UNIVERSITY OF MYSORE
Crawford Hall, Mysuru-570 005, Karnataka State.
APPLICATION FOR TEACHING POST
(SUBMITTED IN TEN SETS)
Please type or write in BLOCK LETTERS
BACKLOGPOST
CURRENTVACANCY
(Mark to be
made
Advertisem
ent
No
Post
Professor
Applied
for
Associate
(Tickmark to
be
made)
Affix your
Professor
Passport
recent
size photo
Assistant Professor (PG)
Assistant Professor (UG)
Subject
Area of
Specializati
on
DETAILS OF APPLICATION
FEES PAID
DD No.
DD Date
Bank Name
Amount
Rs. _______
1 FULL NAME
(in block letters)
Gender
Mal
e
Femal
e
(Tick mark to be made)
Marital Status
(Tick mark to be made)
Marrie
d
Un Married
Name of the
Mother
Name of the Father
Name of the
Spouse
1
12
CATEGORY
SC
(Tick mark to be made)
ST
CAT I
HORIZONTAL RESERVATION
Woman
Rural
Cat.
Cat. IIB IIIA
Cat. IIA
Cat.
IIIB
GM
(Tick mark to be made)
Physically
Handicapped
Ex-Service
Man
Kannada
Medium
Project
Displaced
Enclose certificate issued by the competent authority. Application without required
certificate will
be consider under GM category
HYDERABAD-KARNATAKA
(Tick mark to be
made)
SC
HORIZONT
AL
Woman
ST
Cat.
IIA
CAT I
RESERVATION
Cat.
Cat. IIB IIIA
Cat.
IIIB
GM
(Tick mark to be
made)
Rura
l
Physically
Handicapp
ed
Ex-Service
Kannada
Project
Man
Medium
Displaced
Enclose certificate issued by the competent authority. Application without
required certificate will
be consider under GM category
4 ADDRESS FOR CORRESPONDENCE :
PERMANENT ADDRESS : -
Mobile No. :
2
Telephone
Office
STD CODE :
Residence
STD CODE :
E-mail
KNOWLEDGE OF
5 KANNADA
Writing
Reading
6 DATE OF
Place of
Birth
BIRTH
Day
Month
Age as on last date of
application
Year
Nationalit
y
17 PRESENT EMPLOYMENT DETAILS :
Desigantion
Name of the
Organization
Scale of Pay with
AGP/GP
Current Basic Pay
Total
Emolumen
ts (per
month)
Mother
Tongue
18 ACADEMIC RECORD STARTING WITH SSLC : (Attach photocopies)
Certificate
/Degree
Branch/Specializat Board/College/Institut
ion
e/
Year of
University
Completion/
Passing
Percentage/
CGPA
SSLC
PUC
3
UG Course
PG Course
PG Diploma
Ph.D
NET/SLET/SET
09 EMPLOYMENT
(particulars of your employment in chronological order starting with recent
Employment) Enclose Supporting Documents
Name of the
Employer
Post
held
10 EXPERIENCE
PG
UG
Date of
Joining
Date of
Leaving
Gross
Salary
Pay Scale Permanent /
Temporary
(in no. of years) (enclose supporting documents)
Experience certificate should be enclosed. Otherwise it will not be considered.
4
11 RESEARCH EXPERIENCE :
Designation
Institution of
Affiliation
Area of Research
Period
The period spent for acquiring M.Phil and/or Ph.D Degree will not be considered as
research experience
RESEARCH
12 GUIDANCE :
Completed (Ph.D)
Ongoing
(Ph.D)
Completed (M.Phil)
Ongoing
(M.Phil)
13 PUBLICATIONS :
Published
Internationa
National
l
Research Papers :
Books :
14 PATENTS
Gra
nted
:
Filed
:
Accepted/ In Pres
Internationa
National
l
15
CONFERENCES/SEMINARS/WORKSHOPS/SYMPOSIA/TRA
INING PROGRAMMES ATTENDED : (ATTACH
PHOTOCOPIES OF THE CERTIFICATES)
Year
Conference/Seminars/Worshops
Symposia/Trainings attended
Title of paper presented/ Delivered
Lecture/
Chaired Sessions
16 RESEARCH PROJECTS :
Name of the
Research
Project
PI/Other(s)
Date of
Date of
Commencemen
t
Completion
Funding
Amount
Agency
Sanctioned
17 AWARDS /FELLOWSHIP/ MEMBERSHIP IN ACADEMIC
BODIES/ SOCIETIES
AND EDITORSHIP OF REPUTED JOURNALS :
Name of the Body/Society
Name of
Award/Fellowship/Nature of
Membership/Editorship
18 EXPERIENCE IN ADMINISTRATIVE POSITIONS :
19
Consolidated API score from category II/III of table I/II
in appendix III of UGC Regulations 2010 and its
amendments 2016 (details shall be furnished as per
Annexure -1)
20
ANY OTHER RELEVANT INFORMATION :
Please give details of any other credential, significant contributions, awards
received etc., not mentioned
Sl.
No.
Details (mention Year, Value etc., whereever
relevant)
DECLARATION
I hereby declare that all information given in this application are
true, complete and correct to the best of my knowledge and
belief. I understand that in the event of any information being
found false, incomplete or incorrect, my candidature is liable to
be cancelled/ my application is liable to be terminated. I hereby
agree to and abide by the rules and regulations of the University.
Place :
Date :
Signature of the Candidate
CERTIFICATE TO BE FURNISHED BY THE CANDIDATES WHO ARE
PRESENTLY WORKING :
Certified that Sri/Smt ______________________________________________ hold
a
permanent/temporary post of ______________________________________
(Designation)
in
the
Department/
University/ Organization
______________________________________
been
of
from _______________ having
appointed therein under the rules of recruitment. He/She is permitted to
apply for the said
post.
Place :
Date :
Signature of the appointing authority
department/with name and seal
8
LIST OF ENCLOSURES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Signature of the
Candidate
