N a t i o n a l I n s t i t u t e o f T e c h n o l o g y Hamirpur (HP) - 177 005 INDIA APPLICATION FORM FOR FACULTY POSITION (Advertisement 06/2017) Registration (To be filled by the NIT Hamirpur Office) DD Details Bank Name Demand Draft Dated Amount Post Applied for Department/ Centre Category (A): UR SC ST OBC Coloured Signed Photo (B): PWD [ [Please tick ( ) the appropriate one] 1. PERSONAL INFORMATION 1. Name of the Candidate: 2. Father s Name : 3. Date of Birth : 4. Sex {Male/ Female} : 5. Marital Status 6. Permanent Address : : : Pin Code : State : 7. Correspondence Address : : : Pin Code : State : E-mail Id Mobile : :
2. ACADEMIC QUALIFICATIONS: In chronological order starting with High School onwards (Please attach attested photocopies of the certificates of various Examinations / Degrees):- S. Course University/ Discipline Year of Percentage Remarks, /Degree Board Passing / CGPI if any Obtained i. Matric ii. +2 iii. iv. v. Ph.D B.Tech/ B.E./B.Sc. M.Tech/ M.E./ M.Sc./ MBA/ PGDM vi. Any other degree Topic of Research for Ph.D : Field of Specialization : 3. Last date of Promotion : 4. I EXTERNAL SPONSORED R&D PROJECTS:- Title of R&D Project/Patent Heading Status [PI / Co- PI(.)] Present Status of Project [Completed / Ongoing] Patent Granted [Yes / No] Co-PI(.) where. - of Co-PIs e.g. Co-PI(3) Three Co-PIs II CONSULTANCY PROJECTS:- Title of Consultancy Cost (Rs.) Heading Status [CI/Co-CI(.)] Present Status [Completed / ongoing] (Max.10) Co-CI(.) - where. - of Co-CIs e.g. Co-CI(3) Three Co-CIs
III Ph.D. COMPLETED (including thesis submitted cases):- Title of Thesis Supervision Status [Supervisor / Co- Supervisor(.)] Ph.D Thesis Status [Completed / Submitted] IV* Co-Supervisor (.) - where. - of Co-Supervisors e.g. Co-Supervisors (2) Two Co-Supervisors Journal Papers (Paid Journals not allowed):- Title of the paper Journal Status Publication [SCI / (Month / Year) Scopus]** Authorship [Author / Co- Author(.)] V Co-Author (.) - where. - of Co-Authors e.g. Co-Authors (2) ** - Mention source record Id/Serial Conference Paper:- Title of the paper Conference Status [SCI / Scopus/ Web of SC] Publication (Month / Year) Authorship [Author / Co- Author(.)] Two Co-Authors (Max-10) VI* Responsibilities & Duties Performed (Semester Based):- Position Duration Duration in From To Semester(s) 1 HOD 2 Dean 3 Chief Warden 4 Professor In-charge (Training & Placement) 5 Advisor (Estate) 6 CVO 7 PI (Exam) 8 TEQIP (Coordinator) VII* Responsibilities & Duties Performed (Semester Based):- Position Duration Duration From To in Semester(s) 1 Warden 2 Assistant Wardens 3 Associate Dean 4 Chairman/Convener Institute academic Committees 5 Faculty In-charge Computer Centre 6 Faculty In-charge IT Services 7 Faculty In-charge Library 8 Faculty In-charge Admission (Max 16) (Max 8)
9 Faculty In-charge Student activities 10 Faculty In-charge 11 Other institutional activities VIII* Responsibilities Position 1 Chairman 2 Convener 3 Faculty In-charge 4 Any other special committee Standing Committee From Duration To Duration in Semester(s) (Max-3) IX* Responsibilities at Department/ Centre Level:- Position Duration Duration in From To Semester(s) 1 Lab In-charge 2 Any other Committee Member (Max 3) X* Organization of Short Term Courses / Workshop / FDP(Minimum 05 working days):- Activity Title Position Duration Duration [Coordinator / From To in Days Convener] (Max-8) 1 2 3 4 XI* 1 2 3 Organization of National Programmes like GIAN etc. Name of the Programme Duration Duration From To [01 /02 Week] Coordinating Status [Coordinator / Co- Coordinator] (Max-4) XII* 1 2 3 XIII* Organization of National / International Conferences:- Name of the Conferences Duration Acted as From To [Chairman / Secretary] New Lab Establishment:- Name of the Lab Duration Establishment From To Cost (Max-6) (Max-4)
