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INDIAN INSTITUTE OF ENGINEERING SCIENCE AND TECHNOLOGY, SHIBPUR HOWRAH, WEST BENGAL - 711103 FOR OFFICE USE ONLY Application Serial Application ID Post applied for : (Application form for Faculty Position) Advertisement... Dated... Department : Amount : Rs. Date : with AGP DD Number / NEFT/RTGS Code : Self attested Stamp Size photograph to be pasted here dd /mm /yyyy Specialization : Name of Issuing Bank : 1 Name in Full (BLOCK Letter) : FIRST NAME MIDDLE NAME LAST NAME 2 3 Father's Name : Mother's Name : 4 Date of Birth : DD / MM / YYYY Age (as on the date of Advertisement) : 5 Marital Status : (please ) Single Married Gender : M / F 6 Permanent Address (in BLOCK Letter) : Address for Communication (in BLOCK Letter) : P.O. Dist. P.O. Dist. State PIN State PIN Country Country Residence Phone STD Code Mobile no. ISD Code Email Id Office Telephone 7 Nationality : Religion : Category (under which you are seeking reservation / 8 SC ST OBC PWD UR relaxation) : (Please ) 9 Details of Education Qualification (from 10 th Standard onwards) Examination Passed Subject / Specialization/Title of Thesis Board / Univ. Year of Passing Divn / Cls. % of Marks / CGPA PhD Degree Faculty Title of Thesis Obtain from Date of Award DD / MM / YYYY Page 1 of 10

10 Experience of employment(s) in detail (a) TEACHING : TOTAL : POST PhD : Name & Address of the employer Designation Pay Band with AGP / consolidated Pay From To Duration Type of Organization (b) INDUSTRY : TOTAL : Name & Address of the employer Designation Pay Band with AGP / consolidated Pay From To Duration Type of Organization (c) RESEARCH : TOTAL : Name & Address of the Institute Designation Pay Band with AGP / consolidated Pay/Fellowship amount From To Duration Type of Organization 11 Other Information (Experiments/computational Projects added to teaching Laboratories/ Courses offered through application of ICT/E-learning packages prepared) : Page 2 of 10

12 (a) RESEARCH ACTIVITIES (Specify total number and attach list of publication in the each category as per format given) Paper(s) Publication in SCI/Scopus indexed Journal(s): [attach photocopy of 1 st page ] Name of the Title of Paper(s) Name of the Co-Author(s) Page(s) Volume & Year Journal(s) (b) Paper(s) Publication in SCI/Scopus/Web of Science indexed Conference (please mention)/internationally renowned conference [attach photocopy of 1 st page ] Name of the Title of Paper(s) Name of the Co-Author(s, if any Page(s) Volume & Year Journal(s) Page 3 of 10

(c) Number of UG and PG Student(s) Guided or Ongoing UG Student(s) PG Student(s) Guided Ongoing Guided Ongoing (d) Details of PhD students (Guided and Ongoing) Name of Student(s) Title of the Dissertation(s) Status [Awarded (with date ) / Submitted (with date) / ongoing] 13 Name of Book/Monograph/Book Chapter(s) Books / Monographs / Book Chapter(s) written Name of the Co-Author(s), if any Year of Publication Publisher with address 14 Seminar(s) / Short Term Course(s) / Summer School(s) / Winter School(s) organized From To Name of the Course(s) Sponsored by / Self Financed Number of Participants Page 4 of 10

15 Seminar(s) / Short Term Course(s) / Summer School(s) / Winter School(s) attended, if any From To Institute / Industry Sponsored by Name of the Course(s) 16 Research Project(s) / Sponsored Project(s) / Consultancy Activities / Patent(s) Sponsoring Agency Title of the Project(s)/ Patent(s) Period Amount Status 17 Membership of Professional Body/Bodies Name of the Professional Body/Bodies Grade of the Body/Bodies Membership Number Valid upto 18 Administrative / Institute Support Work Post held [Dean, HoD, Chief Warden, Chairman or Convenor of an Institute Committee or Faculty in Charge etc.] From To Responsibilitie(s) 19 Any Other Relevant Information [Separate Sheet(s) may added, if require ] Total Number of Sheet(s) added Marking of the Sheet(s) with Serial be mentioned Page 5 of 10

Calculation of Credit Points by the applicant Activity Credit Points Credit Points claimed 1 One external Sponsored R&D Projects completed or ongoing /Patent granted 8 / project or 8 / patent as inventor (In case of more than one person in a Project, the Principal Investigator gets 5 credit points and the rest to the divided equally among other members) 2 Consultancy projects 2 Credit points @ Rs.5 lakhs of consultancy, subject to maximum of 10 Credit points 3 4 5 Ph.D. completed (including thesis submitted cases) One Journal papers in SCI / Scopus (Paid Journals not allowed) One Conference paper indexed in SCI / Scopus / Web of science Conference / any internationally renowned conference 8 per Ph.D. student. (In case there are more than one supervisor, then the Guide (1st Supervisor) gets 5 credit points per student and the rest to be divided equally among other supervisor(s)) 4 per paper since the last promotion. First author/main supervisor will get 2 and rest will be divided among others 1 credit points/ paper up to a maximum of 10 credit points. First author / Main Supervisor will get 0.6 and rest will be divided among the rest. 6 HOD, Dean, Chief Warden, Professor Incharge (Training & placement), Advisor (Estate), CVO, PI (Exam), TEQIP (Coordinator) 2 points per semester up to a max of 16 credits points since the last promotion. 7 8 9 10 Warden, Assistant wardens, Associate Dean, Chairman / Convener institute academic committees, Faculty In charge Computer Center / IT Services / library / Admission / student activities and other institutional activities, Chairman and Convener of different standing committee and special committee (Ex officio status will not be considered). Faculty in Departmental activities identified by HOD like lab in charges, or department level committee for a min. period of one year. Workshop / FDP / short termcourses of min 05 working days duration offered as coordinator or convener 1 Credit / Semesters up to a maximum of 8 credits points since the last promotion 0.5 Credit / Semesters up to a max. of 3 credits points since the last promotion. 0.5 Credit / Semesters up to a max of 3 credits points since the last promotion. 2 per course up to a maximum of 8 credits since the last promotion. Page 6 of 10

