Indira Gandhi National Tribal University,

Amarkantak (M.P.)

(A Central University established by an Act of Parliament)

Mekal Sadan, Kapiladhara Road, Amarkantak (M.P.) 484 886

web site : www.igntu.nic.in
APPLICATION FORM FOR TEACHING POSTS
Advt. No.IGNTU/Acad/01/2011
Last Date of Submission : 20.01.2012
Post applied for .

vkosfnr in ----------------------------------

Field of Specialization of above post (if any)...........

mi;qZDr in ds fokskKrk dk {ks= ;fn dksbZ gks -----------------------------------Applied Under category Gen / SC / ST /OBC .

Advertisement No.

foKkiu la ------------------------------------------------------Post Code* ......

Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk-@vuq-t-tk@v-fi-o- --- in ekad * -----------------------------------------------------------------------------------------------------------------------------------Particulars of fee Remitted :
Bank Draft No.
Amount

kqYd dk fooj.k%
jkfk #-

Date

cSad MkV la[;k

Issuing Bank

fnukad

tkjhdrkZ cSd

1. Full Name (in Block Letters) ________________________________________________

________________________________________ Affix Recent

Passport Size
Photograph

iwjk uke fgUnh esa lkQ v{kjksa esas ______________________________________________

________________________________________________

2. Fathers/Husbands Name

________________________________________________
________________________________________________

firk@ifr dk uke

3. (a) Address for Correspondence

(b) Permanent Address
i=kpkj dk irk
LFkk;h irk
______________________________________
__________________________________
______________________________________
__________________________________
______________________________________
__________________________________
Tel. No. ____________________________
Tel. No. ________________________________
Fax No. ____________________________
Fax No. ________________________________
e-mail: ____________________________
e-mail: ________________________________
4. Date of Birth & Place
5. (a)
tUe frfFk ,oa tUe LFkku
(b)
___________________________________
___________________________________
Age as on 01.01.2012
01.01.2012 dks vk;q
Years okZ

Months ekg

(c)

Days fnu

6. Marital Status : Married / Unmarried

oSokfgd fLFkfr % fookfgr @ vfookfgr
Note :
Post Code*

Sex: Male/Female fyax

% iq#k

Category : SC

v-tk- / ST v-t-tkOBC v-fi-oxZ

/ General lkekU;

(b)

If person with disabilities

fodykax gksus dh nkk esa

VH oh-,pHH ,p-,p-

Please tick in the appropriate box

7. (a)

@L=h

OH vks-,p-

mi;qZDr ckDl esa lgh dk fukku yxkosaA

Nationality jkVh;rk __________________
Religion /keZ

_______________________

- i.e. PR for Professor, AOP -Associate Professor & AIP - Asst. Professor / Sl. no. of the Post ______
As for Example for Assistant Professor in the Dept. of Tribal Art will be written as : AIP/ Sl. No.- 26

8. Academic Qualification (Commencing with the High School or an equivalent examination)

kS{kf.kd ;ksX;rk gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa
Examination
Degree

ijh{kk@ mikf/k

Subject /
Specialization

Year

fok;@ fokskKrk

Matriculation /
10th / Secondary

okZ

Division
Js.kh

% of
Marks /
Grade

vad %
@xzsM

University / College /
Board foofo|ky;@

Distinctions /
Scholarship

fofkVrk@
Nk=o`fk

dkyst@cksMZ

Intermediate /
+2 / HS
Graduation/ + 3

Honours

Post Graduation

Any other
Qualification

Research Degree(s) kks/k mikf/k;ksa %

Degree

mikf/k

University

foofo|ky;

Specific date of
submission

kks/k&izcU/k tek djus

dh frfFk

Specific date of award

mikf/k izkfIr dh frfFk

Title of the thesis

kks/k&izcU/k dk khkZd

M.Phil

,e-fQy
Ph.D / D.Phil

ih&,p-Mh@Mh-fQy
D.Sc/ D.Litt.

Mh-,l&lh@Mh-fyV~
(i)

Whether Ph.D awarded as per UGC Regulation 2009 (if yes, Please give documentary
proof) D;k kks/k mikf/k ;w-th-lh- jsxwysku 2009 ds vuq:i gSA ;fn gk] rks lk{; dh Nk;kizfr

layXu djsaA

(ii) Whether qualified NET/SLET etc. (Conducted by UGC/CSIR/ICAR/State) (Indicated the

date and attach documentary proof) D;k ;w-th-lh-@lh-,l-vkbZ-vkj@vkbZ-lh-,-vkj-@jkT;
vkfn }kjk lapkfyr jkVh;@jkT; ik=rk ijh{kk mkh.kZ gSa% frfFk nsa ,oa izek.k layXu djsa

