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Document Sample
APPLICATION FORM Affix Recent
Passport Size
Photograph
UNIVERSITY OF AGRICULTURAL SCIENCES
RAICHUR – 584 102 (KARNATAKA)
APPLICATION FORM FOR APPOINTMENT OF
DIRECTOR OF EDUCATION / REGISTRAR / DIRECTOR OF
RESEARCH / DIRECTOR OF EXTENSION / DEANS
Name of the Candidate ____________________________________________________
Post Applied for __________________________________________________________
Advertisement No. & Date No. R / UASR / Rectt. / Advt. 5 / 2011 Dt. 4.11.2011.
DD / IPO / Banker’s Cheque No. & Date _________________________________
----------------------------------------------------------------------------------------------------------
INSTRUCTIONS TO THE CANDIDATES
1. The application should be filled-in by the applicant in his/her own handwriting.
2. Please answer each item clearly, completely and legibly, and use extra sheets if
necessary.
3. Incomplete applications are liable to be rejected.
4. The application form downloaded from the website should be accompanied by
prescribed fee (i.e. for SC/ST Rs. 500/- & for others Rs. 1,000/-) in the form of DD /
Banker’s Cheque / IPO (drawn in favour of the “The Comptroller, UAS, Raichur”)
at the time of submission of filled-in application, or else, the application will be
rejected.
APPLICATION FORM
1. Name of the post applied for
2. Name in full (BLOCK LETTERS)
(as entered in SSLC or equivalent )
3. Address for communication with
pin code
4. E-mail ID
5. Contact numbers (with STD codes) Telephone No. :
Mobile No. :
6. Date of birth
(bonafide certificate to be enclosed)
7. Place of birth with full particulars Place :
Taluk :
District :
State :
8. Religion
9. Caste
10. Sub-caste
11. Nationality
12. Name of the State to which you
belong
13 a) Do you belong to Scheduled Caste * SC / ST
or Scheduled Tribe? (Please tick)
b) Do you belong to Other Backward * Cat. I / 2A / 2B / 3A / 3B
Classes? (Please tick)
c) Do you claim reservation under * Rural / Woman / Ex-serviceman / Kannada
any of the Special Categories? Medium / Physically Handicapped / Project
(Please tick)
*(Respective Category / Caste Certificate
Displaced Person
from the competent authorities as per the
prevailing Govt. Orders in the prescribed
formats have to be enclosed)
2
14. Father’s Name
Address
Occupation
Nationality
15. Have you been outside India? If so, give particulars
Country Period of visit Purpose of visit
16. Languages that you can read write or speak
Reading Writing Speaking Examinations passed
3
17. Particulars of examinations passed and degrees obtained starting from SSLC
Examination or Percentage of Subject Board / University Year
Degree Marks /
AGP / OGPA
1. SSLC
2. PUC
3. Bachelor’s
Degree
4. Master’s
Degree
5. Post Doctoral /
PG diploma / a. / b. / c. / d.
M.Phil. (to be ticked as
indicated below*)
6. Ph.D.
7. Mode of
obtaining Ph.D.
degree
8. Others
Note: 1. Field of specialization should be indicated clearly at the PG level.
2. The candidates who have studied under Trimester System and other than 10 point
grading system are required to produce the equivalent percentage certificates
obtained from the respective University.
3*. In respect of Ph.D. degree, the following is to indicated:
a) Whether obtained Ph.D. with Course Work of any Agricultural University / by any
other University with 4+2+3 system (Trimester / Semester System).
b) Whether obtained Ph.D. from Traditional University (3+2+3 system) with course
work and Ph.Ds. from foreign Universities without course work.
c) Candidates obtaining Ph.D. by research alone in any University on Full Time /
Regular Basis.
d) Candidates obtaining Ph.D. by research alone in any University on External Basis.
4
18. Particulars of Experience:
a. Total Regular Service Rendered (in all the cadres):
Post held Name of Date of Date of Period of service Reason for Basic pay
Employer joining leaving (years / months / leaving (Certified
days) copy of the
pay drawn to
be enclosed)
b. Academic / Administrative Experience (in the cadre of Professor and above):
Post held Name of Date of Date of Period of Reason for Basic pay
Employer joining leaving service (years leaving (Certified
/ months / copy of the
days) pay drawn to
be enclosed
Note: The period of service rendered in the cadre of Professor, Professor and Head of any
Department / Scheme, University Head, ADR / ADE / Extension Co-ordinator / Special
Officers / Officers should be indicated clearly and individually.
