THE TECHNOLOGICAL INSTITUTE OF TEXTILE & SCIENCES
Birla Colony, Bhiwani – 127021 (Haryana)
PHONE : 91-1664-242561 Website : http://www.titsbhiwani.ac.in
APPLICATION FORM FOR DIRECTOR / PRINCIPAL
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Important Instructions:
1. Only the candidates applying for the post of Director / Principal, with reference to the advertisement, must also
send one set of application along with copy of all documents to the Dean, College Development Council,
Maharshi Dayanand University, Rohtak-124001 (Haryana) by regd. post.
2. Any application not received at both places (Institute and MDU) shall be rejected.
Advertisement Reference: Name of Newspaper: _______________________Date: ___________
1. Full Name (including Surname)
2. Father’s Name
3. Date of Birth
4. Category : Gen / SC / ST / OBC / OTHER
5. Postal Address for correspondence
(Any change of address should be
communicated at once to the Institute)
Telephone/Mobile No.
E-mail Address
6. Permanent Address
(mention Tehsil, District and State you belong to)
1
7. Were you at any time declared medically unfit;
Asked to submit your resignation; discharged or
dismissed from Govt./Semi-Govt./Autonomous
Body or Private Service? If Yes, give details in
a separate sheet.
8. Academic Qualifications: (i) Please attach self-attested copies of certificates including Date of Birth
S.No. Class/Degree Subject Division/Grade/ Year of Board/University
/Specialization %age of marks Passing
Max. Marks %
Marks Obtained
1 10th Class /
equivalent
2 10+2/Hr.
Sec./
equivalent
3 Bachelor's
Degree
(B.Tech)
4 Master's
Degree
(M.Tech)
5 NET
6 Ph. D/D.Phil
9. Professional/Teaching/Research Employment (Give particulars in descending chronological order starting
with the present post. If space is insufficient, attach separate sheet).
S.No. Employer Post held Regular/ Pay Scale Total Period of
Contr Salary Employment
act pm. (Month/Year)
/Ad-
hoc
From To
10. Research and Academic Contributions
10.a Research papers published in journals.
(Attach separate sheet, if needed)
2
10.b Research publications (books, chapters in books, other than refereed journal articles)
(Attach separate sheet, if needed)
10.c Research Projects
(Attach separate sheet, if needed)
10.d Research Guidance
(Attach separate sheet, if needed)
10.e Training Courses and Conference/Seminar/Symposium/Workshop attended.
(Attach separate sheet, if needed)
10.f Papers in Conference/Seminars/Symposia/workshops etc.
(Attach separate sheet, if needed)
10.g Invited for conference/Workshop/Seminar/Symposia to deliver lectures / Chair Sessions
(Attach separate sheet, if needed)
11. Teaching Experience:
(i) Total No. of Years:
(ii) Attach list of courses taught
(iii) Innovation in Teaching:
(iv) No of Ph.D Supervised
12. Any other information:
(i) Membership/Fellowship and Position of responsibility in Professional Societies:
3
(ii) Prizes/Medals/Awards/Distinctions:
(iii) Scholarship received:
(iv) Any other awards/activities:
(v) Attainments in sports and extracurricular activities (including N.C.C):
(vi) Knowledge of foreign languages:
13. References: Give names of at least two referees with their complete postal address. Referees
should be the persons with or under whom the candidate has worked) :
1.
2.
Details of documents enclosed Attach separate sheet, (if needed):
(i)
(ii)
(iii)
DECLARATION
I…………………………………………………………………………….…. hereby declare that the
information furnished above is true, complete and correct to the best of my knowledge and belief. I
understand that in the event of my information being found false or incorrect at any stage, my
candidature / appointment shall be liable to cancellation / termination without notice or any
compensation in lieu thereof.
_____________________
Signature of the Candidate
Place : ___________
