UNIVERSITY OF LUCKNOW

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S.No UNIVERSITY OF LUCKNOW APPLICATION FORM FOR TEACHING POST. (to be filled by candidate in his/her own hand writing, blind or physically disabled candidates are however exempted from this requirement. Applicants in employment should enclose a No Objection Certificate from the employer or bring the same at the time of interview) For office use only : Date of receipt of application : IMPORTANT : USE ONLY BLOCK LETTERS TO FILL THIS PAGE (i) POST APPLIED FOR In the subject/deptt. of FACULTY OF (ii) ADVERTISEMENT No. DATED (iii) Lucknow University, Lucknow. DETAILS OF FEE PAID : Fee to be paid is Rs.1000/=(Gen. & OBC Candidates) and Rs.750/= (SC/ST Candidates) by means of a Demand Draft Favoring the Finance Officer, Lucknow University & Payable at Lucknow. (Name of the issuing Bank) Demand Draft No. Date Amount 1. FULL NAME (as recorded in the Matriculation or equivalent certificate) 2. PRESENT POSTAL ADDRESS WITH PHONE NO. (First Name) (Middle Name) (Surname) 3. PERMANENT POSTAL ADDRESS (if any) 4. FATHER S NAME (as recorded in the Matriculation or equivalent certificate) 4A. MOTHER S NAME 5. SEX MALE/FEMALE (Strike-off whichever in not applicable) 6. DATE OF BIRTH (as recorded in the Matriculation or equivalent certificate) (Date) (Month) (Year) 7. PLACE OF BIRTH (District) (State) (Country) (1)

8. NATIONALITY 9. MARITAL STATUS MARRIED/UNMARRIED(Strike off whichever is not applicable) 10. WHETHER BELONG TO YES/No (Strike off whichever is not applicable) SCHEDULED CASTES/TRIBE. OTHER BACKWARD CLASSES 11. CANDIDATES MOTHER TONGUE 12. WHAT OTHER LANGUAGES (S) (if any) THE CANDIDATE CAN SPEAK, READ AND WRITE FLUENTLY 13. DATE OF PASSING DIFFERENT EXAMINATIONS AND CLASSES OBTAINED : Sl.. EXAMINATION YEAR OF NAME OF NAME OF THE SUBJECTS MARKS/GRADE No. PASSING INSTITUTION UNIV./BOARD (S) OBTAINED &%/Percentile 1. Matriculation/High School/Senior Cambridge/I.C.S.E./C.B.S.E. or equivalent examination 2. Intermediate/ I.S.C. or equivalent examination 3. B.A./B.Sc./B.Com/BCA/B.P.Ed/ or equivalent examination 4. B.A./B.Sc./B.Com/BCA/B.P.Ed/ (Hons.) or equivalent examination 5. LL.B. or equivalent examination 6. M.A./M.Sc./M.Com./MCA/M.P.Ed/ or equivalent examination 7. LL.M or equivalent examination 8. M.Phil. 9. Ph.D./D.Phil. 10. D.Litt..D.Sc. or equivalent 11. Diplomas N.B. : Strike off alternatives, which do not apply in your case. (2)

14. WHETHER THE CANDIDATE HAS CLEARED ANY ONE OF THE FOLLOWING TEST : U.G.C.- J.R.F. Examination YES/NO C.S.I.R.-J.R.F. Examination YES/NO NET UGC/CSIR YES/NO (Strike off which is not applicable and attach Self-attested copy of the award letter) 15. ANY OTHER SCHOLARSHIP/ FELLOWSHIP AWARDED (attach self-attested proof thereof) 16. RESEARCH PUBLICATIONS (give the subject/topics of the paper published together with the name of journals. Reprints of all paper stated here should be enclosed with the application) (Please attach separate sheet, if necessary ) 17. BOOKS/MONOGRAPHS/ REVIEWS PUBLISHED (attach proof thereof) 18. ANY POSITION OF AUTHORITY HELD OR DISTINCTIONS (other than Scholarship) GAINED AT SCHOOL & COLLEGES INCLUDING GAMES AND SPORTS AND OTHER SOCIAL ACTIVITIES 19. APPOINTMENTS (if any) SO FAR HELD S.No. Nature of Posts Date of Joining Date of Leaving Basic Salary Last Drawn Reasons for Leaving the Posts Name & Address of Employer 20. ANY OTHER QUALIFICATION (S) RELEVANT TO THE POST APPLIED FOR (3)

