( 2009 )

Annexure I

CENTRAL UNIVERSITY OF TAMIL NADU

(Established by an Act of Parliament, 2009)
/Neelakudi Campus, /Kangalancherry,
/Thiruvarur - 610 101
:04366-277256 / email: establishment@cutn.ac.in

Advt. No: CUTN/T/06/2015

Application Form for Faculty positions
(Please read the instructions and general information before filling the application form)

Affix recent
passport size
photograph

Post applied for:

Subject:
Area of specialization:
1. Application No: (For Fees Exemption)
(Please refer the List of Candidates for those who had applied in response to our previous notification. For
details, please see 1.9.1 of General information & conditions in detailed (website) notification)

1.1 Application fee for fresh applicant (Non-refundable):

a. Indian Overseas Bank (IOB) deposit Challan * Enclose the University copy
Transaction No. Date
Amount (Rs.)
IOB Branch / Code
Branch Name / City
b. NEFT from Other Banks (Where IOB is not available)
Unique
Date
Amount (Rs.)
Bank Name / Code
Transaction No.

Branch Name / City

c. Demand Draft
Demand Draft No.

Date

Amount (Rs.)

Bank Name / Code

(Part A)
2. Personal Information (In capital letters):
2.1 Name in Full
2.2 Date of Birth (DD/MM/YYYY)
2.3 Gender
(Male/Female/Transgender)
2.4 Nationality
2.5 Category (SC/ST/OBC/General/PWD

Dr./Mr./Mrs./Ms. :

Age (as on 31.10.2015)

Material Status
Religion

HH, OH, VH /Minority). Please attach self-attested

copy of the certificate (if applicable)

2.6 Father / Spouse Name

2.7 Particulars of Physical

Disability, if applicable
Page 1 of 10

Branch Name / City

3. Address (In capital letters):

Mailing Address

Permanent Address

PIN CODE :
Email ID:
Phone No:
Mobile No:

PIN CODE :
Fax No.

4. Educational Qualifications (Matriculation onwards)

Name of the
Exam

University/
Year of
Institution/ Board Passing

Percentage
of Marks

Specialization
(if any)

Subjects

Division/
Class/CGPA

Please add additional sheet, if required, retaining the above tabular format.

Whether Qualified
UGC/CSIR /NET/ SLET/
SET Exam:

YES

NO

Ph.D. (Mark in
Degree Awarded
[
] Thesis
[
]
appropriate box)
Submitted
If Ph.D. awarded, whether Ph.D. degree is in accordance with UGC regulations,
2009 or not? If yes please submit the proof of evidence.
5. Title of Thesis/Dissertation (If published, give details on a separate sheet)
Ph.D.
M.Phil.
Master
5.1 No. of publications:
Refereed
Published
Journal only
Books (only with ISBN or similar
identification mark)

Accepted

Book Chapters
Conference Proceedings
(full papers only)

Page 2 of 10

Patents
6. Academic Distinctions (Award/Scholarship/Rank, etc.)

7. Membership/Fellowship of learned/accredited bodies (Give details)

8. Present Position:
Designation

University/
Institution

From
Date

Basic
Pay (BP)

Pay Scale
(PS)/Pay Band
(PB) (Rs.)

Gross Pay/
Total Salary
P.M. (Rs.)

Next
Increment
Date

Nature
of duties

9. Experience (Enclose additional sheet, if required, in the same format):

Post Held, Basic
Pay & Pay band
with Grade Pay/
Academic Grade
Pay

Period
University/
Institution

9.1. Total Experience

(excluding M.Phil. /

From

Teaching

To

No. of years
/ months

UG

Page 3 of 10

Nature of work

PG

Mphil /
Ph.D.

Reason for
Leaving

Ph.D. Research Degree

period)
10. Research Guidance

Research
(Postdoc)
Guide / Co-Guide

Enrolled

Submitted

Awarded

(enclose proof of evidence)

M.Phil. Degree
Ph.D. Degree
11. Research Projects Undertaken (other than that for research degree)
Title of Project

Date of
Commencement

Date of
completion

Emoluments
Drawn

Under whose
Auspices

12. Experience in Other activities like:

University Administration
Extra-Curricular activities
of students
Residential life of
students
If any other
13. Competence in Computer Application:

14. Do you have a near relative among the staff of this University?

YES / NO

If YES, Please furnish the details in the table given below:

Name of the Person

Designation

Relationship with the candidate

15. Additional information, if any (please attach additional sheet, if required):

16. Have undertaken any foreign travel for academic purposes? If yes, give details
Duration
&Year

Country
visited

Financial support
(Personal / Private /
University/UGC)

Sponsoring Institution /
University / Agency

Page 4 of 10

Purpose of Visit

17. Name and Complete postal address of three referees (In capital letters):
Reference 1

Reference 2

Reference 3

PIN CODE:
Email:

PIN CODE:
Email:

PIN CODE:
Email:

Phone No.:
Mobile No:
Fax:

Phone No.:
Mobile No:
Fax:

Phone No:
Mobile No:
Fax:

18. Teaching preference. Applicants are requested to write down their current and future
academic plans in about 200 words.

