Indian Institute of Information Technology Vadodara

APPLICATION FORM FOR NON-TEACHING STAFF POSITION

ADVT. NO. IIITV/RECRU/NON-TEACHING/2019-20/001 DATE:________________

Details of Application Fee:

DD No. Date Amount Name of Issuing Bank

Affix Recent Passport

size photograph

Demand Draft should be drawn in favour of “Indian Institute of Information Technology

Vadodara” payable at Gandhinagar, Gujarat (SBI branch Code: 60228).

Post Applied: POST OF ASSISTANT REGISTRAR

1. Personal Details:

Full Name :Hakani Raj Arvindumar

Email ID :raj.hakani1990@gmail.com
Mobile No :9724082290
Date of Birth : 15/02/1990 Gender : MALE
Father’s/Husband’s Mother’s
Name : Hakani Arvindkumar Amrutlal Name : Hakani Ila Arvindkumar
Marital Status : Married Nationality : INDIAN
Category (UR/SC / ST / OBC) : UR Religion : JAIN
PWD : VH : HH : OH :
Address for
Correspondence :B/3/29 Meghavi Flats, B/H Devpath Flats, New-Wadaj, Ahmedabad Pin Code:380013

Permanent Address: B/3/29 Meghavi Flats, B/H Devpath Flats, New-Wadaj, Ahmedabad Pin Code:380013

2. Educational Qualification Details(Attach self attested photocopies of Relevant Certificates & Mark sheets) : Attach extra
sheets if required.
Matriculation onwards

Sr. Name of Name of School/ Board/ Year of Marking % of Class/

No. Exam. College/ University Passing Mode Marks/ Grade/
Passed Institute CGPA Division
FIRST -
M.Tech Institute of DIST
(a). 2014 CGPA 7.76
(EC) Technology Nirma University

FIRST -
(b). B.E (EC) LDRP - ITR Gujarat University 2011 Percentage 69.31
DIST
Swastik Higher DIST
(c). H.S.C Gujarat Board 2007 Percentage 78.6
Secondary SChool
Swastik Higher DIST
(d). S.S.C Gujarat Board 2005 Percentage 84
Secondary SChool
3. Whether employed or not: Yes/ No_____YES_____________

(Furnish details of previous/ present employment in chronological order in following table and attach self
attested Photocopies of Relevant Certificate) : Attach extra sheets if required.

Adhoc/ Period
Sr. Organization / Regular/ Scale of Pay/
Total Period Nature of Duties
No. Institute Temp./ From To Consolidated Pay
Contract
Government
Polytechnic
09-09- 31-05-
1 College, Visiting 0Y 9M 8000/- Teaching
2011 2012
Ahmadabad

Institute of
Temp. 05-07- 05-07- Project Work
2 Plasma Research, 1Y 0M 8000/-
(Project Intern) 2013 2014 (ITER INDIA)
Bhat Gandhinagar

Silver Oak College

07-07- 31-05-
3 of Engineering Regular 0 Y 11 M 15000/- Teaching
2014 2015
and Technology

Gujarat Teaching, Research

15-06-
3 Technological Contract Present 4Y0M 58486/- Administrative &
2015
University Accounting (PFMS)

Total 6Y8M

4. Working knowledge of Computer: Yes / No_________YES__________

5. Special Qualification/ Experience in Computer Knowledge : MS OFFICE, Prog. in C

6. Name, Designation, Address and Contact No. of two responsible and reputed persons:

(a). Ms. Kavita Kripalani, Deputy Director, GTU, Shed No 4, Chandkheda, Ahmedabad
(b). Dr. K N Kher, Registrar, GTU, B-212, B- Wing, Chandkheda, Ahmedabad , 079-23267606

7. Any relevant information :

 Qualified GATE Examination in Year 2012 & 2014 with 95.71 and 88.19 Percentile
 Handling PFMS account of DIC (Design Innovation Centre) as Coordinator of DIC
 Handling CIC3 Section and Doing Research work in Robotics and Automation
 Taking Lecture in GTU - Graduate School of Engineering and Technology
 Selected as Mentor of change by MHRD for ATAL Tinkering Lab
 Technical Committee Member for GTU SSIP Cell
 Write Proposal for following Grants SSIP, DIC, Super Computer, DST - IOT Lab
 Taking 6 Expert Lecture in Various Renowned Colleges and Conferences

8. Details of enclosures in support of information mentioned above.

(a). Experience Certificate (Silver Oak, IPR & Govt. Polytechnic Ahmadabad)
 (b). UG & PG Degree Certificate

(c). GATE 2012 & 2014 Mark sheet

(d). Research Paper Publication List

(e). Award List (University Level and Personal Level)

(f). ____________________________________________________________________________________

(g). ___________________________________________________________________________________

(h). ___________________________________________________________________________________

9. Declaration : I do hereby declare that all statements made in this application are true, complete and correct
to the best of my knowledge and belief. In understand that in case of any particular information furnished by me is
found false/ incomplete or ineligible, my candidature is liable to be rejected or cancelled and even after appointment it
is found false or incorrect, my services are liable to be terminated without any notice.

Place:___________________________

Date:____________________________ Signature of Applicant