MANIPUR UNIVERSITY: CANCHIPUR (A Central University) Imphal 7900, Manipur, India APPLICATION FORM FOR EMPLOYMENT (Teaching) (Use separate form for each post & to be filled in English) To be filled in by Applicant (Please read carefully the instruction given in the eligibility criteria before filling up the form. All the entries should be in the candidate s own handwriting) Post applied for: Paste here recent passport size photograph and sign across it Category: UR OBC SC ST PWD Department/ Centre: Amount of fees paid: DD : Bank: Date of Issue: (Please write Name & post applied for on back of DD). Name of the applicant : (in block letters). Father s name :. Mother s name :. Date of birth :. Sex : 6. Marital Status : 7. Address for correspondence (With PIN CODE) : Telephone number, E-mail ID, & Fax : 8. Permanent address (With PIN CODE) : Telephone number, E-mail ID, & Fax :
9. State of domicile : 0. Academic qualifications (Beginning from HSLC, please attach attested copies of certificates & mark sheets in the same order. Convert the Grade points to percentage of marks): Examinations passed Board/University Year % of marks Div. Subjects Distinction achieved. Have you passed NET/SLET or equivalent examinations as recognised by UGC? If yes then please attach the attested copy of Certificate) (for the post of Assistant Professor only) Yes /No Roll Year & month of passing you are exempted from NET etc.? : Yes No (as per UGC guidelines) (Please ) If YES, please justify :. Do you belong to (please ) Scheduled Caste : Yes No Scheduled Tribe : Yes No Other Backward Classes : Yes No Are you a person with disability? (as per government of India guidelines) [If YES please attach attested copy of certificate]: Yes No
. Teaching / Professional / Research & : Employment Experience (Give particulars in descending order starting with the present post) Name of the employer (Please indicate whether Govt./Quasi Govt./ Autonomous/ Private) Post held Last basic pay drawn with pay scale Period From To Nature of assignment. Total teaching experience : From To Under Graduate : Post Graduate : Professional :. Total research experience (excluding the time spent for attaining M.Phil./PhD) : 6. Have you visited foreign countries for academic purposes? If YES furnish details. : Yes No 7. What is your area of Specialisation? : 8. Do you fulfil the specialisation as per the advertisement? : Yes No 9. Technical qualification, if any :
0. Are you a dismissed employee? : Yes No If YES please furnish details. Academic performance Indicator (Details of PBAS proforma annexed in application-not necessary for Assistant professor) Category III (Research & Academic Contributions) Note: Please read the instructions given in the PBAS Proforma for calculating in each category. III A. i) Research papers published in Journals Title with page no. Journal ISSN/ISBN refereed, Impact factor, if any of Coauthors you are the main author ii) Full papers in Conference Proceedings Title with page no. Details of conference Publications ISSN/ISBN of Coauthors and Date of Publication you are the main author
III B. (i) Articles/Chapters published in Books Title with page Book International, no. Title, national or editor & local level publisher ISSN/ ISBN peer reviewed. of Coauthors and Date of Publication you are the main author (B) (ii) Books published as single author or as editor Title with page no. Type of Book & Authorship International, national or local level Publisher ISSN/ISBN peer reviewed. of Coauthors and Date of Publication you are the main author III C. Ongoing and completed research projects and consultancies (C) (i & ii) Ongoing Research projects and consultancies Title Agency Period Grant/Amount Mobilized (Rs Lakhs)
(C) (iii & iv) Completed Research projects and Consultancies Title Agency Period Grant/Amount Mobilized (Rs Lakhs) Policy Documents/Patent as outcome (D) Research Guidance M.Phil. Number Enrolled at present Thesis Submitted, title and year of submission Degree Awarded,title and year of award Ph.D. (E) (i) Participation in refresher courses, Training Courses, Teaching-Learning- Evaluation Technology, Faculty Development Programmes Programme Duration & date Organised by 6
(E) (ii) Organisation of refresher courses, Training Courses, Teaching-Learning- Evaluation Technology, Faculty Development Programmes Programme Duration & date Organised by (E) (iii) Papers presented in Conferences, Seminars, Workshops, Symposia Title of the paper presented Title of Conference/Seminar etc Date(s) of the event Organised by International/National/State/R egional/university or College Level (E) (iv) Invited Lectures Conference/Seminars and Chairmanships at National or International Title of Lecture/ Academic Session Title of Conference/ Seminar etc Date(s) of the event Organised by International/Na tional 7
F. Total score: G. Minimum for the post:. Names and address of two responsible persons (not relatives) who know about the work, conduct etc. of the applicant well and one of whom must be the present employer in case of the applicant already in service:... Additional information which are not covered above (additional sheets may be used if space is insufficient):. (i) of enclosures submitted with the application : (ii)list of enclosures (please attach copies of certificates, sanction orders, papers etc wherever necessary) a. b. c. d. e. 8
Certificate of Authenticity I certify that the foregoing information is correct and complete in all respect to the best of my knowledge and belief. If any information is found incorrect/wrong, I shall be liable to action as decided by the University authority. I am not aware of any circumstances, which may debar me for employment in Manipur University, Canchipur. Date: Place: Full signature of the Applicant N.B: Applicants in service should apply through proper channel. Employer s certificate/recommendation Shri/Ms/Dr is a permanent / temporary employee of this organization holding the post which carries the pay scale/ pay band + AGP of Rs and his/her application is forwarded for consideration and necessary action. Place: Date: Signature Seal 9