Gautam Buddha University, Greater Noida, Gautam Budh Nagar — 201 312 (U.P.) India Application Form for the post of Assistant Professor IMPORTANT: To be filled in by the Candidate/Applicant only Note: Please read the “Advertisement” and “Terms and Conditions” carefully before filling the application form. No column should be left blank. All the desired details must be given in word, and not by and dots. Far Office Use: Application No. Postal Ordar/Bank Draft/Datais of Payment/Reference No. = eeenDBt®. ‘Amount (RS).-nsossnsosnaName of the Post Officeyfank 4. (2) Name of the Applicant in Full (In Capital Letters): (&) Post Applied for () Department Name = ‘Aix a recent Passport (@) School Name size Photograph (€) Subject: (9 Specialization (¢) Advertisement No, & Date 2, Details_of Educational Qualifications (from Graduation onwards to final degree) (Please attach self attested marksheets and certificates/Deqrees) Degree/ Exam | University/College/ | Specialization | Year of | Percentage | Division | Duration of passed (with Board “(Subjects | Passing | Marks/ | /Grade | Course ‘liscpline) Grade obtained Graduation Post Graduation [ M.Phil Ph.D Others, any 3. Details of Ph, D Research (Please attach an abstract of the Ph. D Work, and furnish the following details) [| PhD. Thesis Title Ti__| Area of PhD, research work Ti,__| Date of foingfregistration of Ph. D Programme Tv._| Date of submission of Ph. D Thesis ¥._| Date of completion of Ph. D Programme vi_| Name(s) of Thesis Supervisors) vi_| Whether Part time Ful Time vit_[ Institution 7 University 4. Details of Employment/Work Experience (Please attach self-attested copies of the experience certificates Position Held* | Organization] | Dateof | Date of | Total period | Nature of Duties ast pay Pay Institute | Joining | Leaving Band and Pay Grade (Rs.)+ Please specify if the position is concurrently with Ph, D or Post Ph.D. 5. Teaching Experience (Please attach self-attested copies of the experience certificates) Course(s) Taught (Code and Name of the Level UG/PG | Institute Course and credits) Duration 6. Experience of working in Research Laboratory/ Laboratories (Please attach self-attested copy of the Foot Name of Research ‘Organization Period Position Nature of work Laborator Fro [Te Totar 7. Particulars of referred journals and books carrying your Research Papers, Reviews and Chapters* Papers Published ‘Name of the Joumal/BooK Impact Factor | No. of Papers Published | Broad areas (a)_International (National "Please attach self atested proof and complete Getals of the publications in separate she=t(s). 8. Details of Conferences/Seminars, etc., attended and paper(s) presented (Please attach self-attested proof of presentations)* Name of Conference When and Where (a)_International9, | Other Published works (No) “Technical Report ‘Monograph ‘Book/Edited or (attach selfattested proof and details in a ‘Authored separate sheet) TO.) Number of Thesis] Dissertation supervised | Awarded Submitted Tn progress, (Attach sef-attested proof and details in 2 separate sheet) Ph.D. 7, PRIM, TERME /M. SeMATEA TH] Pries/Madals/ Awards] Honours received: (Please attach sel-atested proof and detalls in a separete sheet) 72.] Special Training () /Assignment(a) attended, Fany (Please attach sel-atiested proof and detals na separate sheet) Ta.| Nemberchip) Falowship of tre Professional Societies, ir any (Please ettach sel-atested proof and details in a separate sheet) Ta] Etre ~cunikular Ades) Administrative Responabilties handled: (Please attach selrattested proof and detais in a separate sheet Ec] any other Information Ta Tavour of the candidature of the applicant: (Please attech self-attested proof and details in a separate sheet) 16. In-house Research Projects (Please attach selfattested proof) Title (Mention PI/Co- | Sponsoring Agency Completed) | Duration | Institute where the research was [ Amount lyMember) On going carried out (Rs.Lakh) 17. Sponsored Research Project (Please attach self-attested proof) TTitie (Mention PI/Co- | Sponsoring Agency Completed/ | Duration | Inctitute where the research was [ Amount prjMember Ongoing comtied out (Rs.takh) 18, Consultancy Projects (Please attach seltattested proof) Title (Mention your role | Sponsoring Agency Completed] | Buration | Institute where the work was) Amount and responsibilty) On going carried out (Rs.Lakh) 19, Title of Patents Awarded/Applied for 2) Awarded : (Give Patent Number also) | Year Patenting Authority Single Multiple Patenters (©) Applied for20._Personal Details (@)_| Father's / Husband's Name ()_| Mathers Name (©)_[ Date and Piace of bith (attach self- attested proof) (@_| Gender (©) | Martal Status (0_| Rationality (@) | Category (Pease atiach selfattested vali proof) (General/OBC (Creamy Layer)/ OBC (Non-Creamy Layer)/SC/ST/PWD (Person with Disability) (hy | Permanent Address Pin Code: - ()_| Address for Correspondence in Code: @_| Ema (&)_| Phone No with STD Code @_| Mabie no. (in) | Adhar card Wo, (Please attach sal-attested valld proof) 21,_General LT Are you wiling to secept the inital pay of the grade? Yes/No (if no, stte the minimum pay acceptable or expected with jusiification forthe same) Period needed for joining the duties, Fthe post offered ‘Were you ever declared medically unit or asked to submit resignation or discharged) dismissed? Yes/iio If yes, give detail in @ separate sheet 2 References: Give Name, Designation and Address, Email, Mobile, & Phone No. of three Referees who are acqualnted with your Teaching /ResearchjProfessional work , I, Declaration 1, hereby, declare that I have carefully read end understood the instructions and particulars advertised, and that al the information provided by me in this application are true to the best of my knowledge and belief. If at any time I {am found to have concesled/suppressed any materia/information or given any false detail, my appointment shall be lable to be surimarily terminated without notice or compensation. Place: Signature of the Applicantue Gautam Buddha University, Greater Noida Gautam Budh Nagar ~ 201 312 (U.P.) India Summary Sheet for the post of Assistant Professor Post Applied for ‘Advt. No. & Date Subject Department: Specialization School: Primary Information Name: Fathers | Husband's Name Mathers Name: Date and Place of Birth : Category: ‘Agha card No. Phone/ Mobile No.: Landline: [email Present Address: (a)_Academic Qualification Degree/ Exam | Specilization/Subjects | __Universty/College/Board Percentage of Year of passed Marks) Grade | Completion ‘obtained Graduation Post Graduation M.Phil Ph.D (Others, any (b) Posts Held Present Position (Organization Pay Scale with AGP (Rs, (©) Achievements ‘Mention significant achievements GF any) _-(d)_Experience (No. of years) Total | In Inda | Abroad | Teaching | Research Industry Tndustrial | Administrative Research (e)_Publications Number of Publcations Refereed Conference Books | Chaptersin Reviews aie Journals Presentations Books Patents Name ication No. Granted/Appied(a) Awards/ Rewards/Recognitions ‘Awards/Reward Recognition ‘Academics Rewards Fellowship/Membership of Academic) ‘Special Awards Professional Bodies Committee(s)/Assignments, itary (h) Checklist for Attachments Put a (¥) tick mark as applicable S, Documents Attached Yes | No No 1] Self attested copies of Degree Cerifeates and Mark Shows 2. | Brief Description of Ph.D. work 3._| Ust of Publications with complete details and proof (sel attested) 4._ | Photocopies of ful texts of three best Publications 5. | Roplcation to be submitted both in soft and hard copies along with Fee 6. | Have you sent your application through proper channel? (Attach no objection cerinicate from the employer, if serving in Government) Semi-qovernment/ Private organization) 7,_| Selt-attested copy of Certificate of Date of Bith 8. | SelFsttested copy of the Certificate supporting your Status (W applicable) as SC/ST/OBC | (creamy tayer/Non-creamy layer) /Physically Challenged or diferent able (@__Ust of Publications (1) Refereed Journals (The list of publications (research papers, review, book chapter and article) in International and Nationel Journas/ Books should be given separately. (i) The standard format of particulars of publication giving: the name(s) of author(s), title of the Paper, name of the book or Journal, Volume, Year and page number in that order, must be used, (Craton Index of the paper and ISBN/ISSN No, should be given for each publication, (2) Conference/Seminar/Workshop attended (The list of papers presented In Conference/Seminar/Workshop attended overseas and in India, should be given separately. (i) The format of particulars of papers presented giving: the names) of author(s) the of the paper, rhame and place of the Conference/Seminar/Workshop, dates of the Conference; page numbers ‘and ISBN/ISSN No. in that order, must be given for each presentation, (@ _Research/ Teaching/ Industry/Consultancy/Administration/Other Experiences ‘S.No ‘Category Yes No] T._| industal experience 2. | Sponsored/Insttutional Research Project experience 3. Consultancy experience 4. | Experience concurrently with Ph.D 5.___ | Post-Doctoral Research Work 6. J Ust of courses taught to Undergraduate, Post Graduate, M.Phil and Doctoral research level Z| Details of setting up of Laboratories 8.___| Any other relevant information (Please atch seatested proof) Date: Place: Signature of the Applicant