XIV* Courses Taught beyond 6 Theory s per Semester:- Name of the Theory Course s Duration of Teaching in Semester (Max-6) XV* PG Dissertation Guided:- Title of PG Dissertation Academic Year Supervision Status [Supervisor / Cosupervisor(.)] (Max-10) XVI* UG Projects:- Title of UG Project Academic Year Supervision Status [Supervisor / Cosupervisor(.)] (Max-4) XVII* Text / Reference Books published on relevant subjects from reputed International Publishers:- Title of the Book Year of International Publication Publisher (Max-18) XVIII* Text / Reference Books published on relevant subjects from reputed National Publishers:- Title of the Book Year of Publication National / International Publisher (Max-6) XIX* Significant outreach Institute out Activities:- Outreach Activities Duration From To (Max-4)
XX Fellowship IEEE, FNA, FNAE, FNASc:- Agency Fellowship From To (Max-10) IEEE FNA FNAE FNASc XXI* Association with Placement Work only for the Placement Cell Officer/Faculty Incharge of Placement:- Position Academic Year Placement [Tick ( ) the appropriate one] P 85% 75% P 84 % (Max-10) XXII Length of service since last promotion: Year(s); :... * - s for the activity shall be counted only after the last date of promotion. 4. Present Pay Band: Present Basic Pay: Grade Pay : Date of Next Increment: 5. Period required for joining the post, if selected : 6. Enclosures in support of eligibility for AGP / Post:-
7. List of three referees (The referees should be residents of India and holders of responsible positions. They should be intimately acquainted with the character and work of the applicant but must not be in relation. 1 Name of the Referees Designation Complete Address with Mobile / Landline & Email ID. 2 3 DECLARATION I hereby declare that all the statements made in this application form are true and complete to the best of my knowledge and belief and nothing has been concealed /distorted. I am aware that if at any time I am found to have concealed / distorted any material information, my appointment is liable to be summarily terminated without notice. Signature : Name of the candidate : Place: Date : For the candidates who are already employed:- I have applied for the post (s) through proper channel / I have informed my employer in writing that I am applying for the above post(s). Signature : Name of the candidate : Place: Date :
ENDORSEMENT OF THE PRESENT EMPLOYER The application of Dr./Mr./Ms./Mrs. (Name & Designation of the applicant) for the post(s) of at NIT, Hamirpur [HP] is forwarded and recommended for consideration. In case he / she is selected for employment at NIT, Hamirpur [HP] he / she will be relieved to join on notice. Place: Date : Name & Signature of the Head of the Organisation (with stamp)
CREDIT POINTS FORM (To be attached with application form) S. Activity Description I External Sponsored R&D Projects II Consultancy Projects III Ph.D. Completed (including thesis submitted cases) IV* Journal Papers (Paid Journals not allowed) V Conference Paper VI* Responsibilities & Duties Performed (Semester Based) VII* Responsibilities & Duties Performed (Semester Based) VIII* Responsibilities IX* Responsibilities at Department/ Centre Level X* Organization of Short Term Courses / Workshop / FDP(Minimum 05 working days) XI* Organization of National Programmes like GIAN etc. XII* Organization of National / International Conferences XIII* New Lab Establishment XIV* Courses Taught beyond 6 Theory s per Semester XV* PG Dissertation Guided XVI* UG Projects XVII* Text / Reference Books published on relevant subjects from reputed International Publishers XVIII* Text/Reference Books published on relevant subjects from reputed National Publishers
XIX* Significant outreach Institute out Activities XX Fellowship IEEE, FNA, FNAE, FNASc XXI* Association with Placement Work only for the Placement Cell Officer/Faculty In-charge of Placement XXII* Length of service over and above the relevant minimum teaching experience required for a given cadre * s for the activity shall be counted only after the last date of promotion. Note: Necessary and relevant documents to be attached regarding proof of above credit points. Signature of the Candidate