21. LIST OF SELF ATTESTED TESTIMONIALS ATTACHED HEREWITH (Original to be produced at the time of Interview) (Please tick( ) the ones, applicable) (i) Matriculation Marksheet (ii) Matriculation Certificate (iii) Intermediate Marksheet (iv) Intermediate Certificate (v) B.A./B.Sc./B.Com. /BCA/B.P.Ed/B.B.A. (Final) Marksheet (vi) B.A./B.Sc./B.Com./ BCA/B.P.Ed/ B.B.A. Degree. (vii) M.A./M.Sc./M.Com./ MCA/M.P.Ed/M.B.A. (Final) Marksheet (viii) M.A./M.Sc./M.Com./ MCA/M.P.Ed/ M.B.A. Degree. (ix) LL.B. Final Marksheet (x) LL.B. Degree. (xi) LL.M. Marksheet (xii) LL.M. Degree. (xiii) M.Phil. Degree. (xiv) Ph.D./D.Phil. Degree (xv) D.Litt., D.Sc., LL.D. Degree (xvi) NET, UGC-JRF, CSIR-JRF, Award Certificate (xvii) Any other Degree. (xviii) Cast Certificate issued by the competent authority (OBC/SC/ST) (xix) (xx) Total Number of Self attested testimonials attached -----------------(in words) ----------------- N.B. : Applications without the above self attested testimonials (applicable to the candidate) will not be entertained. DECLARATION I,-------------------------------------------------------------- Son/Daughter of ----------------------- ----------------------hereby declare that all statements and entries made in the application are true, complete & correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the Selection Committee and Executive Council meetings, my candidature / appointment may be cancelled by the University. Signature of the candidate* *Name as signed (in BLOCK LETTERS) *Application not signed by the candidates is liable to be rejected. (4)

Annexure I API Proforma for Professor, Associate Professor & Assistant Professor ACADEMIC PEFORMANCE INDICATORS BASED ON PERFORMANCE BASED APPRAISAL SYSTEM TO BE SUBMITTED BY EACH APPLICANT FOR APPOINTMENT OF TEACHERS AND OTHER ACADEMIC STAFF AS PER UGC REGULATIONS, 2010 Advertisement No. Name of the Applicant Date of Birth Post applied for and Subject Name of the Department SCORES FOR ACADEMIC PERFORMANCE INDICATORS (APIs) IN RECRUITMENTS AND CAREER ADVANCEMENT SCHEME (CAS) PROMOTIONS OF UNIVERSITY / COLLEGE TEACHERS CATEGORY I: TEACHING, LEARNING AND EVALUATION RELATED ACTIVITIES Brief Explanation: Based on the teacher s self-assessment, API scores are proposed for (a) teaching related activities; (b) domain knowledge; (c) participation in examination and evaluation; (d) contribution to innovative teaching, new courses etc. The minimum API score required by teachers from this category is 75. The self assessment score should be based on objectively verifiable criteria wherever possible and will be finalized by the screening/selection committee. S. No. Nature of Activity Maximum Score 1 Lectures, seminars, tutorials, practicals, contact hours undertaken taken as percentage of lectures allocated 2 Lectures or other teaching duties in excess of the UGC norms 3 Preparation and Imparting of knowledge / instruction as per curriculum; syllabus enrichment by providing additional resources to students 4 Use of participatory and innovative teaching- learning methodologies; updating of subject content, course improvement etc 5 Examination duties (Invigilation; question 25 paper setting, evaluation/assessment of answer scripts) as per allotment. Total Score 125 Minimum API Score Required 75 50 10 20 20 Self Assessment Score (to be filled by applicant) Verified API Score (for official use) # Supporting documents, wherever required be attached. (Signature of Applicant)

