Form A11

MEPCO SCHLENK ENGINEERING COLLEGE, SIVAKASI

FACULTY APPLICATION FORM

For the post of Professor Asst. Prof Senior Lecturer Lecturer SRF JRF

In the Dept. of Civil EEE ECE CSE Mech IT Biotech

MBA MCA English Maths Physics Chemistry

Reference : Advertisement in ______________________ appeared on _____________

1. PERSONAL DETAILS

Name

Father / Husband Name

Marital status : Married Un-Married

If married, Spouse : Employed Unemployed

Sex : Male Female

No. of Children :
Age : Date of Birth :
Community : FC BC MBC SC/ST
Religion :

Nationality : Caste :

Address for Communication

1
Phone / Mobile : Email :

2
 2. ACADEMIC QUALIFICATIONS *

Full
No. of
time /
subject
Part s
Class / Agg.
Year of time / passed
# Degree Specialization Positio % / Institution University in more
Passing Distanc
n CGPA than 1
e
attemp
Educati t
on

1.

2.

3.

4.

5.

6.

* Attach Xerox copies of relevant certificates

3. EXPERIENCE DETAILS *

i. Teaching (in Engg. Colleges only) – chronological order

Experience (in
Sl.No. Designation Institution Experience (Duration)
years)

1.

2.

3.

4.

TOTAL

Last Salary drawn (Gross) Rs…………………. / month

3
ii. Others (Industry, Research, Teaching in Arts College / Polytechnic / School) – chronological order

Designation Experience (in

Sl.No. Institution Experience (Duration)
years)

1.

2.

3.

4.

5.

TOTAL

4. PUBLICATIONS

Book publications (give the title, publisher & year

of publication)

Paper : Journal Publication (give the no. of International :

publications) (attach the Xerox copy of the first page National :
of the publications)

Paper : Conference Publication (give the no. of International :

publications) National :

5. SEMINARS / CONFERENCES

Seminars / Conference organised (give the

Conference Theme and the date)

Seminars / Conference attended (give the number) International :

National :

4
 6. ANY OTHER INFORMATION

Undertaken any Sponsored Research Projects Yes No

If 'yes', provide details

Membership in Professional bodies

Awards & Achievements (if any)

I declare that the above particulars furnished by me are true to the best of my knowledge

Place : SIGNATURE
Date : Name :

* Attach Xerox copies of relevant certificates / documents wherever necessary.