YES

gk
YES

gk

/ NO
@ ugha
/ NO
@ ugha

9. Teaching/Professional/Research Employment (Give particulars in descending order starting with the present post)
v/;kiu@O;olkf;d@vuqla/kku fu;kstu orZeku in ls izkjEHk djds vojksgh e esa fooj.k nsaA
Name & Address of
Employer fu;ksDrk dk

Post Held

in

uke vkSj irk

**Present

Pay Scale

osrueku

Basic Pay as
on date

Total
Gross
Pay

ewy osru

ewy osru

Period of
Employment

fu;kstu dh vof/k
From

ls

To

Nature of
Duties/Work

dk;ksZa ds Lo:i

rd

Must enclose the Pay slip with Pay Band for each post held
* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;kkklh@futh
** Mention whether revised or unrevised, if relevant. d`i;k lakksf/kr vFkok vlakksf/kr osrueku dk mYys[k djsaA

10. Summary of experience/performance dk;Z vuqHko @fuiknu dk laf{kIr fooj.k

A.

Teaching Experience

(i)

Under Graduate Lukrd

(ii)

Post Graduate Lukrdkskj

v/;kiu vuqHko

From

To

ls

rd

Total years & Months

dqy okZ vkSj eghus

(iii) Total Teaching Experience

dqy v/;kiu vuqHko

Participation in production of Educational TV programme

(iv) Vh-oh- fk{k.k dk;Zeksa ds fuekZ.k esa Hkkx ysus dk fooj.k

(v)

Short term/Continuing Education/Specialist Courses conducted

B.

Courses developed (No.)

c-

vYikof/k @vuojr~ fk{kk @ fokskKrk ikB~;eksa dk vk;kstu

ikB~;eksa dk fodkl la[;k

U.G.

Lukrd

P.G.

Lukrdkskj

C.

Research and academic contributions

kks/k vkSj kS{kf.kd lg;ksx

(i)

Research papers published in Refereed Journals/Non-refereed but reputed journals having ISBN /ISSN
(Please give the details in Annexure A)

leh{kkRed if=dkvksa esa kks/k&i= d`i;k layXud A) esa fooj.k nsa

Research Publications (Other than refereed journal articles)

kks/k izdkku leh{kkRd if=dkvksa ds vfrfjDr

(ii)

Books/Chapters in books (Please give the details in Annexure B)

iqLrdsa @ iqLrdksa esa v/;k; d`i;k layXud B) esa fooj.k nsa

Note :

List of publications with details, reprints of papers and acceptance letters (in case of accepted papers) must be
enclosed.

izdkfkr kks/k&i=ksa dh lwph] mudh iqueqZfnzr izfr;k ,oa Lohd`r kks/k&i=ksa ds Lohd`r i= dh Nk;kizfr;k layXu
djsaA

D.

Research Projects (Please give the details in Annexure C)

E.

Research Guidance

(i)

Number of Thesis Supervised (Please give the details in Annexure D)

i;Zos{kd kks/k dh la[;k d`i;k layXud D esa fooj.k nsa
Awarded
Submitted

bZ
bZ

vuqla/kku ifj;kstuk;sa d`i;k layXud C esa fooj.k nsa

kks/k i;Zos{kd

iznk

(ii)

Ph.D.

(iii)

M.Phil

ih&,p-Mh

,e-fQy

iw.kZ gqbZ

In progress

izxfr ij

F.

Prizes/Medals/Awards/Honors

iqjLdkj @ ind @vokMZ @lEeku

G.

Extra curricular activities-give details, if any, of proficiency acquired in games, sports and of participation in
other extra curricular or social activities such as NCC, Public Lectures, Debates, Social Service etc.

vU; xfrfof/k;ksa dk fooj.k& ;fn dksbZ gS] [ksy dwn] ,u-lh-lh-] laokn izfr;ksfxrk vkSj lekt lsok vkfn

As a student

fo|kFkhZ thou esa

After entering into service

ukSdjh esa vkus ds ckn

11.

Training courses and conference/seminar/workshop papers (Please give the details in Annexure E)

izfk{k.k dk;Ze vkSj lEesyu ,oa ifjlaokn xksBh @ dk;Zkkyk esa i= d`i;k layXud E esa fooj.k nsaA

12.

(a) Membership/Fellowship of professional societies:

v O;olkf;d lkslkbVh dh lnL;rk@v/;s;rk o`fr

(b) Other activities/Responsibilities:

c vU; xfrfof/k;k @ mkjnkf;Ro

(c) Are you willing to accept the initial salary of the grade? (if no, state what is the minimum salary acceptable
with justification thereof)

l D;k vkidks vkosfnr osrueku dk U;wure Lohdk;Z gS \ ;fn ugha] dkj.k lfgr LiV djsa fd fdruk U;wure~
ewy osru Lohdk;Z gSA

(d) if appointed, what period would you require before joining the post ?

n fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko;drk gS \

(e) Any other relevant information, if not given above:

bZ vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks ij u nh x;h gks %

13.

