राष्ट्रीय प्रौद्योगिकी संस्थान पुदुच्चेरी

थिरुवेत्ताकुडी, कारैक्काल – 609 609

NATIONAL INSTITUTE OF TECHNOLOGY PUDUCHERRY
Thiruvettakudy, Karaikal – 609 609

Application Form for Teaching Post (Faculty on Contract – purely temporary

Basis/Visiting Faculty)

For office use

APPL. No:
Walk-in Interview for Faculty (on Contract)/Visiting Faculty
[Purely Temporary position on Contract basis]

Please read the information carefully on website prior to filling up this application form.
You may use separate sheet/s wherever required. Documentary evidence(s) is/are to
be attached for the data provided in this application failing which due
weightage will not be given during scrutiny.

Advertisement No. & Date: ……………………………………………………

Post Applied for: Faculty (on Contract)/Visiting Faculty Please affix recent passport
size photograph
Department: ……………………………………………………………………

Specialization: ………………………………………………………………...

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1. (i) Full Name (in BLOCK letters) : ………………………………………………………...…...…….....

(ii) Father’s/Husband’s Name :….:………………………………………………………………...........

(iii) Whether belonging to GEN/ SC/ST/OBC/PH: …………………………………………………
(Attach Certificate)

2. Date of Birth: …………………… 3. (a) Nationality: …………………….... (b) Gender: Male /

Female

(c) State/UT to which you belong:

………………………………………………………………………........

(d)Marital Status: Married / Unmarried / Divorced

…………………………………………………...........

4. Postal Address for correspondence. 5. Permanent Address (with Phone no. &
Mobile):

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

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

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

..…………………...Pin Code: ………........... ……………………....Pin Code:

………..................
Phone No.: Office: Phone No.: Office:
………………………… ... …………………………............

Res.: ……..………………………………….... Res.: ……..

………………………………….............
(With STD Code)
Mobile No.: ………...……….... …....E-mail ID: ………………………………..
………………………………

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6. (a) Educational Qualifications (Start with Highest Qualification):

Division /
Sl. Examination Name of the Month Subject/ % of Marks/ Class
University/
No. Passed Board & Year Specialization Grade (CGPA)
of
Passing

(b) Have you qualified NET / SLET/GATE?

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

7. Prizes, Awards, Rank received etc. (if any, attach certificate): ……………………...
……….................

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

………………………………………………………………………………...................................................
......
8. (a) Post held at present:

Date of
Post held Appointment Nature of the Post Name & Address of
(Temporary/Probation/ Employer *
Permanent)

* Copy of appointment order to be attached

(b) Present Pay Scale: ………………… AGP/GP …………………… Any other Pay:..
…………………........

Basic Pay: ………………........ Dearness Allowance: ………………..... Gross Pay:

…………………………..
Emolument: …..………………

(c) Type of organization (Government/Semi-Government/Govt. Aided/Autonomous Body/

Private etc.)
………………………………………… ...……………………………………………………………….............

………………………………………… ...……………………………………………………………….............
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9. Professional Experience (In the reverse chronological order):

Period of
Sl. Name of the Post held Employment Pay Scale and Total Reasons for
No Employer Basic Pay Emolument Leaving
. drawn
From To

10. (a) Total Experience:

(i) Teaching U.G.:…………….Year(s) …..………Month(s)

…….….…
P.G.:…………….Year(s) Month(s)
(ii) Research (excluding Ph. D
duration) : …………….Year(s) ……..…… Month(s)

(iii) Industrial : …………….Year(s) .……….…Month(s)

(b) Any break in Service: Yes/No

If yes, state the period of break &
reasons: …………….Year(s) ……..……Month(s)

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

11. (a) Thesis supervised: Ph. D. (If any)

Title of the Thesis

Sl. Supervised Completed (year) In progress Principal or
No. (With Status) Co- Supervisor

(b) Thesis supervised: M. Tech. / M.S. / M. Phil.

Title of the Thesis

Sl. Supervised Completed (year) In progress Principal or
No. (With Status) Co- Supervisor
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 (c)List of Publications (International Journals, Identify whether SCI): Attach the Reprint
of SCI journals only

Title of the
Sl. Journal Name Impact Vol. Year/Page Nos. Authors paper SCI
No. with ISSN/doi Factor No. Yes/No

(d) List of Publications (National Journals, Identify whether SCI): Attach the Reprint
of SCI journals only

Title of the
Sl. Journal Name Impact Vol. Year/Page Nos. Authors paper SCI
No. with ISSN/doi Factor No. Yes/No

(e) Research Activities (with documentary evidence):

