application msu baroda
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The Maharaja Sayajirao University of BarodaVadodara
APPLICATION FORM FOR
DIRECT RECRUITMENT
(As per UGC Notification No. F.3-1/2009 Dated June 30, 2010)
Notification No. & Date ______ ___________________________________________________
Application Form for: Assistant Professor,
Lecturer & Pradhyapak
Name of the Post applied for _________________________________________________
Faculty/Institute/College_____________________________________________________
Department ________ ______________________________________________________
Demand Draft/Challan Details:
Number__________________________Dated___________________
Name of the Bank__________________________________________
*In case of Offline Challan payment through Bank of Baroda branch; the bank will retain one copy of the challan and give you back the remaining two copies: one of which (original + one copy) you are required to send along with this application form, while the other is for your record.
PART A: GENERAL INFORMATION AND ACADEMIC BACKGROUND
1 Name (in block letters)
2 Father’s / Mother’s Name
3 Date and Place of Birth
4 Gender
5 Marital Status
6 Nationality
7 Indicate whether belongs to SC/ST/OBC/PH category (Please tick
SC ST OBC PH
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Passport size Photograph
in the relevant box) Certificate from competent authority to be attached.
8 Address for correspondence (with Pin code)
9 Permanent Address (with Pin code)
10 Contact Number
11 E-Mail
12 Department
13 Current Designation & Grade Pay
14. Academic Qualifications (Matriculation onwards):
Examination Board/University Year % of marks obtained
Division & Distinction
Matric / SSC
Intermediate/HSC (10+2)
Graduate degree
Post graduate degree
M.Phil.
Ph.D./D.Phil.
D.Sc./D.Litt.
Other Exams (if any)
In case of M.Phil/Ph.D. Examination, an attested copy of the degree and/or the result notification for the same be attached.
15. A. Record of academic service other than The M.S. University (please attach relevant certificates of service experience)
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Institution Designation
Essential qualifications for the post at the time of appointment
Nature ofappointment
(Regular/ Fixed term/Temporary/
Adhoc)
Nature of
Duties
PayScale
Date of Joining
Date of Leaving
Reasons for
Leaving
Please indicate, whether in previous service:
i) The essential qualifications of the post held were lower than the qualifications prescribed by the UGC?
ii) The minimum qualifications as prescribed by the UGC for appointment to the post were the same?
iii) The post is/was in an equivalent grade or of the pre-revised scale of pay?
iv) The post was filled in accordance with the prescribed selection procedure as laid down in the Regulations of University/State Government/Central Government/Concerned Institution, for such appointments?
v) The previous appointment was as guest lecturer for any duration or an ad-hoc or in a leave vacancy of less than one year duration?
15. B. Present Assignment:Designation Employer Date of Joining
Date/Month/Year
Nature of Appointment (Adhoc/Temporary/Permanent/
Contractual
Basic Pay p.m (Rs.)
Pay Band (Rs.) GP/AGP (Rs) Gross Salary Increment
p.m(Rs) Date(Date/Month)
Important/unique contributions(s) in the present assignment:
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16. Period of teaching experience: P.G. Classes (in Years) U.G. Classes (in Years)
17. Research experience
i. Total Number of years : ______________________________
ii. Years spent in M. Phil. / Ph.D. : ______________________________
iii. Years of Guiding Ph.D. / M. Phil. : ______________________________
iv. Total No. of papers published in
i. International Journals ………….
ii. National Journals ………….
iii. Conference Proceedings …………
(Not abstract but full paper)
v. Total No. of Conferences/Seminars/Workshops attended
i. International ……………
ii. National ……………
iii. State Level ……………..
18. Awards /Prizes/ Honours / Recognitions :
19. Fields of specialization under the Subject/Discipline
a)
b)
20. Academic Staff College Orientation/Refresher Course/QIP attended (Attach certificates) :
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Nature of the Course/Summer School
Place Duration Sponsoring Agency
21. List of publications (Attach copies for the purpose of evaluation): (Full list can be attached as appendix)
S.No. TitleName of the Journal, Vol. No.,Year (ISSN/ISBN No.)
Main/ co-author
22. Proficiency of the Languages
S. No.
LanguageRead & Write
onlyRead, Write and Speak
Examination Passed, if any
a) English
b) Gujarati
c) Any Other Language
23. FUTURE PLANS:
23(a). Your vision for the Department:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________
23(b). Your contribution in the Department, Faculty and University:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________
23(c). Future academic development plan for self as well as department:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
24. Any other relevant information:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
DECLARATION
I hereby solemnly affirm that the information given in this form is true and correct. If found incorrect, my candidature will be liable for cancellation at any stage. I shall abide by the decision of the University.
Date__________________ Signature of the Candidate
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Place __________________ Forwarded through:
For employees of M S University of Baroda:
I herewith forward the application of _________________________________________________ for the post of ___________________________________________ at the M. S. University of Baroda. He/she is working as a ________________________. I have "No Objection" to his/her application being considered and, if selected, for his/her appointment to the concerned post in the University.
____________________________________________ ____________________________Name and Signature of the Head of the Department Name and Signature of the Dean /
Principal / Head of the Institution
Date and Place:
For candidates employed outside of the M. S. University of Baroda:
I herewith forward the application of Mr./Ms./ _________________________________________________ for the post of ___________________________________________ at the M. S. University of Baroda. He/she is working as a __________________________________ in our organization on a temporary / permanent / ad hoc / contractual basis. We have "No Objection" to his/her application being considered and, if selected, for his/her appointment to the concerned post in your University.
__________________________________________________________Name and signature of the authority competent to forward with seal
Place and date:______________________________________________________________________________________List of Enclosures:
1.2.3.4.5.6.
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