FOR OFFICE USE ONLY

Application Received on:

Registration No.: _________________

GOVT. MAHILA ENGINEERING COLLEGE, AJMER

(An Autonomous Inst. of Govt. of Rajasthan)
Nasirabad Road, Makhupura, Ajmer- 305001
Tel.No. 0145-2695535, Fax No. 2695102
www.gweca.ac.in

website:

APPLICATION FORM FOR THE TECHING POSTS

Name of the Post applied for:
_______________________
Department/Field of
Specialization:__________________
Advertisement No.
______________________________
DD No._________

Amount__________Dated:_________

Name of Bank: _____________________________________

Affix your
photograph
here
(Self
attested)

1.

Name :( IN BLOCK LETTERS):

2.

Father's/Husband's Name:

3.

Date of Birth:
Place of Birth:
(Proof Enclosure No.
)
Present Age (As on last date of submission of application) : ____

4.

_
_

5.
Sex
(Male/Female):
7.

6. Marital Status:

Nationality:

8. Religion:

9. (a) Category (UR/SC/ST/OBC):

_____

(Proof of category- Enclosure No.

*The OBC Certificate should not be older than 6 months.

(b) Do you belong to Physically Handicapped category):
YES/NO
(If yes, enclose relevant certificate - Enclosure No. )
10. Address:
For Correspondence:

Permanent Address:

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

PIN Code: ___________________________

Tel. No: _____________________________

PIN Code: __________________________

Tel. No: _____________________________
1

Mobile No. ___________________________

Mobile No. ___________________________

11. Academic Qualifications (Secondary School Examination Onwards):

Exami
Board/
nation/
University
Degre
High
School/
Secondary
Sr. Secondary

Subject Year CGPA/ Divisi

of
s/
%Mar on
Specializa Passin ks

Proo
f
Encl.

B.E. / B.Tech/
M.E. / M.Tech
Ph.D.
Others

12. Details of Experience in academic institution/research organizations

(chronological order):
Period
S.
No.

Post Held

Organization

From

To

Total
Perio
d

Pay
Scale

Basic
Proof
Pay or
Encl.
AGP/GP No.

13. Details of Industrial/Field Experience (chronological order)

Period
S.
No.

Post Held

Organization

From

To

Total
Perio
d

Pay
Scale

Basic
Proof
Pay or
Encl.
AGP/GP No.

14. Details of Scholarships/ Rewards/ Honour with Proof (Enclose

separate sheet, if necessary):
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
15. Details of Academic achievements with Proof (Enclose separate
sheet, if necessary):
________________________________________________________________________________
_____________________________________________________________________________
___
_____________________________________________________________________________
___
_____________________________________________________________________________
___
16.

Developed / Participation in production of educational programs with

proof (Enclose separate sheet, if necessary):
______________________________________________________________________________

17.

Conducted Short Term/ Continuing Education Program/ Other

Courses with proof (Enclose separate sheet, if necessary):
______________________________________________________________________________
18. Attended STTP/Conference/Workshop/Symposium etc. (Enclose
separate sheet, if necessary):
______________________________________________________________________________
19. Special
necessary):

Training/

Assignments

(Enclose

separate

sheet,

if

20. Publications (in numbers): (Enclose separate sheet, if

necessary):
(A)
S.
No.

PAPERS

1 Papers in Refereed
International Journals:
2 Papers in Refereed National
Journals:

Publishe Accepted
d (Nos.)
(Nos.)

Communica
ted
Remarks
(Nos.)

3 Papers in
Conferences /Symposia :
4 Books :(Enclose Detailed List)
5 Review/ Research/ Feasibility
Reports :
(Enclose Detailed List)

(B) List of Publications in Journals (Enclose separate sheet, if

necessary):
S.No
.

Details (Author(s)/Title/Volume/Page/Year)

Cumulative
Impact INDEX
(with proof)

(C) List of Publications in Conference Proceedings:

S.No
.

Details

(D) Details of IPRs/ Patents etc. (Enclose separate sheet, if necessary)

_____________________________________________________________________________
_
_____________________________________________________________________________
_
_____________________________________________________________________________
_
21. Thesis Supervision (in numbers): (Enclose separate sheet, if
necessary)
S.No
.
1
2

Description

Ph.D.
M.E./ M.Tech./ M.Sc.

Awarde
d

Submitte
d

In
Progress

Remarks

Others

22. Sponsored Research/ Consultancy Projects: (Enclose separate sheet,

if necessary)
S.
No
.

Name of Project

Funding Agency

Status
(Complete
d/
In

Amou
nt

Remar
ks

Progress)

23. Membership/Fellowship of Professional Societies/ Bodies:

24. Administrative Responsibilities Held in chronological order (Enclose

separate sheet, if necessary):
S.
No
.

Period
Position Held

Organization

From

To

Nature of
Responsibi
lity

25. Give names, designations and addresses of two referees, not

related to you but well acquainted with your academic and
administrative performance and conduct:
(a) ________________________________
_______________________________
_

(b) ___________________________________
___________________________________

Email___________________________
Mobile
No.______________________

Email______________________________
Mobile No._________________________

26. Details of Present Employer

Name &
Address
of Present

Contact
No.

Nature of
Present
Post

Scale

Present Pay Details

AGP/G
Other
Total
P
Allowanc
Emolume

es

[Mark()
]
Permanen
t
Temporar
y
Ad-hoc
Contractu
al

Employer

nts

27
If appointed, the minimum time you will require to join the post?
____________________
28. Have you been punished during your service or, convicted by court of Law? If
so, give details:

29. Were you, at any time, declared medically unfit or discharged/dismissed from
service? If so, give details:

31.
Any
other
information
sheet)___________________________

you

wish

to

give?

(Attach

extra

that

the

DECLARATION BY THE CANDIDATE

I,

hereby

declare

information given by me in this application form is true to the best of

my knowledge and belief. If, at any time, I am found to have concealed
any

material/information

or

given

any

false i n f o r m a t i o n ,

my

candidature/ appointment may be summarily rejected /terminated

without any notice or compensation and I am liable for legal action
against me.

Place:
______________________

Date:

(Signature of the
Applicant)

The certificate to be given in the institute/organization/Industry's

official letter pad

CERTIFICATE FROM THE PRESENT EMPLOYER

(This certificate must be signed by the Employer in case of the candidate already in
service whether in Permanent/ Ad-hoc/ Temporary capacity)

No.

Dated:

___

Forwarded, Shri/Smt./Dr. ________________________________bearing the designation

of _____________________________________ holds the post in our Institution/
Organization i n Permanent /Temporary/ Ad-hoc/contractual capacity.
He / She, is dra wing the pay in the pay band/ scale

______________

w it h AG P/GP ___________ . This

no objection to

Institution/Organization has

the candidature of the applicant being considered for appointment to the post
of ..................... in Govt. Mahila Engineering College, Ajmer.

(Signature of the
Employer)

Place:
Date:

Name
Designation

Seal of the Institution / Organization

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