faculty appln. form 2011_257

8/6/2019 Faculty Appln. Form 2011_257

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FORM NO. FAC/ 2A

NATIONAL INSTITUTE OF TECHNOLOGY, ROURKELA

SUMMARY SHEET

(To be filled by the Candidate)

1. Name ______________________________________ 2. Date of Birth _________________________________3. Post _______________________________ 4. Department / Centre ___________________________

5. Specialization & Present Research Area _________________________________________________________

6. Education:

Degree Displine University /

Board

Year Division /

Grade/

Percentage

of Marks

Remarks if any

(Rank, Hons etc.)

High

School

(Class- X)Higher

Secondary

( +2 )

Bachelors

(B.A./B.Sc.)

(B.E./B.Tech)

Masters

(M.A./M.Sc.)

(M.E./M.Tech.)

Doctorate

(Ph.D./D.Sc.)

Others (JEERank, GATE

Score, GRE Score

etc.)

7. Employment (in descending chronological order starting with the present employer):

Employer Post Pay Scale Period of Employment

From To

Previous Review,

if any, at NIT,

Rourkela

FORM NO. FAC/ 2A-1

8. Summary of Performance:


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Courses Developed (No.)

U.G. P.G.

Research Publications

Published (Nos.)

Communicated (Nos.)

In Journals In Conferences/Symposia

Past five years Total Past five years Total

Thesis Supervised

- Completed

- In Progress

M. Tech./ M. Phil Ph.D.

Sponsored/Consultancy

Projects

- Completed

- In Progress

- Proposals under

review

Sponsored Projects Consultancy Projects

Books

Authored Edited

9. Special Training / Assignment / Any other relevant Particulars

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Form No. FAC/2B

Registration No. ____________________(To be filled by NITR Office )

Signed Photo


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National Institute of Technology Rourkela

Rourkela 769 008 (Orissa)

Application Form For Faculty Position

Advertisement No.______________________________Field of Specialisation __________________________

Post Applied for ______________________________Deptt./Centre___________________________________

To be returned to the Registrar, National Institute of Technology, Rourkela-769 008

NIT Rourkela is an Equal opportunity Employer

Appointments are made on the recommendations of Statutory Selection Committee

1. Full Name (including Surname) ________________________________________________(in block letters)

2. Date and Place of Birth ________________________________________________

3. Sex Male / Female (Strike off whatever is not relevant)

4. Marital Status Married / Unmarried (Strike off whatever is not relevant)

5. (a) Nationality : _______________________________________________

(b) Category: SC ST OBC

(C) Whether belong to PH Category: YES NO

6. (a) Mother's Name and Address _______________________________________________

(b) Father's Name and Address _______________________________________________

7. Postal Address for correspondence _______________________________________________

(any change of address should be _______________________________________________

communicated at once to the Institute) _______________________________________________

Pin Code _______________________________________

Telephone No ___________________________________

Mob.No. ______________________________________

e-mail ID______________________________________

8. Permanent Address _______________________________________________

(Mention Tehsil, District and State _______________________________________________

you belong to) _______________________________________________

Fac-2B-2

9. Were you at any time declared medically unfit;

asked to submit your resignation; discharged or


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dismissed from Govt./Semi-Govt./Autonomous

Body or Private Service ? If yes, give details

In a separate sheet. ______________________________________________

10. Academic Qualifications: (1) Please attach Xerox copies of certificates including Date of Birth.

(2) Give particulars in a chronological order starting with High School Certificate.

Sl. No. Degree/

Certificate

Subject/ Specialization Division/ Grade/

% of Marks

Year University

/Board

11. Professional/Teaching/Research Employment (Give particulars in descending chronological order starting

with the present post. If space is insufficient, attach separate sheet)

Sl.No Employer Post held Pay Scale Basic Pay Period of Employment

(Month/Year)

From To

Fac-2B-3

12.(a) Title of your M.Tech./Ph.D. Thesis with name and address of Ph.D. Guide.(Enclose abstract of thesis)

Degree Title of Thesis Guide University


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(1) M. Tech,

(2) Ph. D.

(b)Thesis supervised M.Tech./M.Phil (Attach separate sheet)

Ph.D.(If space is insufficient attach separate sheet)

Degree Name of Student Brief Title of Thesis Year

Completed

Co-Superviso

if any

Ph. D.

