NATIONAL INSTITUTE OF TECHNOLOGY MIZORAM
CHALTLANG, AIZAWL (MIZORAM) 796012
(Application Form for TRAINEE TEACHERS)
Advertisement No. & Date : NIT-MZ/RECRUIT(TTS)/01/2014; 26/03/2014
Department (applied for) : Please paste self
attested recent
passport size colour
photograph
1. Full Name(in block letters) :
2. Fathers/Mothers Name :
3. Date of Birth (DD/MM/YYYY) : 4. Age (as on last date):
5. Nationality : 6. Gender: Male/Female
7. Category (GEN/OBC/SC/ST/PWD) :
8. Marital Status (Married/Unmarried) :
9. Native Place (Village/Town, District & State) :
10. Postal Address for correspondence :
Pin Code:
Phone No.: Mob. No.:
Email-ID:
11. Permanent Address :
(Mention Village/Town, District and
State you belong to)
Pin Code:
Phone No.: Mob. No.:
Email-ID:
12. Are you a B.Tech graduate from :Yes/No
CFTIs/pursuing your study in any of Name of Institute:
the CFTIs (like IIT, NIT, IIIT, etc.), if Address:
yes, mention the Institutes name &
address
13. Required for candidates from non-CFTIs Yes/No Percentile/Marks:
Do you have a valid GATE score (If Year:
yes, please furnish the details)
14. Do you belong to Top 15% of the : Yes/No
students in your Institute Your Rank in your branch:
Page 1 of 4
15. Educational Qualifications (matriculation onwards and each semester B. Tech result (i.e., from I st to
VIIIth)):
Sl. Examination Name of the Year of Subject/ Branch % of Marks/ Rank
No. Passed Board/ Institute/ Passing Specialization/ Grade (CGPA)
University
1. Class-X
2. Class-XII
3. BTech - Ist Sem
4. BTech IInd Sem
5. BTech - IIIrd Sem
6. BTech - IVth Sem
7. BTech - Vth Sem
8. BTech - VIth Sem
9. BTech - VIIth Sem
10. BTech VIIIth Sem
11.
16. (a) Details of B.Tech. Thesis/Project:
Title of the Thesis Ongoing / Completed Name of the Supervisor Paper presented /
Published (if any)
Page 2 of 4
(b) Give details of the summer training (if any)
Sl.No. Name of the Duration Title of the Project/ Remarks (If any)
Organization (From to...) Training Programme
(c) Conference/Seminar (National and International level) participated:
Sl. Name of the National or International Month/ Venue Title of the paper presented (if any)
No. Conference/Seminar Year
17. Prizes, Awards, Distinction received etc. (if any): ......
........
18. Extra Curricular Activities/Hobbies:..
................................................................................................................................................................................
19. Please give details of two referees:
(i) Name: (ii) Name:
Designation: Designation:
Full Address (Office): Full Address (Office):
Contact No.: Contact No.:
Email: Email:
Page 3 of 4
20. Any other relevant information:.......
DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief.
I understand that any misleading or wrong information supplied by me may lead to summarily rejection of
my application /appointment (if found subsequently).
Date: ------------------------------------
(Full Signature of Applicant)
Place:
Page 4 of 4