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    2 views4 pages

    (Assistant Prof. in E & C) Application Form

    Uploaded by

    jitu_4

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 4
    2panDays [mee 2 = Atmiya Institute of Technology & Science a 2 (Managed by Sarvoday Kelavani Samaj) 4 5 “Yogidham”, Kalawad Road, Rajkot - 360 005, aN © Ph. No. : (0281) 2563445 Teo Fax 91 281 2563952 APPLICATION FORM FOR ACADEMIC POSTS Instructions: 1, Separate application form is to be filled up for each post. 2. Please attach certified copies of: school Leaving Certificate, Graduation and Post- Graduation mark sheets, Degree Certificates, Experience Certificates, and Prizes wards st. 3. Please attach extra sheet if required. 4. Post for which applied ASSISTANT pRoressoR (EPC DEF ) 5. Affix Photograph in the box To, ‘The Secretary, Sarvoday Kelavani Samaj, “Yogidham", Kalawad Road, Rajkot ~ 360 005. Sit, In response to your advertisement appeared in__S ANDESH (Name ofthe Newspaper) cated_04 | 12]14 thereby apply forthe captioned post My particulars are as under: [A] Personal Details 1. Full Name = AGT MS. / MIS. / DF. _C CHORE Tr TERORAKUMAR RALKRUSHNA ‘Sumame) (Name) (Fathers 7 Hushdnds Name) 2. Permanent Address: So]s) SURTAN AGAR SocreTy IZGHAG-2, NEAR MARUTIDHAM | | ZRNAG-2, NEAR PARUTE Di OC NEW KOSAD RIAD AMR, |sac, NEW EOsAD Road, AMROvT, Pincdde: SURAT — 394104 Pincode: SURAT— 394 OF | Ph. No. (R):_026)-2495085 — PhNo.(R): O26)- 2495085 “ Now (My: 994 Ph. No. = o 1¢5 Email: Gl ie 3, Family Background : Father's Occupation: PRINCZPAL Jqy patmARy SCHOOL (mc) Mothers Occupation : PRINCI PAM Zn) PRIMARY SCHOOL Cs c) 4, Date of Birth ;_13 |12] 5. Age:_25 6. Place of Birth : HALES CAN, Min 7. Sex: _MA1E 8. Nationality: _ENDLAN. 9, Marital Status: SENGLE 10, PANNo ARR PCEFE 5411. Religion HINO LADWANE 12. caste OPEN ceepuscsisen9 13, Blod Group _B* 14, Languages Known (Please place tick [“] mark} mAPATHE English Hindi [ Gujarati_| Any Other{Specify] | Read “a a Ve Va Write wa ima — = ‘Speak = = wa za _[B]__ Educational Qualifications (Attach Mark sheets): Pidoens Year | University Class | %Marks | Remarks a 2004| GSRSEB oes ge sy | wh eaH tye as HSC 2006| GS RS-EB] PCM bE eq 00 | Good Graduate ETO rast 1 eo BE-CE4C) [2010 YNSGU bteatad cones £513 | Good Postgrad thas VST — | emer romonaute| con | GTO lores, pay| al 40 | Ne Ph.D. ‘ny Ofer [C]__ Academic Experience : Designation | Institution ce Basic Pay. | Remarks From, To. aml eseoma le 16 p00 | Tencnans fe $eeeer| surat afogn aa] 07}" fim ak woe| PROSE T (TNousTRHIL) [D] Professional Experience: Designation | Organization dictate Emolument | Remarks From To TONTOR | wanse CaRUFT Ecectesap aa afer] pa}os) | 120108 [esta I 2 Te AHMmEDnS emaene LEN epee [E] Research Experience : No. of* Designation | Organization Uncle procitea ; | Remarks From To published SCET, FEE vel stwat] SET [ocfocfor|osfocfto] + | BFFs GEC, 7 [evened pG[stuvent] MoS hos [oF] Iiforfia] ee [F] Text Books / Reference Books Authored *: N () Title Year Published By E64, DESTSH , TROUBLES HTH Ware OTS 1a Com FERRE ne F007?) |, HOPG Kone * Attach a separate detailed list. sk A Name of Activity ‘State/ National Level Year + (paxe|7 Posten TRESENTATIEN store (Gust) 2014 (ore PE) MopeL PRESENTA HRN QUIAPAT ” 2610 [E] _ Extra-Curricular Activities (attach a separate sheet if necessary) : Sports/Fine-Arts/Elocution Competition/NCC etc. at State/National Level. IF] _ Name of References (other than relatives): DR CATE A- THAYER DR wIFRV svat ] PROFESSOR AND HEAD of DE etl gk) PSSOCHATE PROFESSOR IN EDC N GEC, CHANDLHEDA , BUTT EDABAD- EDT “Kee Hane Barrer Pincode: S200 | Pincode: 2 Ph. No. |PhNo 04923242904 Ph no(W): 04a 2ESS STO Pate ow zeaontie ‘Email: 3atha ie Ze0R@)spmail Cove Email Tac @grnail-corn 201) Any other relevant Information*;_G ATE Watach a separate sheet F neces) ‘Current Basic Pay/Month Rs. Current Gross Emoluments/Month RS. Expected Basic Salary/Month Rs. 2,50,000 PA, Time required to join Ay 1, hereby declare that the above information is true to the best of my knowledge. If, selected, I assure you to work most sincerely and satisfy my superiors, ‘Thanking you, pate: 09 |12]14 Yours Sincerely, Place: SURAT , GuTAPAT

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