Advertisement No. Name of the Applicant Date of Birth Post applied for and Subject Name of the Department CATEGORY II: CO-CURRICULAR, EXTENSION AND PROFESSIONAL DEVELOPMENT RELATED ACTIVITIES. Brief Explanation: Based on the teacher s self-assessment, category II API scores are proposed for co- curricular and extension activities; and Professional development related contributions. The minimum API required by teachers for eligibility for promotion is 15. A list of items and proposed scores is given below. It will be noticed that all teachers can earn scores from a number of items, whereas some activities will be carried out only by one or a few teachers. The list of activities is broad enough for the minimum API score required (15) in this category to accrue to all teachers. As before, the self-assessment score should be based on objectively verifiable criteria and will be finalized by the screening/selection committee. S. No. Nature of Activity Maximum Score Self Assessment Score (to be filled by applicant) 1 Student related co-curricular, extension 20 and field based activities (such as extension work through NSS/NCC and other channels, cultural activities, subject related events, advisement and counseling) 2 Contribution to Corporate life and 15 management of the department and institution through participation in academic and administrative committees and responsibilities. 3 Professional Development activities (such as participation in seminars, conferences, short term, training courses, talks, lectures, 15 membership of associations, dissemination and general articles, not covered in Category below) Minimum API Score Required 15 Verified API Score (for official use) # Supporting documents, wherever required be attached. (Signature of Applicant)

Advertisement No. Name of the Applicant Date of Birth Post applied for and Subject Name of the Department CATEGORY-: RESEARCH AND ACADEMIC CONTRIBUTIONS Brief Explanation: Based on the teacher s self-assessment, API scores are proposed for research and academic contributions. The minimum API score required by teachers from this category is different for different levels of promotion and between university and colleges. The selfassessment score will be based on verifiable criteria and will be finalized by the screening/selection committee. S No. APIs Engineering/Agriculture /Veterinary Science/Sciences/Medi- cal Sciences A (B) Research Papers published in: Research Publications(books, chapters in books, other than refereed journal articles) Faculties of Languages Arts/Humanities/Social Sciences/Library/ Physical education/management Max. points for University and college teacher position Refereed Journals * Refereed Journals* 15 / publication Non-refereed but recognized and reputable journals and periodicals, having ISBN/ISSN numbers. Conference proceedings as full papers, etc. (Abstracts not to be included) Text or Reference Books Published by International Publishers with an established peer review system Subjects Books by National level publishers/state and Central Govt. Publications with ISBN/ISSN numbers. Non-refereed but recognized and reputable journals and periodicals, having ISBN/ISSN numbers. Conference proceedings as full papers, etc. (Abstracts not to be included) Text or Reference Books Published by International Publishers with an established peer review system Subject Books by / national level publishers/state and Central Govt. Publications with ISBN/ISSN numbers. 10 / Publication 10/ publication 50 /sole author; 10 /chapter in an edited book 25 /sole author, and 5/ chapter in edited books Self Assessment Score (to be filled by applicant) Cap Score claimed by the applicant Verified API Score (for official use) Verified Cap Score (for official use) Subject Books by Other local publishers with ISBN/ISSN numbers. Chapters contributed to edited knowledge based volumes published by International Publishers Chapters in knowledge based volumes by Indian/National level publishers with ISBN/ISSN numbers and with numbers of national and international directories Subject Books by Other local publishers with ISBN/ISSN numbers. Chapters contributed to edited knowledge based volumes published by International Publishers 15 / sole author, and 3 / chapter in edited books 10 /Chapter Chapters in knowledge based 5 / Chapter volumes in Indian/National level publishers with ISBN/ISSN numbers and with numbers of national and international directories