5
c. Details in respect of handling externally funded projects (In the cadre of Professor
and above):
Name and location of the Project Outlay in Handled in the Achievement / growth rate
Scheme / Project and the Rs. capacity of
sponsoring agency (PI / Co-PI)
d. Organizing Symposium / Seminar / Summer Institute / Winter Institute / Refresher
Courses / Workshops and Training Programmes / Krishi Mela / Extension Field days
/ Exhibitions / National / University Meets / Camps (in the cadre of Professor and
above):
Particulars of the Nature of the activity Handled in the capacity Year and period
activity (International / National / of Leader / Director /
University Level) Assoc. Leader / Co-
Director
Note: Details of each of the activities including participation as Resource Person for imparting
training should be indicated individually and clearly.
6
e. Details in respect of Scientific Publications (in the cadre of Professor and above):
Sl. Titles of the Papers / Books Total number of Published in Name of the
No. published etc. publications Journal and Year
/ Publisher
Full length Papers published International /
in Refereed Scientific National Level
Journals
Research Note / Abstracts
published in Journal /
Seminar / Symposium
Conference
Full length Papers presented
and published in Seminar /
Symposium / Conference
Proceedings
Short Communication
presented and published in
Seminar / Symposium /
Conference
7
Books published by
Individuals
Research Bulletins /
Extension Bulletins /
Chapters in Books published
by Universities / National
Institutes / Govt.
Departments / Standard
Commercial Publishers /
Training Manuals / Teaching
Manuals
Extension Leaflets / Folders /
Brochures published by
Universities / National
Institutes / Govt.
Departments / Standard
Commercial Publishers
Popular Articles published in
leading Dailies / Institutional /
Govt. Department Periodicals
/ Radio Talks / TV
Programmes / Phone-in
Programmes
Note: The publications indicated above should have been published as on the last date
prescribed for submission of filled-in application.
8
f. Outstation Experience (in the cadre of Professor and above):
Sl. No. Experience No. of years of service
1. C class city
2. Others
19. Special Awards / Medals / Fellowships / Recognitions only for Professional Excellence
in Teaching / Research and Extension (in the cadre of Professor and above):
Sl. Particulars of Award No. of Year of Awarded for
No. Awards Award
International Awards :
National Awards:
State Level Awards:
University Level Awards:
Any Awards / Medals / Recognitions from
Professional Societies (except American
Bibliography Award / Non - Professional
Awards
Note: Details of Leaders of Team Awards / Medals / Recognitions should be clearly indicated.
9
20. Discipline contribution / Institution Building/ Special Attainment in Teaching / Research
/ Extension (in the cadre of Professor and above)
Details regarding Centers of Excellence and infrastructure created, Executive Committee Member
of National Professional Bodies, Member, NAAS / INSA and Fellow of Academic Bodies,
Chairman / Co-Chairman of International Conference Session, Members of Academic Council /
Governing Body of other Universities / Institutes, QRT Member, RAC Member, Institute
Management Committee / Research Council / Extension Council of other Universities, Editorial
Board of National / International Journals, Technology released included in Package of Practices,
Member of Accreditation Committee, Task Force Member, National Award Evaluation Committee,
Member of Deans Committee constituted by ICAR, Guiding a student who gets Jawaharlal Nehru
Award, Member (ASRB), Co-Chairman of International Conference sessions are to be provided.
21. Number of Registrations for patents made
22. International Exposure
Particulars Details of experience / year / duration
Experience of working in international
organization / laboratory with exposure of
minimum of three months
Note: An international exposure towards
obtaining Masters or Ph.D. Degree and Post-
Doctoral experience will not be considered.
No. of activities / year / duration :
As expert / Advisor on invitation / Government
deputation, Presentation of Research papers
at the International conferences
10
23. Names and addresses of three persons who would be referred to
1)
2)
3)
24. Additional information, if any
25. Were you offered employment in this University before? Did you reject the same? If so
when? Indicate full particulars of the post with date of offer
I hereby declare and certify that the entries furnished above are true to the best of my
knowledge and belief.
Date: SIGNATURE OF THE APPLICANT
11
Forwardal Certificate by the Employer
Certified that Dr. / Mr. / Ms. ______________________________________ is working
as _______________________________ in the Office / Department / Institute / Organization
of ______________________________________________ w.e.f. _____________ in the
scale of Rs. _______________________. He / She is at present drawing a basic pay of
Rs. _______________________. The DA and other allowances amount to
Rs.________________________________.
This institution has no objection in forwarding his / her application for employment in
the University of Agricultural Sciences, Raichur.
Place:
Date: Signature and Designation
Forwardal Certificate (Applicable only to UAS, Raichur Employees)
Certified that Dr. / Mr. / Ms. / ___________________________________________________
is working as _______________________________ in this Office / College / Research
Station w.e.f. ___________ in the scale of Rs. ___________________________.
His / Her present basic pay is Rs.________________________________
Place:
Date: Signature and Designation
12
