INDIAN INSTITUTE OF TECHNOLOGY (BHU),VARANASI
APPLICATION FORM

Application ID
Advertisement No.
Post Applied for
Date of Application
Department/School

A. Personal Details

1. Name in Full

First Name Middle Name Last Name

1A. Parent Name

Father Name Mother Name

2. Address

Present Permanent
Phone:Phone:
Fax:Fax:
Email: Email:

3. Date of Birth: Uploaded Proof of Age Certificate

4. Nationality:

5. Gender:

6. Marital Status:

7. Category: Uploaded Proof of Category Certificate

7A. Category you wish to apply for:

8. Religious Faith:

9. Whether Differently Abled:

10. h-Index: NA

11. i10-Index: NA

12. No. of Citations: NA

13. Aadhar No: NA

B. Educational Details

1. Academics record (PhD with First class or Equivalent in the preceding degree.)

i. From Matriculation up to Graduation Level

DegreeyearBoard/
University		Specialization% of marksRemarks

ii. From Post Graduation onwards

Degree year DepartmentUniversity% of marksName of
Supervisor/
Advisor		Thesis Title

iii. Doctoral Level

DegreeDate of Thesis Defence DepartmentUniversity% of marksName of
Supervisor/
Advisor		Thesis Title


2. Broad Area of Specialization:



3. Current Area(s) of Research:



C. Professional Details

1. Present Employment Details:

OrganizationDesignationFromToRoles and ResponsibilitiesScale/Pay Band/Pay MatrixTotal Salary

2. Previous Employment Details:

OrganizationDesignationFromToRoles and ResponsibilitiesReason of LeavingScale/Pay Band/Pay MatrixTotal Salary Experience Certificate

D. Teaching and Research Details

1. Courses Taught:

SI No.Course Title with Hours of Teaching per weekLevel with class sizeSole/With OthersDeveloper of Course

2. Post Graduate and Doctoral Thesis Supervision:

(i) Master's Level:

SI No.Name of The Student(s)Date of RegistrationDate of SubmissionYear of Completion or in ProgressName of InstituteTitle of ThesisGuide or Co-guideUploaded

(ii) Doctoral Level:

SI No.Name of The Student(s)Date of RegistrationDate of SubmissionYear of Completion or in ProgressName of InstituteTitle of ThesisGuide or Co-guideUploaded

3. Details of Administrative Experience:

SI No.OrganizationDesignationFromToRoles and Responsibilities

E. Projects / Consultancy / Patents Details

1. Sponsored Projects:

SI No.PeriodDate of AwardDate of CompletionSponsoring OrganizationTitle of ProjectAmount of grantCo-Investigator(s)Uploaded Document

2. Consultancy Works:

SI No.PeriodOrganizationProject Amount with Nature of WorkPI/Co-PI (Name of Co-PI),if any

3. Patents Granted/Published:

SI No.Year TitleInternational/NationalDate & Year (with Indicate G for Grant or P for Published)

F. Publications Details

1. Publications:

(i) Mention here five best papers published in Professional Peer Reviewed Journals:

SI No.Author(s)Month & YearTitleName of JournalIssue NoVolumePage No.Indexed inImpact Factor
of Journal		Citations
of Paper		Uploaded

(ii) Give complete list of publications in journal in the following format as Enclosure-I:

SI No.Author(s)Month & YearTitleComplete Reference
of Journal
(i.e. Indexing,Page No., Volume No. etc)		Impact Factor of JournalCitations of Paper

(iii) Give complete list of Full papers(not abstracts) in the following format as Enclosure-II published in Conference proceedings:

SI No.Author(s)Month & YearTitleComplete Reference of Conference

(iv) Give complete list of Papers presented in Conference and not Published (in the following format as Enclosure-III):

SI No.Author(s)Month & YearTitleComplete Reference of Conference

(v) Books (List those published and in press separately):

SI No.Name with Indicate B for Book and C for Book ChapterName of Publisher with ISB No.Year of PublicationTitle of Book/Chapter with Book TitleAuthor or Co-author with Name, if anyPublication Status

2. Membership of Professional Bodies:

SI No.Name of BodyDate of AwardStatus of Membership

3. Give details of Important Seminar/Workshop etc attended or Organizing and not covered under 20(iv) in the following format as Enclosure-IV:

SI No.YearPlaceSeminar/Workshop etc Title of Conference Organizing/Title of the Paper Presented (Indicate with O for Organised / A for Attending)

G. Other Important Details

1. Details of Five Referees (at least two of them should be familiar with your research work):

SI No.NameAddressMobile No.Fax No.E-mail id

2. Awards and Recognitions:


3. Any Other Relevant information:

4. Salary/Total Emoluments Expected at IIT (BHU):

5. Statement of Objective:

i. Please indicate as to why you wish to join IIT(BHU)(not more than 500 words)

ii. How, in your opinion,do you meet the job requirements as advertised? (not more than 250 words)

iii. A short note (not more than 500 words) about the research and development projects you would like to undertake.

iv. A short note (not more than 250 words) about the courses that you would like to teach at UG and PG lavels. Select courses from the approved syllabus of the concerned Department/School.


      I hereby declared thet I have carefully read and understood the instructions and particulars for the post I am applying. Further,I also declare thet all enteries in this form as entries in this form as well form as the attchaed sheets are true to the my knowledge and belief.