Form No.: Paste your recent passport size photograph here
GOKHALE INSTITUTE OF POLITICS AND ECONOMICS (Deemed to be University u/s 3 of the UGC Act, 1956) 846, Shivajinagar, BMCC Road PUNE - 411 004 Telephones: (020) 25650287, 25654288 Website: www.gipe.ac.in
Fax No. (020) 25652579 Email:
[email protected]
Application Form for the post of ASSISTANT PROFESSOR
1. Application for the post of: __________________________________________
Advt. No. GIPE-ADVT (1)-APRIL 2017
2. Full name in block letters: Dr./Mr./Miss/Mrs. ________________________________________________________ 3. Address for Correspondence:
Telephone No.: __________________ Mobile: ___________________ Email: ____________________________ 4. Permanent Address:
5. Date of Birth: __________________ 6. Educational Qualifications: Examination
University/ Board
Month & year of passing
Subjects
% of marks obtained
Class/ Division/ Grade awarded
Matriculation/ S.S.C./S.S.L.C. Higher Secondary/ Pre-University Bachelor's Degree Master's Degree Regular Course in Demography /Population Studies Ph.D. Degree Others (Specify)
7. Have you qualified at the JRF/NET/SET/eligibility for Lectureship?
Yes
No
If yes, date of qualification:______________________________ 8. If the thesis for the Ph.D. degree has been submitted for examination but the Ph.D. degree has not yet been awarded, please give the date on which the thesis has been submitted for examination. _________________
GIPE-ADVT (1) -APRIL 2017
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9. Title of the thesis Master's Degree: M.Phil. Degree: Ph.D. Degree: 10. Area(s) of Specialization: 11. Employment History: Institution
Positions held
Nature of appointment: Permanent/ Temporary
Period of appointment, with dates
12. Present Employment: (a) Name and address of the Institution where employed: ________________________________________________ (b) Designation: _________________________ (c) Date of appointment ___________________ (d) Pay Drawn: _____________ 13. Experience: (Please attach separate sheets if required) (a) Teaching: Institution
Undergraduate/ Postgraduate
Subjects taught
Number of years
(b) Research: Institution
GIPE-ADVT (1) -APRIL 2017
Title of the Project
Funding / Sponsoring agency
Date of commencement
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Date of completion
14. Publications: (Please attach separate sheets if required) Title of the article/book
Publisher
Year
15. Any additional information such as scholarships, prizes, etc., awarded to you: (Please attach separate sheets if required) 16. Specify whether the candidate is a Person with Disability. If yes, specify the nature and extent of the disability.
17. If selected, what period would you require for joining? ___________________________ 18. Please give the name, address, E-mail and contact numbers of two referees who can support your application.
I hereby declare that all information furnished in this application and its other enclosures is true, complete and correct to the best of my knowledge. I understand that in the event of any information being found false, incomplete or incorrect, my candidature/appointment is liable to be cancelled/terminated. Place: __________ Date : __________
Signature of the Candidate
_____________________________________________________________________________________ 19. Details of Payment DD Number
GIPE-ADVT (1) -APRIL 2017
Date
Amount (Rs.)
Name of the Bank
Name of the Branch
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