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

BACKLOG POST

CURRENT VACANCY

(Mark to be made

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Post Applied
Professor
for
Associate Professor
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made)

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recent
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Assistant Professor (PG)

Assistant Professor (UG)

Subject
Area of
Specialization

DETAILS OF APPLICATION FEES PAID

DD No.

DD Date

Bank Name

Amount

Rs. _______

1 FULL NAME
(in block letters)
Gender

Male

Female

(Tick mark to be made)

Marital Status

Married

Un Married

(Tick mark to be made)

Name of the Mother

Name of the Father
Name of the Spouse
1

CATEGORY (Tick mark to be made)

SC

ST

CAT I

Cat. IIA

Cat. IIB

Cat. IIIA

Cat. IIIB

GM

HORIZONTAL RESERVATION (Tick mark to be made)

Woman

Rural

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

ST

CAT I

Cat. IIA

Cat. IIB

Cat. IIIA

Cat. IIIB

GM

HORIZONTAL RESERVATION (Tick mark to be made)

Woman

Rural

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

4 ADDRESS FOR CORRESPONDENCE :

PERMANENT ADDRESS : -

Mobile No. :
2

Telephone
Office

STD CODE :

Residence

STD CODE :

E-mail

Writing

5 KNOWLEDGE OF KANNADA

Reading

DATE OF
BIRTH

Place of
Birth

Day
Month
Age as on last date of application

Year

Nationality

Mother
Tongue

PRESENT EMPLOYMENT DETAILS :

Desigantion
Name of the
Organization
Scale of Pay with
AGP/GP
Current Basic Pay
Total
Emoluments
(per month)

ACADEMIC RECORD STARTING WITH SSLC : (Attach photocopies)

Certificate
/Degree

Branch/Specialization Board/College/Institute/
University

Year of
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

Date of
Joining

Date of
Leaving

Gross Salary

Pay Scale

Permanent /
Temporary

10 EXPERIENCE (in no. of years) (enclose supporting documents)

PG
UG
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

12 RESEARCH GUIDANCE :
Completed (Ph.D)

Ongoing (Ph.D)

Completed (M.Phil)

Ongoing (M.Phil)

13 PUBLICATIONS :

Published
National
International

Accepted/ In Pres
National
International

Research Papers :

Books :

14 PATENTS

Granted :

Filed :

15 CONFERENCES/SEMINARS/WORKSHOPS/SYMPOSIA/TRAINING
PROGRAMMES ATTENDED : (ATTACH PHOTOCOPIES OF THE CERTIFICATES)
Year

16

Conference/Seminars/Worshops
Symposia/Trainings attended

Title of paper presented/ Delivered Lecture/

Chaired Sessions

RESEARCH PROJECTS :

Name of the
Research
Project

PI/Other(s)

Date of
Commencement

Date of
Completion

Funding
Agency

Amount
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/

______________________________________

from

Organization

_______________

having

of
been

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:
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Signature of the Candidate