AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

1. Position Applied For:

2. Name: Mr./ Ms/ Mx.

3. Address for Correspondence:

4. Residential Address:

5. Telephone number:

6. Email id:

7. Date of birth:

8. Nationality:

9. Have you been earlier interviewed by the Foundation (Field/University/Philanthropy)?

If yes, when and for what role?

10. Language Proficiency: Please tick (√) against the language mentioned

Languages
Speak Read Write
Known

11. Educational Qualification

Educational Year of Distinction

Institution
Qualification Qualifying (if any)
1.

2.

2016 Page 1
 AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

3.

4.

5.

12. Work Experience:

Work Experience Institution Duration Position Salary Drawn

(in “mm-yyyy
to mm –
yyyy” format)

1.

2.

3.

4.

5.

6.

Expected Salary:

13. Teaching Experience

Courses taught Institution/s Number of Level: UG / PG / School /

Years Other
1.

2.

3.

4.

5.

2016 Page 2
 AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

6.

14. Research Experience

Research Name of Year Distinction

Experience Publication * (if any)
1.

2.

3.

4.

5.

6.

7.

*Publication could include article, op-ed, research paper, book chapter, book, monograph,
consultancy report (should be identified as such)

2016 Page 3
 AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

Give three references under whom you have either worked / received education from or
who knows you professionally.

Sl. Name Nature of Position Address Contact E Mail Id

Acquaintance Number
No

2016 Page 4