Application No.

:
(to be entered by theOffice)

NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING (NITIE)

VIHAR LAKE, MUMBAI 400 087

FORM TO BE FILLED IN BY THE APPLICANT

Please read instructions given at the bottom of this form photograph

APPLIED FOR THE POST OF ASSISTANT PROFESSOR

(Please select) :

Whether willing to be considered Yes No

for a lower post:

Area of Specialization applied for Industrial Engineering

(Please select) :
Present (or Last) Post / Designation:

Details of Present (or Last) Pay Pay Band Basic Pay Grade Pay
(For Govt. & Autonomous Govt. only)

Total Emoluments (in present post Rs. Per month

or last drawn) :
as on MMM,YYYY: (Proof to be attached with hard copy)

(1) PERSONAL INFORMATION

Full Name :

Gender :

Date of Birth (dd/mm/yyyy) Age as on 01-07-2019

Nationality Indian Others (Specify)

Category : General

Religion :

Marital Status

Mailing Address

City Pin Code

State Country

Permanent Address

City Pin Code

State Country

Page 1
Faculty - 2019
Telephone No(prefix STD) Mobile

Email-Id :

Knowledge of Languages : English Hindi Others ( Specify)

Speaking

Reading

Writing

(2) EDUCATIONAL QUALIFICATIONS *In chronological order from X Std onwards other than Ph.D.

Period of Study
Exam passed Year of Class / University / Subject of specialization
passing From To %mark Board

*Please indicate your position in University / Board merit

list (if any)

(3) DETAILS OF Ph.D/ FELLOW

a) Whether Ph.D. or Fellow :

Date of Award
b) Ph.D./Fellow Award Status
dd/mm/yyyy
Date of Submission
c) Ph.D./Fellow Submission Status
dd/mm/yyyy
Date of Joining
d) Ph.D./Fellow Joining dd/mm/yyyy

e) Ph.D./Fellow Institute
and University Name :

f) Ph.D./Fellow
Topic in Full :

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g) Area of Specialization : (Ph.D./Fellow Research Area and Current Research Interests)

(1)

(2)

(3)

(4) PROFESSIONAL MEMBERSHIPS

Name of Organization Period (Year) Category of

Sl.
(Specify Indian or International) From To Membership

1.

2.

3.

4.

(5) SUMMARY OF PUBLICATIONS Filling the details in the below mentioned format is compulsory

Total number of publications

(mention period)

1. Papers in International Journals

2. Papers in National Journals

3. Papers Published in Conference Proceedings

4. Books / Chapters Edited

5. Conference Papers presented (National) (International)

6. Conferences Attended (National) (International)

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 (6) LIST OF RECENT/ BEST PUBLICATIONS

I. JOURNALS:

Author Name Year of Title of Paper Name of Journal

Sl. with Co-Authors Publication

II. CONFERENCES/SEMINARS:

Author Name Year of

Sl. Title of Paper, Proceedings Name of Conference/
with Co-
Authors Publication Seminar

* If required, attach additional sheet with the hard copy of the application and send by post.

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(7) WORK EXPERIENCE (OTHER THAN TEACHING EXPERIENCE)
Designation in
chronological order From To Nature of experience Details of Work *
Industry Research
(Post and Organization)

Total Work Experience (Years): Industry : Research :

(8) TEACHING EXPERIENCE

Designation in
chronological order From To
(Post and Organization)

Total Teaching Experience (Years) :

* If required, attach additional sheet with the hard copy of the application and send by post.

Faculty -2019 Page 5

 (9) SUBJECTS TAUGHT * One Row for each Subject
Sl. Subject Title UG/PG Class Size
1.
PG

2.
PG

3.
PG

4. PG

5.
PG

6.
PG

7. PG

(10) TEACHING INTERESTS (IF SELECTED)

Sl. List of Subjects that you are interested to teach in preference order

1.

2.

3.

4.

5.

6.

* If required, attach additional sheet with the hard copy of the application and send by post.

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 (11) RESEARCH PROJECTS / CENTRES (provide names of co-investigators if any)

Sl. Sponsor Title of Project / Center Duration Amount

(12) DOCTORAL STUDENT GUIDANCE COMPLETED

Sl. Student Thesis Title University/ Award Co-Guide
Date /
Name Institute Name
Status
1

3
4

5
DOCTORAL STUDENT GUIDANCE IN PROGRESS with progress status
1

3
4

(13) CONTRIBUTIONS TO INSTITUTE ADMINISTRATION

Sl. Position Description From To

* If required, attach additional sheet with the hard copy of the application and send by post.

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(14) OUTREACH ACTIVITIES (Executive Training, Consultancy to Industry)

Sl. Clients Title of Assignment Duration Amount

2
3

(15) ANY OTHER INFORMATION Please provide details that you would like, example
Books, Patents, Awards, Recognitions, etc.

* If required, attach additional sheet with the hard copy of the application and send by post.

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(16) REFERENCES Please provide contact details of two persons holding responsible
positions and FULLY acquainted with the applicant and not related to the applicant.

1 Name 2 Name

Designation Designation

Institute/ Institute/
Organization Organization

Address Address

Telephone No. with STD Telephone No. with STD

Mobile No. Mobile No.

LIST OF TESTIMONIALS
Original Testimonials are to be produced only at the time of interview.

1. No Objection Certificate from the present employer, if applicable

2. Work Experience Certificates
3. Teaching Experience
4. List of Publications & full printout of 3 best publications
5. Educational Qualifications
6. Caste Certificate, as applicable for reserved posts
7. Proof of Date of birth
8. Others (Specify)

I hereby declare that the above information is correct and complete to the best of
my knowledge and belief.

Place:

Date: Signature of the Applicant

Instructions (for filling the Application Form) :

1. Download this blank PDF application form and save it in your computer.
2. Open this PDF Application form in Adobe. Please do not make changes to the form.
3. Enter your details, and save it in your name (your_full_name.pdf) in your computer.
4. Email this filled and saved PDF form to email-id: nitierecruit@nitie.ac.in

Please note: Please do not send the certificates, photo, etc. by email. The hard copy of the
application form along with the copies of certificates, etc. should be sent by post as
mentioned in the Advertisement. List of Certificates required: Date of Birth, Photograph,
Educational Qualifications, Experience, and Caste Certificate for reserved post.

Faculty -2019 Page 9