Page 1 of 6
NATIONAL INSTITUTE OF ANIMAL
BIOTECHNOLOGY (NIAB)
(An Autonomous Institute of the Dept. of Biotechnology,
Ministry of Science & Technology, Government of India)
Visiting Scholars House, Lake View Guest House, University of Hyderabad Campus,
Prof. C.R. Rao Road, Gachibowli, Hyderabad, Andhra Pradesh, India 500 046
Website: www.niab.org.in; Tel: +91 40 2301 2425; Telefax: +91 40 2301 0745
APPLICATION FORM FOR SCIENTIFIC POSITIONS
(Advertisement 1/2012)
To be filled in by the candidate
Particulars of
Advt. No._____________
application fee:
Affix your recent
Amount(Rs.)___________
Post applied for
coloured passport
_______________________ __ size photograph
DD No.
________________
Post Code, if
Date __________________
any_________
_______________________ Name of the Issuing
bank &
Branch________________
_
_______________________
1.
For Office use
D.D. for Rs._______
REMOVED
Application
S. No:
Rectt. Section
Date of receipt:
_________
Name (IN BLOCK LETTERS): ..
2. Area of Specialization: ..
..
3. Father's/Husbands Name: .
.
4. a) Date of Birth (DD-MM-YYYY): ...
b) Age as on the last date for receipt of applications: YY. MM....
DD.
5. Gender: ..... 6. Marital Status:
.
7. Correspondence Address.
.......................
.
..
...
PIN CODE..
Phone No: (with STD/ISD code)....... Mobile No.
..........
E-mail:
..
Page 2 of 6
Permanent Address..................
.
...
.........
PIN CODE..
8. a) Are you a citizen of India?
Yes/No
b) Are you a person who has migrated from Pakistan with the intention of
permanently settling in India or subject of Nepal?
Yes/No
9. State whether you are a member of Scheduled Caste/ Scheduled
Tribe/ Other Backward Class/PH/Ex-servicemen/Others. If so, attach an
SC
attested copy of the prescribed certificate in support of your claim from
the Competent Authority (Tick the appropriate Category)
ST
OBC
PH
Exservicemen
Ot
hers
GEN
10. Are you related to any employee(s) of NIAB? If so, give details:
..................
..
...................
.
...................
.
11. Have you been convicted by a Court of Law? Is there any legal case filed against you
in a Court of Law? Yes/No.
If yes, provide details
.
12. Educational Qualifications:
Division/Gra
Level
de & % of
marks
Matriculation/ SSC/
Equivalent
Year of
Passing
Board/
University
Subject(s)
Page 3 of 6
Intermediate/ Equivalent
Graduation
Post Graduation
Ph. D.a
Ph. D. Thesis Title:
Any other diploma/certificate
1.
2.
13. Any other qualification (e.g. knowledge of computers, etc.)
..................
.....................
.
14. Details of employment (starting from current employer):-
Period
Name of
the
employer
Post
Held
From
(Month
-Year)
To
(Month
-Year)
No.
of
Year
s
No. of
Month
s
Permane
nt/
Tempora
ry
Salary &
Grade
Page 4 of 6
15. Details of Professional Recognitions/Awards/Fellowships received (if any)
1.
...............................................................................
...................
2.
...............................................................................
...................
3.
.....................................................................................
.............
16. Teaching/Research experience (starting from current organisation):-
Universi
ty/
Instituti
on/
Industry
Period
Countr
y
Post
Held
From
(Mont
hYear)
To
(Mont
hYear)
No.
of
Yea
rs
No.
of
Mont
hs
Designat
ion
Nature of
duties
17. Guidance of Research (Number of successful theses supervised independently and
jointly)
Page 5 of 6
MPhil/MTech/MSc/MVSc/ME
Supervised Independently:
Supervised Jointly:
Ph.D./D.Phil.
Supervised Independently:
Supervised Jointly:
18. Major Research Projects
Period of Operation
Project Title
From
(MonthYear)
To
(MonthYear)
Sponsoring Agency
Budget
19. Patents Awarded/filed:
S No
Title
Number &
Year
National/International
Granted/Filed
20. List up to five publications to which candidate has contributed significantly
(Title of Paper (Year), auth/jou/vol/page(s), Impact Factor, Citations) {Attach copy for
each publication}
1.
2.
3.
4.
5.
21. Total No. of Publications in Standard reviewed journals:
Page 6 of 6
22. Are you willing to accept the minimum initial pay of the scale? If not, state what is
the lowest initial pay that you would accept in the prescribed payband: ........................................................
23. Time period required for joining:
24. Names and addresses of references (with email address and telephone)
1.. 2.
..
..
...
..
....
...
..
3..
..
....
25. List of enclosures:
1.
2.
3.
4.
DECLARATION BY THE CANDIDATE
1. I hereby declare that the entries in this form and the additional particulars, if any,
furnished herewith are true to the best of my knowledge and belief.
2. I have informed my Head of Office/Department in writing that I am applying for
this post and shall produce No objection certificate at the time of the interview.
Place:
Signature________________________
Date:
Name__________________________________
Candidate's
Full
