NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR

Application Form For Ad oc Fac!lt"

Ad#$rti%$m$nt No. NIT JSR&ESTT&'()*&)*'+

Dat$, *-&''&)*'+
(i) Post Applied for: (ii) Department: (iii) Specialization: For Office Use (i) Registrarion Photograph (Paste a JPG file for soft copy submission)

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(ii) Signature of the Recei!ing "fficer: (iii) Date of Receipt:

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ame in %ull
(In Block Letters)

Date of 'irth:
(dd/mm/year) ,nstitute-"rganization

Gender:
Male/Female Designation

Age:

(arital Status:
Married/Unmarried

ationality:

Present *mployment +ith Salary Details

ature of .or/ Pay 'and Grade Pay 0otal Salary (Per month) in Rs$

1$

Address for 2orrespondence

Pin 2ode:

4$

0el$ os$-%a3 os *mail Permanent Address

Pin 2ode:

5$

*ducational 6ualifications (Please add more ro+s if needed)

Sl$ o$ (i) (ii) (iii) (i!) (!) (!i) Degree "btained Ph$D$ ($Sc$-(2A-($0ech$ '$Sc$-'$ 0ech$ :,, 2lass : 2lass "ther if any Specialization ame of the 7ni!ersity-,nstitute 8ear of Passing 9 of (ar/s2GPA 2lassDi!ision

;$

Ph$D$ Degree Details

(i) Ph$D$ 0hesis 0itle (ii) Research area of Ph$D$ 0hesis +or/ (iii) Date of Submission of Ph$D$ 0hesis (i!) Date of the A+ard of Ph$D$ Degree (!) ame(s) of Super!isor(s) < Address

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($Sc$-(2A-($0ech$ Degree Details

(i) ($Sc$-(2A-($0ech$ Dissertation 0itle (ii) Area of ($Sc$- (2A-($0ech Dissertation +or/ (iii) ame(s) of Super!isor(s) < Address

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Post Doctoral %ello+ship Details

(i) o$ of years of Post Doctoral fello+ship (ii) Area of Specialization (iii) ,nstitute- R<D ?ab

#@$

,ndustrial *3perience Details (PostAPh$D$)

,ndustry-"rganization Start Date *nd Date

PostAPh$D$ ,ndustrial *3perience (in years): Duration Designation ature of +or/ Pay Scale

##$

,ndustrial *3perience Details (PreAPh$D$)

,ndustry-"rganization Start Date *nd Date

PreAPh$D$ ,ndustrial *3perience (in years): Duration Designation ature of +or/ Pay Scale

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0eaching *3perience Details (PostAPh$D$)

,nstitute-"rganization Start Date *nd Date

PostAPh$D$ 0eaching *3perience (in years): Duration Designation ature of +or/ Pay Scale

#)$

0eaching *3perience Details (PreAPh$D$)

,nstitute-"rganization Start Date *nd Date

PreAPh$D$ 0eaching *3perience (in years): Duration Designation ature of +or/ Pay Scale

#1$

R < D *3perience Details (PostAPh$D$)

,nstitute-"rganization Start Date *nd Date

PostAPh$D$ R<D *3perience (in years): Duration Designation ature of +or/ Pay Scale

#4$

R < D *3perience Details (PreAPh$D$)

,nstitute-"rganization Start Date *nd Date

PreAPh$D$ R<D *3perience (in years): Duration Designation ature Pay Scale

of +or/

#5$

Administrati!e *3perience Details

,nstitute-"rganization Start Date *nd Date

Administrati!e *3perience (in years): Duration Designation ature of +or/

Pay Scale

#;$

2ourses 0aught during last 4 years (Add more ro+s if needed)

(i) 2ourse 0itle ?e!el (7G-PG) 'ranch o$ of 0imes

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umber of 2ourses De!eloped (Add more ro+s if needed) :

2ourse 0itle ?e!el (7G-PG) 'ranch

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umber of Academic Programmes De!eloped:

