- 1 -

Vyavsayi Vidya Pratishthan D.D. in favor of Vyavasayi Sanchalit Vidya Pratishthan - Rajkot. V.V.P.Engineering College Payable at Rajkot Vajdi-Virda,Kalawad Road, Price : Rs. 200 Rajkot-360 005. Sr. No. Date of issue:

Application Form for the post of Assistant Professor in __________________________ Note:- (i) The application should be submitted along with true copies of the relevant certificates within 10 days from the date of advertisement. (ii) Additional sheets of paper may be attached if the space provided against any item is insufficient.

(iii) For GTU Norms: Please refer http://www.gtu.ac.in/affiliation/ 2014/09072014.pdf

1.0 Name in full:- ( in Block Letters) Mr./Mrs./Ms._________________________________________________________ (SURNAME) (NAME) (FATHERS/HUSBANDS NAME) 2.0 Full address for correspondence : __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ________________________________________________ Pin ______________ Telephone No. ________________STD Code ( ) Mobile No._____________________________ E-Mail Address:_________________________ 3.0 Date of Birth:_______________ Age :_______ Years______ Months Nationality: ________________ Caste:____________Mother tongue ____________ 4.0 Birth Place : Town/Village :_______________ Tal._________________ Dist:_______________ State:-________________ 5.0 Languages Known :-

READ WRITE SPEAK

Affix

Passport size Photograph

(self attested )

- 2 -

6.0 Educational Qualifications: (Begining with SSC/HSC Exam.)

Examination passed

University/ Board

Year of passing

Div/ Class

% marks*

Subjects/ Discipline

(Specialisation) S.S.C. H.S.C. B.E./B.Tech/Equi. M.E./M.Tech/Equi. Ph.D.(Engg./Tech.) *(% Marks to be included nearest to second decimal and attach relevant Photocopies of Marksheet.) 7.0 Details of Professional Experience: (after obtaining the basic degree and as on date of advertisement.)

Period of service

Nature of service full time/adhoc/temp. and period of service

Name and address of the employer

Designation of the

post held From To Year Months Nature

Total salary drawn p.m.

(a) As a Trainee or Apprentice (b) As Employee other than Teaching Staff (c) As a Teaching Staff (Sp. Note:-Please attach Photocopies of experience certificates. Part-time/Visiting faculty experience not to be included in this column.)

- 3 -

8.0 Research Experience: (a) Research work done as student for Master/Doctorate Degree.

Period

Degree Topic From To Institution/ University

Name of Guide

% Marks

for Masters Degree

(b) Research work done other than above including guiding Thesis:

Period Degree Topic From To

Institution/ University

Name of Guide/

Co-Guide

9.0 Training Programmes after graduation/ Post graduation :

Period Name of programme From To Details of place/

institutes etc.

(AICTE/ISTE/UGC approved short term courses/summer schools/winter schools/workshop etc. please attach photo copies of participation certificates.) 10.0 Papers presented in conferences/seminars/symposium etc.

Name of conference/

seminar /symposium

Title of paper presented

Date/ Dates and place

whether said paper is published in

preprints /proceedings etc.

National Level: International Level: Please attach photo copy of certificate /xerox copies of preprints/papers published.

- 4 -

11.0 Details of publication :- (a) Books/Monographs/chapter in Enclyclopedia

Title Authors Year Name of publisher

(b) Research papers published:

Page Title of paper Name of Journal Year From To 12.0 Extra-curricular activities:- Sports/Fine arts/Eloqution _____________________________________ competition/ NCC etc. at _____________________________________ state/National level. _____________________________________ (Specify relevant details and attach a copy of the proof for each category.)

13.0 Special achievements: Gold medal /Prizes/other Medals ___________________________________ received. (please attach a proof) ___________________________________

Also National/International ___________________________________ Awards received. ___________________________________

14.0 Details of any innovation /activity ____________________________________ involved during professional ____________________________________ career. ____________________________________

15.0 Names and address of two references who are not related to the candidate but who are acquainted with the work and character of the candidate. (1) (2) ____________________________ _______________________________ ____________________________ _______________________________ ____________________________ _______________________________ ____________________________ _______________________________

16.0 Present pay Rs.________________ Pay scale__________________________ Total emoluments p.m. Rs.____________ Date of next increment__________

17.0 Approximate time required for joining if appointed: ______________ month/months

- 5 -

18.0 For retired/ likely to retire candidate:

Please specify all the relevant details like Designation, Last salary, Pension etc. ______________________________________________________________________________________________________________________________________________________________________________________________________

19.0 Any other information in support of the application: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ I hereby declare that the information given above is correct to the best of my knowledge and belief. I understand that in the event of any particular or information given herein is found false or incorrect, my candidature is liable to summarily rejected or cancelled.

Place : Date: Signature of the applicant List of photocopies of certificates self attached with this application:- (as per sequence) 1 S.S.C. Marksheet 2 S.S.C. Degree Certificate 3 H.S.C. Marksheet 4 H.S.C. Degree Certificate 5 B.E. Marksheet (All) 6 B.E. Degree Certificate 7 M.E/M. Tech. Marksheet (All) 8 M.E./M.Tech. Degree Certificate 9 Ph.D. Degree Certificate 10 School Leaving Certificate

11 All Experience Certificate (if applicable)

12 Other University Endorsement Letter for the post of Director/Principal, Professor, Associate Professor/HOD to consider teaching experience.

13 Gazette Copy/Marriage Certificate for confirmation of candidate name (if applicable).

14 UGC approval letter for the degree awarding private/deemed universities outside of Gujarat.

15 AIU equivalent certificate for University out of India.

16 Paper Presentation Certificate

17 Seminar Attended Certificate 18 Conference Attended Certificate 19 Symposium Certificate 20 Details of Paper Publication 21 Details of Book Publication 22 Patents details 23 Other