Indira Gandhi National Tribal University,

Amarkantak (M.P.)
(A Central University established by an Act of Parliament)
Mekal Sadan, Kapiladhara Road, Amarkantak (M.P.) – 484 886
web site : www.igntu.nic.in

APPLICATION FORM FOR TEACHING POSTS

Advt. No.IGNTU/Acad/01/2010 Last Date of Submission : 22.11.2010

Post applied for ………………………. vkosfnr in ---------------------------------- Advertisement No. …………

Field of Specialization of above post (if any)……………...........…

foKkiu la -------------------------------------------------------
mi;qZDr in ds fo”ks’kKrk dk {ks= ¼;fn dksbZ gks½ ------------------------------------
Post Code* …….....…………….
Applied Under category Gen / SC / ST /OBC ……………….
in Øekad -----------------------------------------------
Js.kh ftlds vUrxZr vkosnu fd;k gS] lkekU;@vuq-tk- tk-@vuq-t-tk@v-
tk@v-fi-
fi-o- ---
--------------------------------------------------------------------------------------
------------------------------------------------------- -------------------------------

Particulars of fee Remitted :

Amount Bank Draft No. Date Issuing Bank
“kqYd dk fooj.k% cSad Mªk¶V la[;k fnukad tkjhdrkZ cSd
jkf”k ¼#-½

1. Full Name (in Block Letters) ________________________________________________

________________________________________ Affix Recent
Passport Size
iwjk uke fgUnh esa ¼lkQ v{kjksa esas½ ______________________________________________ Photograph
________________________________________________
2. Father’s/Husband’s Name ________________________________________________
firk@ifr dk uke ________________________________________________

3. (a) Address for Correspondence (b) Permanent Address

i=kpkj dk irk
______________________________________
______________________________________
______________________________________
Tel. No. ________________________________
Fax No. ________________________________
e-mail: ________________________________
LFkk;h irk
__________________________________
__________________________________
__________________________________
Tel. No. ____________________________
Fax No. ____________________________
e-mail: ____________________________

4. Date of Birth & Place 5. (a) Sex: Male/Female fyax % iq#’k @L=h
tUe frfFk ,oa tUe LFkku (b)
___________________________________ Category : SC v-tk- / ST v-t-tk- /
___________________________________ OBC v-fi-oxZ / General lkekU;
Age as on 1.11.2010 (c) If person with disabilities
1.11.2010 dks vk;q fodykax gksus dh n”kk esa
VH oh-,p- HH ,p-,p- OH vks-,p-
Years o’kZ Months ekg Days fnu
Please tick in the appropriate box
mi;qZDr ckDl esa lgh dk fu”kku yxkosaA
6. Marital Status : Married / Unmarried 7. (a) Nationality jk’Vªh;rk __________________
oSokfgd fLFkfr % fookfgr @ vfookfgr
(b) Religion /keZ _______________________
Note :
Post Code* - Post Code as per Advertisement/ Sl. no. of the Post ______
As for Example for Assistant Professor in the Dept. of Tribal Art will be written as : AIP/ Sl. No.- 15
8. Academic Qualification (Commencing with the High School or an equivalent examination)
“kS{kf.kd ;ksX;rk ¼gkbZLdwy vFkok led{k ijh{kk ls izkjEHk djsa½
Examination Subject / Year Division % of University / College / Distinctions /
Degree Specialization o’kZ Js.kh Marks / Board fo”ofo|ky;@ Scholarship
ijh{kk@ mikf/k fo’k;@ fo”ks’kKrk Grade dkyst@cksMZ fof”k’Vrk@
vad % Nk=o`fÙk
@xzsM
Matriculation /
10th / Secondary

Intermediate /
+2 / HS

Graduation/ + 3

Honours

Post Graduation

Any other
Qualification

Research Degree(s) “kks/k mikf/k;ksa %

Degree mikf/k University Specific date of Specific date of award Title of the thesis
fo”ofo|ky; submission mikf/k izkfIr dh frfFk “kks/k&izcU/k dk “kh’kZd
“kks/k&izcU/k tek djus
dh frfFk
M.Phil
,e-fQy