(a) Has there been any break in your academic career ? If so, give details

v D;k dHkh vkidh fo|ksiktZu dk e Hkax gqvk \ ;fn gk rks dkj.k lfgr fooj.k nsaA

(b) Have you been punished during your studies at college/University ? If so, give details.

c D;k dHkh vkidks fo|ksiktZu ds nkSjku foofo|ky; @ dkyst }kjk n.M fn;k x;k \ ;fn gk rks fooj.k nsaA

(c) Have you been punished during your services or convicted by a court of law ? If so, give details.

l D;k dHkh ukSdjh ds nkSjku vkidks nf.Mr fd;k x;k gS ;k fdlh U;k;ky; }kjk vkidks nkskh izekf.kr fd;k
x;k \ ;fn gk rks fooj.k nsaA
(d) 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.

n D;k dHkh vki LokLF; ijh{kk esa v;ksX; ?kksfkr gq;s] vkils R;kxi= nsus ds fy;s dgk x;k vFkok vkidks fdlh
ukSdjh ls ineqDr ;k c[kkZLr fd;k x;k gS \ ;fn gk rks i`Fkd i`B ij fooj.k nsaA

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

/k D;k vkids fo#) dksbZ U;kf;d ekeyk fopkjk/khu gS\] ;fn gk rks fooj.k nsaA
14.

Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three reference not related to you.
Reference should be of persons with or under who have intimate knowledge of your work.

rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs Qksu] QSDl ua- ;fn gS ds lkFkA lUnHkZ O;fDr og gksuk pkfg;s ftlds
lkFk ;k ftlds v/khu vH;FkhZ us dk;Z fd;k gks ;k tks vH;FkhZ ds dke ls iw.kZr;k voxr gksA
(i)

Name & Address:

Ph.No.

Mobile No.

E-mail :

(ii)

Name & Address:

Ph.No.
(iii)

Mobile No.

E-mail :

Mobile No.

E-mail :

Name & Address:

Ph.No.

List of Enclosures (Please tick in the box)

layXu izys[kksa dh lwph ckDl esa lgh dk fukku yxk;sa

(a) Bank Draft & Photograph
v cSad MkV ,oa Nk;kfp=
(b) Copies of Mark-sheets & Certificates of educational qualifications &
certificate of clearing NET/SLET/JRF etc.

vad&i=ksa] kS{kf.kd izek.k&i=ksa ,oa jkVh;@jkT; ik=rk ijh{kk@dfud v/;srk ikl djus ds izek.k i=ksa
dh Nk;kizfr;k
(c) Copies of certificate of experience
vuqHko izek.k i=ksa dh Nk;kizfr;k
(d) List of publications with details, reprints of papers and acceptance letters (in case of accepted papers)

izdkfkr kks/k&i=ksa dh lwph] mudh iqueqZfnzr izfr;k ,oa Lohd`r kks/k&i=ksa ds Lohdkj i=ksa dh Nk;kizfr;kA
(e) Copies of other relevant certificates & documents.

vU; lEcfU/kr izek.k i=ksa dh Nk;kizfr;k

Declaration to be signed by the candidate

I _______________________________________ hereby declare that the entries in this form are
correct and true to the best of my knowledge and belief. If at any time, I am found to have concealed
/suppressed any material/information or given any false details, my appointment shall be liable to be
summarily terminated without notice or compensation.

vH;FkhZ }kjk gLrk{kfjr ?kksfkr i=

eSa ----------------------------------------------------------------------------------------------- ;g ?kksfkr djrk@djrh gw fd bl vkosnu esa nh x;h lHkh
lwpuk;sa esjh iw.kZ tkudkjh ,oa fookl esa lR; gSA ;fn fdlh le; ;g ik;k x;k fd eSaus dksbZ lwpuk fNik;h gS
vFkok esjs }kjk nh x;h dksbZ lwpuk vlR; ik;h x;h rks esjh fu;qfDr fcuk fdlh uksfVl vFkok eqvkots ds c[kkZLr
dj nh tk;sxhA
Place:

Signature of Applicant

Dated:

Name in BLOCK LETTERS

LFkku

fnukad

vH;FkhZ ds gLrk{kj

uke

Declaration to be signed by the Head of the Institution/ Organization

Forwarded with the remarks that the institution/organization has no objection to the candidature
of the applicant being considered for the post applied for, as above.
bl vkk; ds lkFk vxzsfkr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk
dks dksbZ vkifk ugha gSA
Place:

LFkku

Signature

Dated:

fnukad

Telephone

(Head of the Institution/Organisation

Fax

Designation with SEAL

VsyhQksu
QSDl
bZ&esy

laLFkku@laxBu izeq[k
in

Address :

irk

Remarks:
fVIi.kh%
1. Candidate already employed should submit application through his/her employer.
fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA