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									                                APPLICATION FORM                                                Affix Recent
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        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 _________________________________


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                            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)

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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




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                          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




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