Application No.: (to be entered by the Office)

NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING (NITIE)

VIHAR LAKE, MUMBAI 400 087

FORM TO BE FILLED IN BY THE APPLICANT

APPLIED FOR THE POST OF (Please select) :

Whether willing to be considered

for a lower post:

Area of Specialization applied for(Please select) :

Yes No

Present (or Last) Post / Designation:

Pay Band Basic Pay Grade Pay Details of Present (or Last) Pay (For Govt. & Autonomous Govt. only)

Total Emoluments (in present post or last drawn) : as on MMM,YYYY:

Per month Rs.

(1) PERSONAL INFORMATION Full Name :

Gender :

Date of Birth (dd/mm/yyyy)

Nationality Indian

Category :

Religion :

Marital Status

Mailing Address

Permanent Address

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Age as on 01-07-2019

Others (Specify)

Please read instructions given at the bottom of this form

(Proof to be attached with hard copy)

City

State

Pin Code

Country

City Pin Code

State Country

Knowledge of Languages : English Hindi Others ( Specify)

(2) EDUCATIONAL QUALIFICATIONS *In chronological order from X Std onwards other than Ph.D.

Period of Study Class / Exam passed Year of

passing From To

University /

Board

Subject of specialization

*Please indicate your position in University / Board meritlist (if any)

Whether Ph.D. or Fellow :

(3) DETAILS OF Ph.D/ FELLOW

b)

c)

Ph.D./Fellow Award Status

Ph.D./Fellow Submission Status

Date of Awarddd/mm/yyyy

Date of Submission

d) Ph.D./Fellow Joining Date of Joining

e) Ph.D./Fellow Instituteand University Name :

f) Ph.D./FellowTopic in Full :

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dd/mm/yyyy

dd/mm/yyyy

Speaking

Reading

Writing

MobileTelephone No(prefix STD)

Email-Id :

a)

%mark

g) Area of Specialization : (Ph.D./Fellow Research Area and Current Research Interests)

(4) PROFESSIONAL MEMBERSHIPS

Sl. Name of Organization (Specify Indian or International)

Period (Year) Category of Membership From To

(5) SUMMARY OF PUBLICATIONS Filling the details in the below mentioned format is compulsory

Total number of publications(mention period)

1. Papers in International Journals

2. Papers in National Journals

4. Books / Chapters Edited

5. Conference Papers presented (National) (International)

6. Conferences Attended (National) (International)

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1.

2.

3.

4.

(1)

(2)

(3)

3. Papers Published in Conference Proceedings

(6) LIST OF RECENT/ BEST PUBLICATIONS

I. JOURNALS:

Sl. Author Name

with Co-Authors

Year of Publication

Title of Paper Name of Journal

1

2

3

4

5

6

II. CONFERENCES/SEMINARS:

Sl. Author Name

with Co-Authors

Year of

Publication Title of Paper, Proceedings Name of Conference/

Seminar

1

2

3

4

5

6

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* If required, attach additional sheet with the hard copy of the application and send by post.

(7) WORK EXPERIENCE (OTHER THAN TEACHING EXPERIENCE)

From To Designation in chronological order(Post and Organization)

Nature of experience

Industry Research

(8) TEACHING EXPERIENCE

From To Designation in chronological order (Post and Organization)

Faculty - 2019 Page 5

* If required, attach additional sheet with the hard copy of the application and send by post.

Details of Work *

Total Work Experience (Years): Industry : Research :

Total Teaching Experience (Years) :

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* If required, attach additional sheet with the hard copy of the application and send by post.

(9) SUBJECTS TAUGHT * One Row for each Subject

Sl. Subject Title UG/PG Class Size

1.

2.

3.

4.

5.

6.

7.

(10) TEACHING INTERESTS (IF SELECTED)

Sl. List of Subjects that you are interested to teach in preference order

1.

2.

3.

4.

5.

6.

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(11) RESEARCH PROJECTS / CENTRES (provide names of co-investigators if any)

Sl. Sponsor Title of Project / Center Duration Amount

(12) DOCTORAL STUDENT GUIDANCE COMPLETED

Name

Sl. Student Thesis Title University/

Institute

Award Date / Status

Co-Guide

Name

DOCTORAL STUDENT GUIDANCE IN PROGRESS with progress status

(13) CONTRIBUTIONS TO INSTITUTE ADMINISTRATION

Sl. Position Description From To

* If required, attach additional sheet with the hard copy of the application and send by post.

1

2

3

4

1

2

3

4

5

1

2

3

4

1

2

3

4

(15) ANY OTHER INFORMATION Please provide details that you would like, example Books, Patents, Awards, Recognitions, etc.

Faculty - 2019 Page 8

* If required, attach additional sheet with the hard copy of the application and send by post.

(14) OUTREACH ACTIVITIES (Executive Training, Consultancy to Industry)

Sl. Clients Title of Assignment Duration Amount

1

2

3

4

(16) REFERENCES Please provide contact details of two persons holding responsible

positions and FULLY acquainted with the applicant and not related to the applicant.

1

Institute/ Organization

Address

2

Designation

Institute/ Organization

Address

LIST OF TESTIMONIALS

Original Testimonials are to be produced only at the time of interview.

1. No Objection Certificate from the present employer, if applicable

2.

3.

Work Experience Certificates

4. List of Publications & full printout of 3 best publications

5. Educational Qualifications

6. Caste Certificate, as applicable for reserved posts

8. Others (Specify)

I hereby declare that the above information is correct and complete to the best of my knowledge and belief.

Place:

Date: Signature of the Applicant

Instructions (for filling the Application Form) :1. Download this blank PDF application form and save it in your computer.2. Open this PDF Application form in Adobe. Please do not make changes to the form.3. Enter your details, and save it in your name (your_full_name.pdf) in your computer.4. Email this filled and saved PDF form to email-id: nitierecruit@nitie.ac.in

Please note: Please do not send the certificates, photo, etc. by email. The hard copy of the application form along with the copies of certificates, etc. should be sent by post as mentioned in the Advertisement. List of Certificates required: Date of Birth, Photograph, Educational Qualifications, Experience, and Caste Certificate for reserved post.

Faculty - 2019 Page 9

Designation

Name

Telephone No. with STD

Mobile No.

Name

Telephone No. with STD

Mobile No.

Teaching Experience

7. Proof of Date of birth