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Fax:
(0771) 2252700
(0771) 2253104
NATIONAL INSTITUTE OF TECHNOLOGY RAIPUR
(An Institute
of National Importance) Email: registrar@nitrr.ac.in
G.E. Road, Raipur – 492010 (CG) Website: www.nitrr.ac.in

Application for the post of Temporary Faculty/Teaching Assistant/

Part Time Faculty
Advertisement No. _________ Dated / Fix a Recent
/2020
Passport Size
Department ______________________________Date ___________________ Photograph
(Self
Name _______________________________________________ Attested)

Father’s/Husband’s Name _______________________________________________

Permanent Address _____________________________________________________

Contact No (With STD Code) ______________________ (O) _____________________ (R)

Mobile No __________________________________________________________

E-Mail __________________________________________________________

Present Address _____________________________________________________

_____________________________________________________
Details :

S. B.E/B.Tech./B.Arch./ M.E./M.Tech./ Ph.D. With Industrial Teaching

No MCA/M.Sc./ M.A. % Marks M.Arch. % Marks Year of Experience Experience
obtained in Grand Total or obtained in Grand Award (in Yrs) (in Yrs)
CGPA Total or CGPA

1 2 3 4 5 6
2
3
Attached Scan Documents:
1. The qualification in the chronological order i.e. Ph.D, PG., UG etc.
2. Teaching & industrial experience.
3. Others, if any.
DECLARATION
The information given above is correct as per my knowledge and I undertake that I will join the
department /institute, if selected within seven (07) days of receiving order.

Place: Signature of the Candidate

Date:
Name________________________