C (C) (i) RESEARCH PROJECTS Sponsored Projects carried out/ ongoing (a) Major Projects amount mobilized with grants above 30.0 lakhs (b) Major Projects amount mobilized with grants above 5.0 lakhs up to 30.00 lakhs (c) Minor Projects (Amount mobilized with grants above Rs. 50,000 up to Rs. 5 lakh) Major Projects amount mobilized with grants above 5.0 lakhs Major Projects Amount mobilized with minimum of Rs. 3.00 lakhs up to Rs. 5.00 lakhs Minor Projects (Amount mobilized with grants above Rs. 25,000 up to Rs. 3 lakh) 20 /each Project 15 /each Project 10/each Project (C) (ii) (C) (iii) (C) (iv) Consultancy Projects carried out / ongoing Completed projects : Quality Evaluation Projects Outcome / Outputs Amount mobilized with minimum of Rs.10.00 lakh Completed project Report(Acceptance funding agency) from Patent/Technology transfer/ Product/Process Amount mobilized with minimum of Rs. 2.0 lakhs Rs.10.0 lakhs and Completed project report (Accepted by funding agency) Major Policy document of Govt. Bodies at Central and State level 10 per every Rs.2.0 lakhs, respectively 20 /each major project and 10 / each minor project 30 / each national level output or patent /50 /each for International level, D RESEARCH GUIDENCE (D) (i) M.Phil. Degree awarded only Degree awarded only 3 /each candidate (D) (ii) E (E) (i) Ph.D Degree awarded Degree awarded 10 /each candidate Thesis submitted Thesis submitted 7 /each candidate TRAINING COURSES AND CONFERENCE /SEMINAR/WORKSHOP PAPERS Refresher courses, Methodology workshops, Training, Teaching- Learning- Evaluation Technology Programmes, Soft Skills development Programmes, Faculty Development Programmes (Max: 30 points) (E) (ii) Papers in Conferences/ Seminars/ workshops etc.** (a) Not less than two weeks duration (a) Not less than two weeks duration 20/each (b) One week duration (b) One week duration 10/each Participation and Presentation of research papers (oral/poster) in Participation and Presentation of research papers(oral/poster) in (E) (iv) Invited lectures or presentations for conferences/ symposia a) International conference a) International conference b) National b) National c) Regional/State level c) Regional/State level d) Local University/College (a) International d) Local University/College (a) International 10 each 7.5 / each 5 /each 3 / each 10 /each (b) National level (b) National level 5 /each *Wherever relevant to any specific discipline, the API score for paper in refereed journal would be augmented as follows: (i) indexed journals by 5 points; (ii) papers with impact factor between 1 and 2 by 10 points; (iii) papers with impact factor between 2 and 5 by 15 points; (iv) papers with impact factor between 5 and 10 by 25 points. ** If a paper presented in Conference/Seminar is published in the form of Proceedings, the points would accrue for the publication ( (a)) and not under presentation ( (e)(ii)). Note: The API for joint publications will have to be calculated in the following manner: Of the total score for the relevant category of publication by the concerned teacher, the first/principal author and the corresponding author/supervisor/mentor of the teacher would share equally 60% of the total points and the remaining 40% would be shared equally by all other authors. # Supporting documents, wherever required be attached. (Signature of Applicant)

PRECIS (To be filled in duplicate, A and B) A NAME AND SIGNATURE DATE OF BIRTH EXAM PASSED YEAR PASS% NET/JRF (YES/NO) RESEARCH PUBLICATIONS (No) Ph.D. Guide Teaching Exp.(Yrs.) RESEARCH Exp.(Yrs.) CAP SCORE Remark (for office use only) A B C D E PRECIS (To be filled in duplicate, A and B) B NAME AND SIGNATURE DATE OF BIRTH EXAM PASSED YEAR PASS% NET/JRF (YES/NO) RESEARCH PUBLICATIONS (No) Ph.D. Guide Teaching Exp.(Yrs.) RESEARCH Exp.(Yrs.) CAP SCORE Remark (for office use only) A B C D E

API calculations and Capping- While calculating the API for Category i.e. Research category, capping has to applied as per UGC regulations adopted by University of Lucknow statutes and be Filled in Self-Assessment Coloumn.