11 12 For conducting national programs like GIAN etc. as course coordinator Program of 2 week duration Program of 1 week duration National / International conference organized as Chairman / Secretary 2 credit points per course up to a max of 4 credit points since the last promotion. 1 credit points per course up to a max of 2 credit points since the last promotion. 3 per program up a max of 6 credits points since the last promotion 13 Length of service over and above the relevant minimum teaching experience required for a given cadre 2 credit points per year with maximum of 10 credit points since the last promotion. 14 Establishment of New Lab(s) 4 credit points since the last promotion. 15 Theory Teaching of over and above 6 credit hrs. Course 1 credits/credit hrs. up to a max of 6 credit points since the last promotion. 16 PG Dissertation guided 17 UG Projects 18 19 Text/Reference Books published on relevant subjects from reputed international publishers Text/ Reference book published on relevant subjects from reputed national publishers or book chapters in the books published by reputed international publishers 0.5 credit points per project to a maximum of 10 points since the last promotion. 0.25 credit points / project up to a maximum of 4 points since the last promotion. 6 credit points per book up to a max. of 18 points since the last promotion 2 credit points / unit up to a max. of 6 points since the last promotion 20 21 Significant outreach Institute out Activities Fellow IEEE, FNA, FNAE, FNASc 1 credit points / activity up to a max of 4 credit points since the last promotion. 10 credit points 22 Placement percentage (only for the placement cell officers/ Faculty incharge of Placement) above 85%.. 75% - 84% (% to be based on total no of students passing out and single job offer) 4 credit points per year upto a maximum of 20 points since the last promotion. 2 credit points per year upto a maximum of 10 points since the last promotion. Total Credit Point= Signature of Applicant Page 7 of 10

20 Name and Address of Two References 1 st Referee 2 nd Referee Name : Name : Position : Position : Address : Address : e-mail Id : Contact : e-mail Id : Contact : 21 Did you previously apply for any post in this Institute? If yes, please give particulars: Advt. Year Post Did you called for Interview? (please ) Department YES NO Appeared in the Interview? Y N NA Declaration "I hereby declare that the statements made by me in / above form are true, complete and correct to the best of my knowlegde and belief." Place:... Date:... * * * * * NO OBJECTION CERTIFICATE TO BE FURNISHED BY THE APPLICANT WHO IS ALREADY IN PERMANENT EMPLOYMENT IN ANY GOVT./QUASI-GOVT./STATUTORY BODIES Certified that Dr./Mr./Ms.... son/daughter of Dr./Mr./Ms.... is a permanent/temporary/adhoc employee of the Department/School/Center/Institution/Organization since.../.../... The Department/School/Center/Institution/Organization has no objection, if he/she is appointed in Indian Institute of Engineering Science & Technolgy, Shibpur (IIESTS) against the post(s) advertised by the IIEST, Shibpur vide advertisement no... Place... Date... Signature & Seal of the Forwarding Authority Page 8 of 10

INDIAN INSTITUTE OF ENGINEERING SCIENCE AND TECHNOLOGY, SHIBPUR HOWRAH, WEST BENGAL - 711103 FOR OFFICE USE ONLY Application Serial Application ID 1 Name BIODATA SHEET (To be filled by the applicant) Self attested Stamp Size photograph to be pasted here 2 Address Contact Email Id PIN 3 Date of Birth DD / MM / YYYY Category (Pl. ) SC ST OBC PWD UR 4 Educational Qualifications : Examination Passed Subject / Specialization/Title of thesis Board / Univ. Year of Passing Divn/Cls. % of Marks / CGPA PhD Degree Faculty Title of the Thesis Obtain from Date of Award DD/ MM /YYYY 5 6 7 Post Doctoral Speciallization, if any : Present Position with Salary Details Teaching Experience : Research Experience : Industrial Experience : Position Pay Band / Consolidated Pay Academic Grade Pay Total Experience : Year(s) Post PhD Year(s) Year(s) Year(s) Post PhD Post PhD Post PhD 8 Publication Details (give numbers): Journal Papers : SCI / Scopus Conference Publications : INTERNATIONAL 9 Number of Thesis Guided : UG PG Number of PhD Thesis : guided to completion Ongoing 10 Number of Book(s) and or Chapter(s) Authored / Co-authored : 11 Patent(s) : Name Year Organization 12 Project / Consultancy : Name Year Amount 13 Award(s)/Distiction(s), if any : Name of Award Year Name of Award Year 14 Any other relavant Information : Page 9 of 10

Place :...... Date :... Page 10 of 10