Sponsored/
Sl. Consultancy Duration (date) Sponsoring Funds Present Status
No. Projects Authority Sanctioned (Rs.) (Completed/
In progress)
From To

(f) Conference/ Symposium (International level) attended (Applicable if full text of

paper is published in the proceedings):

Sl. Name of the International Month/ Year / Vol. No./ Title of the paper
Conference/Symposium with
No. Venue Page No. Issue No.
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(g)Conference/ Symposium / Training Programs (National level) attended (Applicable if
full text of paper is published in the proceedings):

Sl. Name of the National Month/ Year Vol. No. Title of the paper
Conference/Symposium /
No. Training / Page No. /Issue No.
Programmes with Venue

(h) Conference / Seminar / Workshops organized as Coordinator/Chairperson:

Month/
Sl. Title of the Conference /
Year Venue Sponsoring Authority
Seminar / Workshop
No.
organized

(i) Summer / Winter Schools/ Training Programmes organized / attended:

Sl. Title Venue Duration Sponsoring Authority

No.

(j) Experiments or Computational design projects added to Teaching labs:

Name of the Lab. &

Sl. Institute Title of the Experiment / Design Year in which added
No. Project
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(k)Any E-learning material prepared for Teaching / Laboratory:
………………………………………...

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

12. Administrative experience: (e.g. Dean /Hostel Warden/HOD etc.)

Sl. Name of the Duration Nature of responsibility

No. Assignment

13.Membership of Technical Societies :

…………………………………………………………………..........
(Including Membership no.)
………………………………………………………………….……………………………………...........

14. Extra Curricular Activities:

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

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

15. Please give details of three referees (Not related to the candidate), At least one
should be the current / previous employer:

(i) Name: ……………………………….............. (i) Name:

………………………………..................

Designation: …………………………............. Designation:

………………………………........

Full Address:……………………………........ Full Address: ………………………………......

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

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

Contact No. …………………………….......... Contact No.

……………………………............

E-mail:………………………………….......... E-mail:………………………………………......

16.Any other relevant information :

………………………………………………………………….............
…………………………………………………………………………………………………………................
…………………………………………………………………………………………………………................
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 DECLARATION

I declare that the statements made in this application are true to the best of my
knowledge and belief. I understand that misleading or wrong information supplied may
lead to summarily rejection of application /appointment (if found subsequently).

Date: ------------------------------------
(Signature of
Place: Applicant)

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Summary Sheet for Teaching Posts (Faculty on Contract – purely temporary Basis/ Visiting
Faculty)
National Institute of Technology Puducherry, Karaikal – 609 609
(All data to be filled by the candidate with documentary evidence for scrutiny)

Name of the
Candidate:
Post applied for: Department:

Name of Institute/
Sl Degree University Year of Passing % of Marks / For
No Grade (CGPA) Office
Use
1 U.G.
P.G.
Ph.D.
2 Experience AGP 6000 / 7000 AGP 9000 or AGP 10,000 or
(In Years / months) / 8000 or equivalent equivalent
equivalent
Teaching / Research
After P.G. After Ph.D.
Teaching
Research
Industrial
Total
Administrative
Experience
3 No. of Publications in
SCI Journals only Internationa National International National
l Journal Journal Conference Conference

4 No. of Thesis P.G. P.G. Ph.D. Ph.D.

Supervised (Ongoing) (Completed) (Ongoing) (Completed)

5 No. of Conferences / International Level National Level

Seminars / workshops
Organized

6 Sponsored Research Nos Project Amount Project Amount

Projects (Rs. 2 lakhs to < 5 (Rs. above 5 lakhs)
lak
hs)

7 Consultancy Projects Nos Project Amount (Rs. In lakhs)

Authore
8 No. of Books d Co - authored

9 No. of Patents
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 Providing this information is Mandatory. If space is left blank answer will
10 Answer
be considered as NO.
Yes /No
(i) Are you B.Tech. / M.Sc. / M.A. from IIT / NIT/IISc?
(ii) Are you M.Tech. / Ph.D. from IIT / NIT/IISc?
(iii) Have you worked on any teaching post in IIT / NIT/ IISc/Govt.
Organization?
(iv) Have you been a rank holder during Academic Career in
NIT/IIT/IISc/University?
(v) Have you prepared e-learning materials (Teaching/Lab)? / Do you have
exposure/expertise in equipments (research/lab)? /Have you cleared
NET/SLET
(vi) Branch of study: B.Tech. / B.Sc / B.A : Branch of study: M. Tech. / M. Sc / M.A:

Ph. D Title:

Note:
1. Kindly enclose 1 best published papers in SCI (Science Citation
Index) Journals only.

2. Above information should be supported with certificate/Degree/Documents

Place:

Date :
Signature of the candidate