACHING, LEARNING AND EVALUATION RELATION ACTIVITIES

EDUCATIONAL QUALIFICATIONS (Starting with highest degree obtained )

Percentage
Year of
Sl. Name of Board/ of Class/Division
Examination/Degree Specialization/subjects Passing/
No. College/University Marks/Final /Grade
Awarding
Grade

Whether Ph.D. awarded: If Yes, please indicate below

Date of
Ph.D/ M.Tech Degree University Title & Area of Work Done
Awarding

Additional Credentials, (NET/SLET/GATE etc..)

DETAILS OF EMPLOYMENT EXPERIENCE (In chronological order starting with the most recent)
Name of Period of employment
Sl. Post held/ Basic/ Gross Nature of
Employer/Status of
No. Designation From To last drawn duties
Institute/University
1

Copyright to MVJ College of Engineering, Bangalore Page 2 of 8

 TOTAL :
TEACHING EXPERIENCE
Years Months
i. Under Graduate
ii. Post Graduate
iii Total Teaching Experience
iv.Short term/Continuing Education / Specialist courses /any other
courses conducted

SUBJECTS TAUGHT
Number of times this subject Course materials prepared if any, for
Subject UG/PG
has been taught the subjects taught

SUBJECTS you can teach other than the above listed Subjects
Sl No. Subject
1

TOTAL :
RESEARCH EXPERIENCE
Years Months
Research Experience other than the period spent for obtaining
Ph.D Research Degree

SECTION B: CATEGORY II: CO-CURRICULAR, AND PROFESSIONAL DEVELOPMENT RELATED ACTIVITIES

1. Student related co-curricular, and field based activities(such as e NSS/NCC and other channels, cultural activities,
subject related events).
Sl No. Description
1

Copyright to MVJ College of Engineering, Bangalore Page 3 of 8

 2. Departmental\Academic\Administrative Responsibilities

Institute Year Responsibility Important Contribution

SECTION B: CATEGORY III: RESEARCH AND ACADEMIC CONTNRIBUTION

RESEARCH PUBLICATIONS
1. Books- Self authored/co-authored/edited

Whether
Sl. Title of the Book (s) Name of Publisher Month&Year of
Sole Author/
No. (with City/ Country) Publication
Co-author

2. Research Articles/Papers published in Journals /Periodicals /Conference proceedings/Newspapers

Name of Month & year of

Whether
Sl. Title of research article / journal Publication, Level Impact
Sole Author/
No. paper(s) (with city/ Volume no. Factor
Co-author
country) & pageno.

Note: Ignore, if other than National or International

Copyright to MVJ College of Engineering, Bangalore Page 4 of 8

 RESEARCH PROJECTS UNDERTAKEN (other than that for a research degree)

Whether
Total Outcome / Whether
Whether Name of
Title/Subject Grants / Outputs final report
Sl. major or Date of Date of Sponsoring/
of Research Funding sent to published as
No. minor Commencement Completion Funding
Project(s) received Sponsoring monograph
project Agency
(Rs.) Govt. book
Agency

RESEARCH GUIDANCE:
Number of scholars who have been awardedPh.D. degree
under yoursupervision both as Guide and/or Co-Guide:

Name of Degree Submitted Awarded

PROJECTS/THESIS SUPERVISED / FACULTY GUIDANCE

Level of Students/No of
Title Year Institute/Organization
students

Instructional Materials prepared, if any (give details)

Type of Instructional
Sl No. Title Subject
Material
1

Copyright to MVJ College of Engineering, Bangalore Page 5 of 8

 IIISECTION B: CATEGORY IV: TRAINING COURSES AND CONFERENCE/SEMINAR/WORKSHOP
Refresher Course, Methodology, Workshops, Training, Faculty Development Programs,etc. attended.

Duration
Sl. No. Name of Course attended Sponsoring Institution
From To

Lecture/Special Lecture in Institutions of repute other colleges

Sl. Name and Place of
Title/Subject of Lecture delivered Date of Lecture Duration
No. Institution

Invited Lectures & Chairmanships at International /Seminars/ Workshops/ Conferences Organized

Sl. Particulars Date

No. Seminars/ Workshops/ Conferences Organized

SECTION C: OTHER MISCELLANEOUS INFORMATION

Membership/Fellowship of other institutions/professional societies

Name of the Society/Body Designation National/International

Other activities/Responsibilities:
Details of Scholarships/Awards/Honours/ Patent awarded

Copyright to MVJ College of Engineering, Bangalore Page 6 of 8

 Any other relevant information, if not given above:
Has there been any break in your academic career? If so, give details.

Were you at any time declared medically unfit or asked to submit your resignation or discharged or dismissed? If yes,
give details in a separate sheet.

Do you have any case pending against you in any court of law? If yes, give details

Do you suffer from any major ailment /medical problem? Yes/No, If yes, give details:

Are you willing to accept the minimum initial pay in the grade? If not, state reasons for claiming higherStarting pay

If selected for appointment, what notice would you require for joining the post?

Do you intend to work for minimum 3 years in MVJCE?

Have you ever applied to / worked for MVJCE before? If yes, give details

Is any member of your family employed in the past or the present in any MVJ group of institutions?If yes, Give details

Expected salary

Names and Addresses of Two Referees*:

1) Name: 2) Name:

Designation: Designation:

Mobile No.: Mobile No.:

Email-Id: ` Email-Id:
*Recommendations from two Referees, not related to the applicants, who are scholars closely acquainted with the
applicant’s academic training, accomplishment and capabilities.
(NOTE: The College reserves the right to contact the persons referred for ascertaining the credentials of the candidate)

To the applicant:
Any additional information which you have not been able to include elsewhere in the application

ANNEXURE 1: List of Scanned Copies of Documents to be enclosed with the Application Form :
Option provided in the last page of this document for attaching of enclosures
Nos. Enclosed / Not Applicable
SSLC Marks Card or Age Proof Document
Last Pay Slip or Bank Statement
Bachelor’s Degree Certificate
Bachelor’s Degree Marks Cards
Master’s Degree Certificate
Master’s Degree Marks Cards
Ph.D Degree Certificate
Research Experience Certificate

Copyright to MVJ College of Engineering, Bangalore Page 7 of 8

 Teaching Experience Certificate
Industrial Experience Certificate .
Research Publications / Papers
Professional Membership Certificates
Reference Letters
Note: Kindly ensure you carry the original copy of the above listed documents for the Interview Process. Availability of
complete documentation will assist in speedy closure of offers.

DECLARATION BY THE APPLICANT

I hereby certify that the information presented in this form and the documents enclosed as mentioned in ANNEXURE
1isAuthentic, Accurate and Complete. Any deviation will be sufficient cause for disqualification or dismissal.

Signature of Candidate_____________________ Date: Place:

Copyright to MVJ College of Engineering, Bangalore Page 8 of 8