(1)

(2)

(3)

(4)

(5)

(c ) Sponsored Research/Consultancy Projects - Completed/In progress/Proposal under review

(If space is insufficient attach separate sheet)

_______________________________________________________________________________________

Title of Project Whether Duration Amount of Sponsoring Co-Investigator(s),

Completed or Grant Agency if anyin Progress

_________________________________________________________________________________________

(1) (2) (3) (4) (5) (6)

_________________________________________________________________________________________

(i) Sponsored Projects

(1)

(2)

(3)

(4)

________________________________________________________________________________________

Fac-2B-4

(ii) Consultancy Projects

(1)


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(2)

(3)

(4)

____________________________________________________________________________________________

(d) Publications :

(i) No. of reviewed publications. [Enclose list of publications in Reviewed Journals (mention co-authors(s),

Title, Journals, Months & Year, Page Nos.)]

(ii) No. of research papers presented in Conferences {(Enclose list of papers presented in Conferences

(mention co-authors(s), Title, Conference, Month & Year, Page Nos.)}

(iii) No. of research papers communicated.{(Enclose list of papers communicated (mention Co-

author(s),Title, Journal /Conference)}

(iv) Review/Research/Degree/Feasibility Reports.

Sl.

No.

Title No. of

Pages

Agency for which

prepared

Co-author,

if any

(e) Patents/Technology Transfer:

(1)

(2)

(3)

13. Books Published:

Title Publisher Year Edition Level Reference Co-author, if any

(1)

(2)

(3)

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14. Teaching Experience:

(a) Teaching at University level:

(i) Total No. of years

(ii) Attach list of courses taught at B.E./M.E. level


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(iii) Short-term/Refresher Courses (Conducted/Attached) (attach list)

(b) Any other teaching - No of years:

(c) Specialized courses/laboratories developed

(d) Innovations in teaching:

15. Short term courses/Continuing Education programmes/Distance

Education programmes E-Learning activities undertaken. [Give Details]

16. Any other information relevant to the post applied for such as :

(i) Membership/Fellowship and position of responsibility in Professional Societies :

(1)

(2)

(3)

(ii) Prizes/Medals/Awards/Divisions:

(1)

(2)

(3)

(iii) Scholarship received:

(1)

(2)

(3)

(iv) Any other awards/activities:

(1)

(2)

(3)

(v) Attainments in sports and extra-curricular activities (including N.C.C.)

(1)

(2)

(3)

(v) Knowledge of foreign languages:

(1)

(2)


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Fac-2B-6

17. Reference (At least names of three referees with their complete postal and electronic

addresses. Referees should be persons with, or under whom, the candidate has

worked)_______________________________________________________________

________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

18. Copies of documents enclosed:

(i) Outline research proposal (Annexure-I)

(ii) Outline course syllabus (Annexure-II)

(iii)

(iv)

(v)

(vi)

Place : Signature of the Candidate

Date :


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Fac-2B-7

Enclose the following: (Please use clear computer print on A4 size paper only, except

where it is not feasible)

1. Outline of research proposal that you would like to submit to a funding agency onjoining NIT Rourkela (Annexure I) (Also applicable to internal candidates).

2. Syllabus of a specialized course in the area that you would like to introduce on joining

NIT Rourkela (Annexure II) (Also Applicable to internal candidates).

3. One page write-up on significant contributions/innovations through teaching, research,

design, or any other innovative/creative activity during past five years - Annexure III

4. Details of Research Publications during past five years - Annexure- IV

(a) Journals

Author(s), Title of the Paper, Conference, Year, No. of Pages.

(b) In Conferences/ Symposia:Author(s), Title of the Paper, Conference, Year, No. of Pages.

(c) Communicated (Separately for Journals and Conferences/ Symposia)

5. Details of theses supervised: (a) M.Tech.; (b) Ph.D. - Annexure - V

Name of student: Thesis title ; Year; Co-Supervisor, if any .

6. Details of Sponsored/Consultancy Projects handled during past five years -Annexure -VI

Title, Funding Agency, Amounts, Duration and Co-workers, if any.

7. Details of technology development, transfer patents - Annexure -VII

Note: Candidates for the posts of Assistant Professor/Associate Professor should attach copies

of grade marks in courses taken during M.Tech./Ph.D. programmes and abstract of Ph.D.

thesis.

All candidates should enclose two copies of the reprints / preprints of three most

significant recent research publications.


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Form No. FAC/ 3

NATIONAL INSTITUTE OF TECHNOLOGY, ROURKELA

ROURKELA 769 008 (ORISSA)

ACKNOWLEDGEMENT

Advt. No. ____________________Registration No. __________________________________

Sub : Recruitment to the post of _____________________Deptt. /Center_____________________

Received an application from Dr./Mr./Mrs._____________________________________________

(Candidate to write his/her name above in capital letters)

for the above mentioned post. For any correspondence in future, candidate must quote the

registration number given above.

Office Superintendent

Date __________________ (Establishment/Recruitment)

To

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

(To be filled by the candidate his/her present address)

faculty appln. form 2011_257

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