19. Are you willing to accept lower position if offered:-

Page 5 of 10

YES / NO

20. Declaration:
I hereby declare that all the entries are 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 application may be
cancelled without assigning any reason

Date:________________

Signature of the applicant

21. Endorsement by the Employer (for in-service candidates only):

To be signed and forwarded by the present employer
Forwarded to:
Recruitment Cell
Central University of Tamil Nadu,
Neelakudi, Kangalancheri Post,
Thiruvarur- 610 101.
The applicant Shri/Smt/Dr./Kum________________________ is a permanent /
temporary employee of the organisation holding the post of ________________________,
w.e.f.____/___/______ in the Pay Band of Rs.________________________. He/She is drawing
a Pay Band of Rs._____________ with AGP of Rs.____________________. His/Her next
increment is due on ___/___/___________.
Certified that no disciplinary / Vigilance can has ever been held or contemplated or is
pending against the said applicant. We have no objection for his/her application being considered
by the Central University of Tamil Nadu. The applicant will be relieved immediately on
selection.

----------------------------------------------------------(Signature of the forwarding authority)

Name:

___________________________

Designation: ___________________________
Place:

___________________________

Date:

___________________________

Page 6 of 10

Office Seal

Annexure II
(Part - B)
Academic Performance Indicators(APIs)
Use Additional sheets wherever necessary
(To be filled only for the position of Associate Professor & Professor)
Name of the applicant:

Subject: .

Post applied for: .

CATEGORY- III: RESEARCH AND ACADEMIC CONTRIBUTION
(NOTE: Applicants must submit documentary evidence in support of each of the claim)
A) Published papers in journals
Sl.
No

Title with
page Nos.

Journal with full

reference and
ISSN/ ISBN.
Whether peer
reviewed. Impact
Factor , if any

No of Coauthors

Whether
applicant is
the main
author

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

B) (i) Articles/Chapters published in books:

Sl.
No

Title with
page Nos.

Book Title ,
Editor &
Publisher (with
ISSN/ISBN)

No of
Coauthors

Whether
applicant is
the main
author

Page 7 of 10

B) (ii) Full Papers in conference Proceedings:

Sl.
No

Title with
page Nos.

Details of
Conference
Publication (with
ISSN/ISBN)

No of Coauthors

Whether
applicant is
the main
author

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

B) (iii) Books published as single author or as editor:

Sl.
No

Title with
page Nos.

Type of Book &

Authorship (with
ISSN/ISBN)

No of Coauthors

Whether
applicant is
the main
author

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

C) Ongoing and Completed Research Projects and Consultancies:

C) (i & ii) Ongoing Projects / Consultancies:
Sl.
No

Title

Agency

Period

Grant/
Amount
Mobilized
(Rs. in Lakhs)

Page 8 of 10

API Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

C) (iii & iv) Completed Projects/ Consultancies:

Sl.
No

Title

Agency

Period (with
Grant
Amount
Mobilized
(Rs. in lakh)

Whether
policy
document/
patent as
outcome

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

D) Research Guidance:
Number
Enrolled

Thesis
Submitted

Degree Awarded

API Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

M.Phil. or
equivalent
Ph.D. or
equivalent

E) (i) Training courses, Teaching- Learning- Evaluation, Technology Programme, Faculty

Development Programme (not less than one weeks duration):
Sl.
No

Programme

Duration

Organized by

Page 9 of 10

API
Score

Sl. No. of
proof
enclosed

API Score
verified by
screening
committee

Note: Please attach additional sheets wherever required.

E) (ii) Papers presented in Conferences, Seminars, Workshops, Symposia:

Conference/ Seminar

Sl.
No

Title of the paper

(Whether International/
National / State / Regional /
University or college level)

Organized
by

API
Score

Sl. No. API Score

verified by
of proof screening
enclosed committee

E) (iii) Invited Lectures and chairpersonships at National or International conference /

seminar, etc.
Sl.
No

Title of Lecture /
Academic Session

Title of Conference/
Seminar (Whether
International /
National)

Organized
by

API
Score

Sl. No.
of proof
enclosed

API Score
verified by
screening
committee

F) API Score (Total of API Scores)

Category - III

Date:
Place:

Signature of the applicant

Page 10 of 10