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No.

Affix passport
size photograph

(to be attested)

TAMIL NADU AGRICULTURAL UNIVERSITY

APPLICATION FORM FOR THE POST OF


ASSISTANT PROFESSOR / ASSOCIATE PROFESSOR / PROFESSOR
(To be submitted in triplicate)

Advertisement No. R3/21497/2017 dated 27.09.2017

Post Applied for :


Discipline :
Applied under category :
(OC,BC,BCM,MBC/DNC,SC,SC(A),ST)
Priority (Differently abled persons) :
Demand Draft No. & Date :

1. Name in full (in Block letters) :

2. Father's / Husband's Name :

3. Date of Birth * :

4(a) Place of Birth and Nativity :


(District and State) *

4(b) Marital status :

5(a) Whether belongs to Hindu / Christian/ :


Muslim

5(b) Community and caste :

6(a) Present address for communication :


with E-mail I.D., Cell No. and Phone
No.

6(b) Permanent Address

* Copies of Proof should be enclosed


7. Educational qualification (University education)*

Degree or Diploma Institution Year of Class or


Specialization
obtained Studied passing Grade

i.

ii.

iii.

iv.

v. Whether undergone
course work in Ph.D.

vi. Whether done


Masters & Ph.D. by
Regular / Open
University System

8. NET / SLET qualified * :

* Copies of proof should be enclosed

9. Experience regarding previous and present employment **

Period of
Sl. Post employment
Employer Pay drawn Y M D
No. held
From To

i.

ii.

iii.

iv.

v.

Total

** Period spent on study for Masters/Ph.D. degrees should not be taken as experience
except part-time study period. (Xerox copies of appointment and relieving orders for each
post held duly attested are to be enclosed)
10. Teaching/Research Guidance/Extension Experience:

Title Details Duration (Year, Additional


months) Informations

1. Teaching

i) UG
ii) PG

2. Research guidance:

i) No. PG students
ii) No. M. Phil
students
iii) No. Ph.D. students

3. Extension services:

11. Publications (Copies of Proof should be enclosed)

a. Books (Only with ISBN No. )

Title Author(s) Year of Publisher ISBN No.


Publication

b. Book Chapters (Copies of Proof should be enclosed)

Name of the Book Title of the Chapter Publisher Year

c. Research Articles (enclose reprints mentioning NAAS rating)

i. International (No.) :
ii. National (No.) :

d. Popular articles (Enclose reprints)

i. in Magazines (No.)

ii. in Newspapers (No.)

12. Medals, Awards and Fellowships obtained (Local / National / International)*

Sl.No. Name of the Award Sponsor

1.

2.

3.

4.

* Copies of Proof should be enclosed

13. Schemes Obtained (Copies of proof should be enclosed)

Name of the Scheme Sponsors Period Budget

14. Additional Responsibilities *

Nature of work Period Y M D

From To
* Includes Farm Manager, Residential Tutor, Course Associate, Computer Centre
in-charge etc., supported by evidence.
15. Seminars/Conferences/Trainings attended and paper presented (Copies of proof
should be enclosed)

Name of the Seminar/Conference/ Organized by Period


Training

16. Membership in Scientific Bodies (Copies of proof should be enclosed)

Name of the Society Type of Membership

17. One page appraisal :

I certify that the information furnished above are true and correct to the best of my
knowledge and belief. Should there be any incorrect or false information having been
furnished or that may come to light in due course, I find myself for such action as the
University may decide.

Place: Signature

Date: Name & Designation of the applicant

Candidate already employed should get the following endorsement signed by his/her
present forwarding authority

1. The entries related to the details of service mentioned by Dr./Shri/Smt./Km


____________________ are correct.
2. There are no circumstances rendering him / her unsuitable for appointment to the
post applied for.
3. There is no vigilance/disciplinary case pending/contemplated against him/her.

Office File Ref. No. :

Official Seal

Signature
Name ..
Designation
Date .
List of enclosures:

1. Demand draft No.____________ dated ________ name of the bank and branch
________________________________ and amount Rs.________.

2.
3.
4.
5.
6.
7.
8.
9.
10.

Note:
1. Applicant in service should apply through proper channel.
2. Advance Copy can be sent, but "No Objection Certificate" of the present Employer
has to be produced on the day of interview, if invited, Otherwise Candidate will not be
allowed to appear before the Interview Board.