Website: http://jobs.puchd.ac.

in

Serial No.________________
The candidate should attach nine Photostat copies of this form alongwith the original

PANJAB UNIVERSITY, CHANDIGARH

Application for Teaching/Research Post
(Use separate form for each post)

Advertisement No. ___________

(For Office Use) Name of the Post with specialization Department A Name in Full(In block letters) Mr./Mrs./Ms Father Name: _________________________________________________ Dairy No. Date

Mother Name:
Date of Birth: Nationality: Place of Birth: Marital Status:
Affix recent Passport size photograph

Member of Scheduled Caste/Tribe/Backward Class/ Physically Handicapped ___________(If Yes, Please Attach certificate from Tehsildar /Magistrate I Class of the area). B. Addresses : Permanent address(in block letters):

Present Address: (for Correspondence) (in block letters): _________________________________________________ __________________________________ __________________________

________________________________________

______________________

Phone/Mobile No. _____________________ E-mail:__________________________________________________

C. Minimum Pay acceptable: _______________________ Joining time (If Selected) __________________________

D. Educational Qualification: (Please attach one set of attested copies alongwith original application only) Examination Univ/Board Main Subject Year of Marks Class/ Passing Obtd. (with Divn./Grade(attach conversion formula) Max Marks) Merit/Prizes /Medals won if any.

1. Matric 2. 10+2/Pre-Med /PreEngg. 3. B.A/B.Sc/B.Com. etc. 4. M.A/M.Sc/M.Com etc. 5. M. Phil 6. Ph. D. 7. Any other Exam. (please specify) 8. Eligibility Test for

Assistant Professor
E. Professional Training : S. No. Organisation Period From Details of Training To

F: Employment Experience (details in chronological order, starting with first job Name & Address Employer/Institution Date of Joining Leaving Designation Nature of Job Pay p Basic.m. & Reason Grade

For Leaving

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Website: http://jobs.puchd.ac.in

G. Period of Teaching Experience (in Years) Subjects/Papers Taught Period From (i)Postgraduate Classes (ii) Degree Class (iii) Any Other

To
________ _

H. Total Academic Performance Indicator (API) score as per guidelines/Instructions (Appendix) available at Panjab University website. However, candidates from other then academic institution should attach detailed account of their personal achievements. (Please attach 9 photocopies) I. Membership of Professional Societies, if any :

J.

National/International Awards / Fellowships

K. Paragraph of self-evaluation regarding different fields of activity relating to the job:

L.

Referees :
These should be professionally competent persons, well acquainted with some aspects of the applicants training, accomplishments, capability and character but must not be relations. At least two of them should be citizens of India. For applicants having done post-graduate or post -doctoral research, the research supervisors must be listed. Supervisior of each major employment and present or most recent employment must be listed.

Name 1. 2. 3.

Occupation/Position

Address

M. Additional Information: (No annexure need be enclosed )

N.

Whether willing to join as temporary/Contract/Guest Faculty (if not selected)

Yes / No

-------------------------------------------------------------------------------------------------------------------------------------------------------------------O . List of Enclosers:

1 . __________________ 2 . _________________ 3 . ____________________ 4 . _________________ 5 . ________________ 6 . ______________ 7 . Draft No . ____________ Dt . ___________ Amount _______

P. Declaration: I solemnly declare that:

i) The foregoing information is complete and correct. I am not aware of any circumstances which may impair my fitness for employment in the Panjab University, Chandigarh ii) I have never been dismissed either from Govt. or from University, College or other Public or Private Organisation service iii) I have never been prosecuted, kept under detention or bound down/fined, convicted by the Court of Law for any offence. ____ ___________ Signature of Applicant

Place: __________________ Date: __________________

_ ____________ Signature of Employer With Official Seal

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