Ph.D / D.Phil
ih&,p-Mh@Mh-fQy

D.Sc/ D.Litt.
Mh-,l&lh@Mh-fyV~
(i) Whether Ph.D awarded as per UGC Regulation 2009 (if yes, Please give documentary YES / NO
proof) D;k “kks/k mikf/k ;w-th-lh- jsxwys”ku 2009 ds vuq:i gSA ;fn gk¡] rks lk{; dh Nk;kizfr
gk¡ @ ugha
layXu djsaA
(ii) Whether qualified NET/SLET etc. (Conducted by UGC/CSIR/ICAR/State) (Indicated the YES / NO
date and attach documentary proof) D;k ;w-th-lh-@lh-,l-vkbZ-vkj@vkbZ-lh-,-vkj-@jkT;
gk¡ @ ugha
vkfn }kjk lapkfyr jk’Vªh;@jkT; ik=rk ijh{kk mÙkh.kZ gSa% ¼frfFk nsa ,oa izek.k layXu djsa½
9. Teaching/Professional/Research Employment (Give particulars in descending order starting with the present post)
v/;kiu@O;olkf;d@vuqla/kku fu;kstu ¼orZeku in ls izkjEHk djds vojksgh Øe esa fooj.k nsaA
Name & Address of Post Held **Present Basic Pay as Total Period of Nature of
Employer fu;ksDrk dk in Pay Scale on date Gross Employment Duties/Work
uke vkSj irk osrueku Ewy osru Pay fu;kstu dh vof/k dk;ksZa ds Lo:i
ewy osru From To
ls rd

* Govt./Quasi Govt./Autonomous/Private. ljdkjh@v/kZljdkjh@Lok;Ùk”kklh@futh

** Mention whether revised or unrevised, if relevant. d`i;k la”kksf/kr vFkok vla”kksf/kr osrueku dk mYys[k djsaA

10. Summary of experience/performance dk;Z vuqHko @fu’iknu dk laf{kIr fooj.k

A. Teaching Experience From To Total years & Months
v v/;kiu vuqHko ls rd dqy o’kZ vkSj eghus

(i) Under Graduate Lukrd

(ii) Post Graduate LukrdksÙkj

(iii) Total Teaching Experience

dqy v/;kiu vuqHko

Participation in production of Educational TV programme

(iv) Vh-oh- f”k{k.k dk;ZØeksa ds fuekZ.k esa Hkkx ysus dk fooj.k

Short term/Continuing Education/Specialist Courses conducted

(v) vYikof/k @vuojr~ f”k{kk @ fo”ks’kKrk ikB~;Øeksa dk vk;kstu

B. Courses developed (No.) U.G. P.G.

c- ikB~;Øeksa dk fodkl ¼la[;k½ Lukrd LukrdksÙkj
 C. Research and academic contributions

l “kks/k vkSj “kS{kf.kd lg;ksx

(i) Research papers published in Refereed Journals/Non-refereed but reputed journals having ISBN /ISSN
(Please give the details in Annexure – A)
leh{kkRed if=dkvksa esa “kks/k&i= ¼d`i;k layXud ¼A) esa fooj.k nsa½

Research Publications (Other than refereed journal articles)

“kks/k izdk”ku ¼leh{kkRd if=dkvksa ds vfrfjDr½

(ii) Books/Chapters in books (Please give the details in Annexure – B)

iqLrdsa @ iqLrdksa esa v/;k; ¼d`i;k layXud ¼B) esa fooj.k nsa½

Note : List of publications with details, reprints of papers and acceptance letters (in case of accepted papers) must be
enclosed.
izdkf”kr “kks/k&i=ksa dh lwph] mudh iqueqZfnzr izfr;k¡ ,oa Lohd`r “kks/k&i=ksa ds Lohd`r i= dh Nk;kizfr;k¡ layXu
djsaA
D. Research Projects (Please give the details in Annexure – C)
n vuqla/kku ifj;kstuk;sa ¼d`i;k layXud ¼ C½ esa fooj.k nsa½