Programme 0itle ?e!el (7G-PG)

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2onducting ?aboratory 2lasses During ?ast 4 years

2ourse 0itle ?e!el (7G-PG)

(Add more ro+s if needed) 'ranch

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Research ?aboratories De!eloped (Add more ro+s if needed)

(!i) ame of the ?aboratory ?e!el (7G-PG) Remar/s

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umber of Publications (Please attach a separate sheet +ith all details and also list the #@ best S2, Journal
papers along +ith ,S' (i) Refereed Journals (iii) 2onference Proceedings o$): ature ational (S2,) ,nternational (S2,) ational (S2,) ,nternational (S2,) ame of Author(s) ame of the Publisher ,S' o$ 8ear of Publication Reprint o$*dition o$ Published (S2,) ,nAPress (S2,)

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umber of 'oo/s Published:

0itle of the 'oo/

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umber of 2hapters Published:

0itle of the 2hapter < 'oo/ ame of Author(s) ame of the Publisher ,S' o$ 8ear of Publication Reprint o$*dition o$

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*ditor of Journals
ame of the Journal ame of the Publisher ational -,nternational

&5$

Re!ie+er of Journals
ame of the Journal ame of the Publisher ational -,nternational

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Ph$D$ 0hesis Super!ised

0itle of the 0hesis

2ompleted: Research area 8ear

"nAgoing: Super!isor2oASuper!isor 2ompleted"nAgoing

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umber of Post Graduate Dissertations Super!ised: Specialization 0itle of the Dissertations

8ear of 2ompletion

Super!isor2oASuper!isor

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umber of Patents:
ame of Patent A+arding "rganization Registration o$ Date < 8ear of A+ard Submitted if any

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Sponsored- ,ndustry ProBects

0itle of the ProBect Sponsored Agency

2ompleted: 8ear of 2ompletion

P,2oAin!estigator

"nAgoing: 0otal Amount in ?a/hs$

2ompleted"ngoing

)#$

2onsultancy ProBects
0itle of the ProBect

2ompleted: "rganization Amount of grant in ?a/hs$

"nAgoing: Period

P,2oAin!estigator

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umber of A+ards- Conours-Prizes-(edals:

A+arded (0itle) ProposedD if any

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umber of Short 0erm 2ourses-.or/shop- Symposiums-Seminars 2onducted:

0ype of the 2ourse-.or/shop-etc$ ame of the 2ourse-.or/shop-etc$ Sponsoring Agency Period of 2ourse 2oordinator- 2oA 2oordinator

)1$

(embership-%ello+ship in Professional 'odies if any

ame of the Professional 'ody (embership status (?ife- Annual)

)4$

8our immediate shortAterm plans (&A) years time frame) for the de!elopment of research at ,0 Jamshedpur$
Also include research and ?aboratory facilities (eEuipmentD spaceD fundsD manpo+er) that you +ill need for the same (i) Research (ii) ?aboratory De!elopment

)5$

?ist the courses you +ould li/e to de!elop at ,0 JSR

2ourse 0itle(s) ?e!el (7G-PG)

);$

?ist the courses you +ould li/e to teach at ,0 JSR

2ourse 0itle(s) ?e!el (7G-PG)

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umber of 2ountries Fisited:

2ountry ame Period Purpose of !isit

)>$ 1@$

(ention notice period needed for Boining if offered a post ame t+o referees +ith complete contact details including addressD 0el$ os$D %a3 os$D *mail address
(i) (ii)

1#$ 1&$

Any other rele!ant information ?ist of *nclosures (Academic and Professional 6ualifications) (i) (ii) (iii) (i!) (!)

