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RASHTRASANT TUKADOJI MAHARAJ

NAGPUR UNIVERSITY
(A State University established by Maharashtra Universities Act, 1994)

Application Form No.


(For office use only)

Dated : 5th February, 2013

Advt.No. : RTMNU/GA/227

APPLICATION FORM
(Please read the general instructions & conditions before filling)
Important Note :
(1) The Application Form available on the University website should not be changed in
any manner; otherwise it will be treated as cancelled. Additional sheets may be
used, if required to fill in the Application form by retaining it.
(2) All Communication during the recruitment process will be made through E-mail only.
Post applied for

Subject

Area of specialization

Affix recent
passport size
photograph

1. Application Fee (Non-Refundable)


Demand Draft No.

Date

Amount (Rs.)

Name of the Bank

Branch Name

Annexure
No. of Proof
Enclosed

2. Personal Details (In Capital Letters)

Full Name
(Surname First)

Date of Birth
(DD/MM/YY)

Age (In Years) as on


7th March, 2013

Gender

Marital Status

(Male/Female)

Nationality

Religion

Category
(SC/ST/OBC/OPEN/PH)

Particulars of Physical
Disability, if Applicable
3. Address (In Capital Letters)
Address for Correspondence

Pin Code :

Permanent Address

Pin Code :
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4. Communication Details
E-mail ID
Phone No.
Mobile No.
Fax No.
5. Educational Qualifications (Matriculation Onwards)
Name of
Exam
/Degree

University
/Institution
/Board

Year
of
Passing

Percentage
of
Marks

Division/
/Class
/GPA

Annexure
No. of Proof
Enclosed

(Please use an additional sheet, if required, retaining the above tabular format)

Ph.D. (Mark in

Degree Awarded [

Thesis Submitted [

Appropriate Box)

Title of Thesis/Dissertation (If Published, give details on a separate sheet)


Ph.D.
M. Phil.
P.G.
Particulars of
NET/SET/
SLET /GATE
or Equivalent
Exam.

6. Present Position
Designation

University/
Institution

From
Date

Basic
Pay (BP)

Pay Scale (PS)/


Gross Pay/
Pay Band (PB) Total Salary p.m.

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Annexure
No. of Proof
Enclosed

7. Teaching Experience
Post Held

Basic Pay &


Pay Band with
A.G.P.

University/

Period

Institution
From

Total Teaching Experience : [

To

Years] [

Teaching
Experience
Years Months

Months]

8. Work [Technical (T)/Laboratory (L)/Workshop (W)] Experience


Post Held

Basic Pay &


Pay Band with
Grade Pay

University/

Period

Institution
From

Total Work (T/L/W) Experience : [

To

Years] [

Work (T/L/W)
Experience
Years Months

Basic Pay &


Pay Band with
Grade Pay

University/

Period

Institution

Total Administrative Experience : [

From

To

Years] [
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Annexure
No. of Proof
Enclosed

Months]

9. Administrative Experience
Post Held

Annexure
No. of Proof
Enclosed

Administrative
Experience
Years Months

Months]

Annexure
No. of Proof
Enclosed

10. Research Experience


....

....

....

....

....

....

....

....

....

....

....

....

....

....

(Enclose additional sheet, if required, in the same format)

Total Research Experience :

] Months

Number of Thesis Submitted under Supervision :

Number of Degrees Awarded under Supervision :

11.

] Years

Publications :

Number of Books Published :

] Own

] Joint Authorship

Number of Books Edited :

] Own

] Joint Authorship

Number of Papers Published :

] Own

] Joint Authorship

Own
International
Journals

[
12.

National
Journals

Joint Authorship

International
Conferences

National
Conferences

International
Journals

National
Journals

International
Conferences

Academic Distinctions (Award/Scholarship/Rank, etc.) :


(Enclose additional sheet, if required, in the same format)

(i)
(ii)
(iii)
(iv)
(v)

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National
Conferences

Annexure
No. of Proof
Enclosed

13.

Membership/Fellowship of learned Accredited Bodies :


(Enclose additional sheet, if required, in the same format)

Annexure
No. of Proof
Enclosed

(i)
(ii)
(iii)
(iv)

14.

Competence in Computer Applications :

Annexure
No. of Proof
Enclosed

..

..

..

..

..

..

15.

Additional Information including Extracurricular Activities, if


any : (Use separate sheet, if necessary)

Annexure
No. of Proof
Enclosed

..

..

..

..

..

16.

Name and Postal Address of Two Referees (In Capital Letters) :


Referee 1

Referee 2

E-mail ID :

E-mail ID :

Mobile No. :

Mobile No. :

DATE :

PLACE :

(Signature of Applicant)

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DECLARATION-I
I hereby declare that all the entries made by me in this application are true to
the best of my knowledge and belief. If anything is found false at any stage, my
candidature for the post of .. may be
cancelled without assigning any reason thereof.

DATE :

PLACE :

(Signature of Applicant)

DECLARATION-II
I, Dr./Shri/Mrs./Ms. ...,
Son/Daughter/Husband/Wife of Dr./Shri
aged years resident at
.
do hereby declare as follows :-

1.

That I have filled my application for the post of

2.

I have .. (. Number) living children as on today, out of


which number of children born after 28th March, 2005 is/are .
.. (Mention dates of Birth, if any.)

3.

I am aware that if total numbers of living children are more than two,
due to the children born after 28th March, 2006, I am liable to be
disqualified for the same post.

DATE :

PLACE :

(Signature of Applicant)

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ENDORSEMENT BY THE EMPLOYER


(For in-service candidates only)
To be signed and forwarded by the present employer
Forwarded to :
The Registrar,
Rashtrasant Tukadoji Maharaj Nagpur University,
Chhatrapati Shivaji Maharaj Administrative Premises,
Ravindranath Tagore Marg,
Nagpur-440001
The applicant Dr./Shri/Mrs./Ms. .,
who has submitted this application for the post of ,
in the Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, has been working
in .., on the post of,
.in a temporary/permanent
capacity with effect from ... in the Scale of Pay
/Pay Band of Rs. with Grade Pay of Rs. .
His/her next increment is due on
Further, it is certified that no disciplinary/vigilance case has ever been held or
contemplated or is pending against the said applicant.
There is no objection for his/her application being considered by the
Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur.

......
Signature of the forwarding authority
Name : ________________________________
Designation : __________________________
Place : _________________________________
Date : __________________________________

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OFFICE SEAL

Proforma-A

RASHTRASANT TUKADOJI MAHARAJ NAGPUR UNIVERSITY


Statement showing details of particulars of applicant for the Post of Subject ...
Specialization - .
Sr.
No.

A/F
Ack. No.
& Date

Name & Correspondence


Address of the Applicant with
Contact No. & E-mail ID

Age /
Date
of Birth

Category :

Category
(Caste)

No. of Posts :

Academic Attainments
Qualifications

Year of
Passing

%/
CGPA

Adv. No. RTMNU/GA/227 dated 5th February, 2013


Experience (Yrs./Months)

Div./
Grade

Teaching

Research

Publications

Admn.

Whether Appl.
Submitted
Through Proper
Chanel?

Rem.

(Yes/
No)

For
Office
use
Only

10

11

12

13

14

International :
Own : ..
Joint : .
Total : .

15
For
Office
use
Only

National:
Own : ..
Joint : .
Total : .
Conference :

I hereby declare that all the entries made by me are true to the best of my knowledge and belief. If anything is found false at any stage, my candidature for the post of
.... Subject .. Specialization .. may be cancelled without assigning any reason thereof.
Date :
Place :

Signature of Applicant : .

Name of Applicant : ..
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