E. Research Guidance
bZ “kks/k i;Zos{kd
(i) Number of Thesis Supervised (Please give the details in Annexure – D)
bZ i;Zos{kd “kks/k dh la[;k ¼d`i;k layXud ¼ D½ esa fooj.k nsa½
Awarded Submitted In progress
iznÙk iw.kZ gqbZ izxfr ij
(ii) Ph.D.
ih&,p-Mh

(iii) M.Phil
,e-fQy

F. Prizes/Medals/Awards/Honors
j iqjLdkj @ ind @vokMZ @lEeku
 Extra curricular activities-give details, if any, of proficiency acquired in games, sports and of participation in
G. other extra curricular or social activities such as NCC, Public Lectures, Debates, Social Service etc.
y vU; xfrfof/k;ksa dk fooj.k& ;fn dksbZ gS] [ksy dwn] ,u-lh-lh-] laokn izfr;ksfxrk vkSj lekt lsok vkfn

As a student
fo|kFkhZ thou esa

After entering into service

ukSdjh esa vkus ds ckn

11. Training courses and conference/seminar/workshop papers (Please give the details in Annexure – E)
izf”k{k.k dk;ZØe vkSj lEesyu ,oa ifjlaokn xks’Bh @ dk;Z”kkyk esa i= ¼d`i;k layXud ¼E½ esa fooj.k nsaA

12. (a) Membership/Fellowship of professional societies:

¼v½ O;olkf;d lkslkbVh dh lnL;rk@v/;s;rk o`fr

(b) Other activities/Responsibilities:

¼c½ vU; xfrfof/k;k¡ @ mÙkjnkf;Ro

(c) Are you willing to accept the initial salary of the grade? (if no, state what is the minimum salary acceptable
with justification thereof)
¼l½ D;k vkidks vkosfnr osrueku dk U;wure Lohdk;Z gS \ ¼;fn ugha] dkj.k lfgr Li’V djsa fd fdruk U;wure~
ewy osru Lohdk;Z gS½A

(d) if appointed, what period would you require before joining the post ?
¼n½ fu;qfDr gksus ds fLFkfr esa dk;Z xzg.k djus ls igys fdrus le; dh vko”;drk gS \

(e) Any other relevant information, if not given above:

¼bZ½ vkosfnr in ls lEcfU/kr vU; dksbZ lwpuk tks Åij u nh x;h gks %

13. (a) Has there been any break in your academic career ? If so, give details
¼v½ D;k dHkh vkidh fo|ksiktZu dk Øe Hkax gqvk \ ;fn gk¡ rks dkj.k lfgr fooj.k nsaA
 (b) Have you been punished during your studies at college/University ? If so, give details.
¼c½ D;k dHkh vkidks fo|ksiktZu ds nkSjku fo”ofo|ky; @ dkyst }kjk n.M fn;k x;k \ ;fn gk¡ rks fooj.k nsaA

(c) Have you been punished during your services or convicted by a court of law ? If so, give details.
¼l½ D;k dHkh ukSdjh ds nkSjku vkidks nf.Mr fd;k x;k gS ;k fdlh U;k;ky; }kjk vkidks nks’kh izekf.kr fd;k
x;k \ ;fn gk¡ rks fooj.k nsaA

(d) Were you at any time declared medically unfit or asked to submit your resignation or discharged or
dismissed ? If yes, give details in a separate sheet.
¼n½ D;k dHkh vki LokLF; ijh{kk esa v;ksX; ?kksf’kr gq;s] vkils R;kxi= nsus ds fy;s dgk x;k vFkok vkidks fdlh
ukSdjh ls ineqDr ;k c[kkZLr fd;k x;k gS \ ;fn gk¡ rks i`Fkd i`’B ij fooj.k nsaA

(e) Do you have any case pending against you in any court of law ? If yes, give details.
¼/k½ D;k vkids fo#) dksbZ U;kf;d ekeyk fopkjk/khu gS] ;fn gk¡ rks fooj.k nsaA

