AMBEDKAR COLLEGE OF ARTS & SCIENCE, WANDOOR (Aided by Govt: of Kerala & Affiliated to University of Calicut) Run By: Indiraji Memorial Society Ambalappadi, Sub Station Road, Pullur, Wandoor P.O -679328 Malappuram Dist, Kerala Ph: 04931249666 Email: [email protected]. Website: www.ambedkarcollegewdr.in ---------------------------------------------------------------------------------------------- Application for the post of: ___________________________________________ Affix recent Notification Date______________________ Details of Application fee paid Passport size Photograph DD/Receipt No Amount & Date Bank 1. Name as per SSLC(in block letters) 2. Father’s Name 3. Permanent Address 4. Communication Address Pin Code Pin Code 5. Date of Birth d d m m y y y y 6. 7. Marital Married/Unmarried Sex Status 8. Phone No STD code Mobile No. 9. Religion & Caste Specify: SC/ST/ OBC/ OTHERS 10. Educational Qualifications Exam/Degree Board/University Subject (s) Year of Percentage Rank Passing of Marks Secured, if Scored any SSLC or Equivalent Pre-Degree/Plus Two Degree Post-Graduation Additional PG 11. National Eligibility Test Qualification Details Eligibility Test Qualified Subject Year of Passing NET JRF CSIR ICAR 12. Research Qualifications Degree Subject Title of the Thesis University Date of Grade and Award Equivalent % M Phil PhD NA 13. Teaching Experience Details Sl. Name of Type of Permane Designation Period of Total No. College/Institution Institution nt/ Employment Days/Mont (Govt., Aided, Tempor hs Private. Autonomous) ary From To 1. 2. 3. 4 5 6 14. Post-Doctoral Fellowship/Experience Details Sl. Name of Subject Title of the Work Period Agency No. Institution/University From To Granted Fellowship 1. 2. 3 15. Award Details Sl. Name of the Agency Instituted Award Category of Date of Level No. Award Award Receipt 1. 2. Agencies: Recognised International Organisations, Govt. of India, Govt of India recognised national level bodies and local bodies, State Government and Universities. Category: Academic, Social, Cultural, Political etc. Level: International, National, State and Local. 16. Academic Fellowships other than Post-Doctoral Sl. Name of the Fellowship Fellowship Nature of Work/Study Period No. Granted by From To 1. 2. 17. Patent/Other Honours received Sl. Patent/Honour Agency Description Date of Receipt Level No. name 1. 2. 18. Research Papers Published in refereed Journals as notified in UGC Care List Sl. Title Name of Publishe Status Month Volume/Iss Leve Whether ISSN Impact No Journal r with of and Year ue/ l listed in No. Factor, . city and Author of Page No. UGC if any Country Publicatio CARE n (Yes/No) 1. 2. 3. 4. 5 6 7 Note: Publications in Journals Deleted from UGC Care List from time to time can also be included if the Journal was included in the care list at the time of publication of the paper in that journal. Status: S: Single Author, Ist: First/Principal Author; IInd : Second author; IIIrd: Third author etc. Level: I: International; N: National, S: State; L: Local 19. Research Papers published in Peer Reviewed Journals with ISSN. Sl. Title Name of Publisher Status of Month and Volume/Iss Level ISSN. Impact N Journal with city and Author Year of ue/ Factor, o. Country Publication Page No. if any 1. 2. 3. 4. 5 6 Status: S: Single Author, Ist: First/Principal Author; IInd : Second author; IIIrd: Third author etc. Level: I: International; N: National, S: State; L: Local 20. Publications Other than Journals (Chapter in Conference Proceedings, Chapter in Books. Text Books and Reference Books with ISBN) Sl. Title of Publisher Type Status Month and Year of Level ISBN. No Book/Proceedings Details of Publication . Author 1. 2. 3. 4. 5 6 Status: S: Single Author, Ist: First/Principal Author; IInd : Second author; IIIrd: Third author etc. Level: I: International; N: National, S: State; L: Local Type: CB: Chapter in Book; CCP: Chapter in Conference proceedings, T: Text Book; R: Reference Book. 21. Present Employment Details, if any. Whether Permanently Employed (√Appropriate Column) Yes No If Yes, Employer Name College/University/ Designation Appointment Date Institution Whether consent of the Employer has been obtained for submitting the application? (√Appropriate Column) Yes No 22. Other information you wish to add, if any. Sl. Information No. 1. 2. 23. List of Testimonials Enclosed along with the hard copy of the application Sl. Description No. 1. 2. 3. 4. DECLARATION I hereby declare that the information given by me in the Application is true, complete and correct to the best of my knowledge and belief and that nothing has been concealed or distorted thereof. If at any stage, I am found to have concealed/distorted any information or given any false statement, my application/appointment shall liable to be summarily rejected/terminated without notice or compensation. Date: Place: Signature of the Candidate Instructions: 1. Type all columns neatly and clearly by the applicant itself 2. Refer the notes given to the tables and fill up the columns accordingly 3. Insert additional rows for the tables if required. .