DECLARATIO , herebyD solemnly declare that the information furnished in this application are true and correct to the best of my /no+ledge and belief$ ,f at any time , am found to ha!e concealed- suppressed any material- information or gi!en any false detailsD my appointment shall be liable to be summarily terminated +ithout notice of compensation$ Place:

Date:

!i"nat#re o$ t%e A&&licant

NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR

!#mmary !%eet $or Ad%oc Fac#lty
Ad#$rti%$m$nt No. NIT JSR&ESTT&'()*&)*'+ *-&''&)*'+ Dat$,

'ost A&&lied $or

D$apartm$nt

Sp$ciali.ation

Reg$ o$ (for office)

#$ &$ )$ 1$ 4$

ame in %ull
(In Block Letters)

Date of 'irth:
(dd/mm/year)

Gender:
Male/Female

Age:

(arital Status:
Married/Unmarried

ationality:

Phone- (obile o$ Present Address +ith *mail id *ducational 6ualifications

Sl$ o$ (i) (ii) (iii) (i!) (!) (!i) Degree "btained Ph$D$ ($Sc$-(2A-($0ech$ '$Sc$-'$ 0ech$ :,, 2lass : 2lass "ther if any Ph$D$ 0hesis 0itle Research area of Ph$D$ 0hesis +or/ Date of Submission of Ph$D$ 0hesis Date of the A+ard of Ph$D$ Degree Specialization ame of the 7ni!ersity-,nstitute 8ear of Passing 9 of (ar/s2GPA 2lassDi!ision

5$

Ph$D$ Degree Details

(i) (ii) (iii) (i()

;$ =$

($Sc$-(2A-($0ech$ Degree Details

(i) ($Sc$-(2A-($0ech$ Dissertation 0itle (ii) Area of ($Sc$-(2A-($0ech Dissertation +or/

Post Doctoral %ello+ship Details

(i) o$ of years of Post Doctoral %ello+ship (ii) Areas of Specialization (iii) ,nstitute- R<D ?ab

>$

Present *mployment +ith Salary Details

,nstitute"rganization Designation ature of +or/ Pay 'and Grade Pay 0otal Salary (Per month) in Rs$

#@$

See/ing Appointment as
(i) Fisiting %aculty (ii) AdBunct %aculty (iii) Professor *meritus 8es 8es 8es in ,ndia o o o in Abroad 0otal

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o$ of 8ears of *3perience (PostAPh$D$)

(i) (ii) (iii) (i!) ature 0eaching Research ,ndustry Administrati!e ature 0eaching Research ,ndustry Administrati!e

#&

umber of 8ears of *3perience (PreAPh$D$)

in ,ndia in Abroad 0otal (i) (ii) (iii) (i!)

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o$ of Publications 6

ature (i) Refereed Journals (ii) 2onference Proceedings ational (S2,) ,nternational (S2,) ational (S2,) ,nternational (S2,)

Published (S2,)

,nAPress (S2,)

0otal

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o$ of 'oo/s Published o$ of 2hapters Published *ditor of Journals ( os$) Re!ie+er of Journals ( os$) o$ of Ph$D$ 0hesis-P$G$ Dissertations Super!ised o$ of Patents o$ of Sponsored ProBects o$ of 2onsultancy .or/s

2ourse Ph$D$ P$G$

Super!isor2oASuper!isor-

A+arded

Submitted

"ngoing

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A+arded 2ompleted 2ompleted A+arded "ngoing "ngoing

Submitted 0otal Amount in ?a/hs 0otal Amount in ?a/hs Remar/sD if any

o$ of A+ards- Conours-Prizes-(edals

ProposedD if any

o$ of Short 0erm 2ourses-.or/shopSymposiums-Seminars 2onducted ?ist the 2ourses you +ould li/e to de!elop at ,0 JSR
2ourse 0itle(s) ?e!el (7G-PG)

&4$

?ist the 2ourses you +ould li/e to teach at ,0 JSR

2ourse 0itle(s) ?e!el (7G-PG)

&5$ &;$ &=$

(embership-%ello+ship in Professional 'odies if any o$ of 2ountries Fisited (ention notice period needed for Boining if offered a post

!i"nat#re o$ t%e A&&licant )it% Date