14. Give names, designations and addresses (Phone/Fax No./e-mail, if any, of three reference not related to you.
Reference should be of persons with or under who have intimate knowledge of your work.
rhu lUnHkZ O;fDr;ksa ds uke] muds Mkd irs ¼Qksu] QSDl ua- ;fn gS½ ds lkFkA lUnHkZ O;fDr og gksuk pkfg;s ftlds
lkFk ;k ftlds v/khu vH;FkhZ us dk;Z fd;k gks ;k tks vH;FkhZ ds dke ls iw.kZr;k voxr gksA

(i) Name & Address:

Ph.No. Mobile No. E-mail :

(ii) Name & Address:

Ph.No. Mobile No. E-mail :

(iii) Name & Address:

Ph.No. Mobile No. E-mail :

List of Enclosures (Please tick in the box)

layXu izys[kksa dh lwph ¼ckDl esa lgh dk fu”kku yxk;sa½
(a) Bank Draft & Photograph v½ cSad Mªk¶V ,oa Nk;kfp=

(b) Copies of Mark-sheets & Certificates of educational qualifications &

certificate of clearing NET/SLET/JRF etc.
vad&i=ksa] “kS{kf.kd izek.k&i=ksa ,oa jk’Vªh;@jkT; ik=rk ijh{kk@dfu’d v/;srk ikl djus ds izek.k i=ksa
dh Nk;kizfr;k¡
(c) Copies of certificate of experience vuqHko izek.k i=ksa dh Nk;kizfr;k¡
 (d) List of publications with details, reprints of papers and acceptance letters (in case of accepted papers)
izdkf”kr “kks/k&i=ksa dh lwph] mudh iqueqZfnzr izfr;k¡ ,oa Lohd`r “kks/k&i=ksa ds Lohdkj i=ksa dh Nk;kizfr;k¡A

(e) Copies of other relevant certificates & documents.

vU; lEcfU/kr izek.k i=ksa dh Nk;kizfr;k¡

1

Declaration to be signed by the candidate

I _______________________________________ hereby declare that the entries in this form are

correct and true to the best of my knowledge and belief. If at any time, I am found to have concealed
/suppressed any material/information or given any false details, my appointment shall be liable to be
summarily terminated without notice or compensation.

vH;FkhZ }kjk gLrk{kfjr ?kksf’kr i=

eSa ----------------------------------------------------------------------------------------------- ;g ?kksf’kr djrk@djrh gw¡ fd bl vkosnu esa nh x;h lHkh
lwpuk;sa esjh iw.kZ tkudkjh ,oa fo”okl esa lR; gSA ;fn fdlh le; ;g ik;k x;k fd eSaus dksbZ lwpuk fNik;h gS
vFkok esjs }kjk nh x;h dksbZ lwpuk vlR; ik;h x;h rks esjh fu;qfDr fcuk fdlh uksfVl vFkok eqvkots ds c[kkZLr
dj nh tk;sxhA
Place: Signature of Applicant
LFkku vH;FkhZ ds gLrk{kj

Dated: Name in BLOCK LETTERS

fnukad uke

Forwarded with the remarks that the institution/organization has no objection to the
candidature of the applicant being considered for the post applied for, as above.

bl vk”k; ds lkFk vxzsf’kr fd vH;FkhZ ds mi;qZDr in gsrq vkosnu djus ,oa in ij p;u gsrq fopkj gksus ij laLFkk
dks dksbZ vkifÙk ugha gSA
Place:
LFkku Signature

Dated:
fnukad
Telephone (Head of the Institution/Organisation
VsyhQksu laLFkku@laxBu izeq[k

Fax Designation with SEAL

QSDl in
bZ&esy Address :
irk
Remarks:
fVIi.kh%
1. Candidate already employed should submit application through his/her employer.
fu;ksftr vH;FkhZ vkosnu i= vius fu;ksDrk ds ek/;e ls HkstsaA