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Dr.

MAHALINGAM COLLEGE OF ENGINEERING AND TECHNOLOGY

(An Autonomous Institution) Udumalai Road !olla"#i $ %&' (()


*o+ A,,li"ation Form Position Applied for I. A,,li"ant In-ormation
Name (in Block Letters) Do) DD/MM/****! Age in *rs!

in the department of

Photo Scanned 4mage!

Gender Male %emale

Marital Status Single Married

%C

Community )C M)C

Caste SC

Address for Communication

Permanent Address

Pin code '. Mail id+ %ather / .us,and/s Name 0ccupation 3ead &rite Spea# Mo,ile No+ Mother/ &ife/s

Pin code -andline+ Name 0ccupation

-anguage 1no2n

Area of 2or# / 4nterest in $eaching / 3esearch i! ii! iii!

'. Edu"ation
Name of the Degree College Studied * / Place Specialization Month & year of Passing No. of Arrears had & completed if any! " of Mar#s Part $ime / %ull $ime / &ee#end / '(ening / Distance

Ph.D. / M.Phil M.'/ M.$ech/ MCA / M.Sc./ M.Com. / MA ).'./ ).$ech/

)CA / ).Sc/ ).Com / )A 'ngineering Diploma

*5ni(ersity is not re6uired.


). E.,/ri/n"/ Attach separate sheets if necessary!+
'7perience in $eaching No. of years %rom $o Position / $itle 4nstitution/ 4ndustry Su,8ects taught / type of industrial 2or#

4ndustry

&. R/s/ar"#
No. of Papers !u+lis#/d in 9ournal National 4nternational No. of Papers !r/s/nt/d in Conference / Seminar National 4nternational No. of Conference / Seminar / %DP/ S$$P at 3egional / National / 4nternational 0rganized Attended No. of %unds O+tain/d from e7ternal agency for research

0. M/m+/rs#i, in !ro-/ssional 1odi/s 4S$': 4': CS4: etc.:! + %. Nam/ o- t#/ ,r/s/nt 2or3in4 institution 5 Industr6 7. !r/s/nt !ost (D/si4nation) )asic pay / month $otal 'moluments 8. !a6 E.,/"t/d at Our 9/r:i"/ ;. *oinin4 tim/ r/<uir/d i- s/l/"t/d =(. R/-/r/n"/> i!

+ + + + 3s. + 3s. + 3s. +

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== . An6 ot#/r in-ormation t#/ a,,li"ant 2is#/s to stat/ (Addl. ?uali-i"ation i- an6)>

Place + Date + 9i4natur/ o- t#/ A,,li"ant

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