भारतीय सूचना प्रौद्योगिकी संस्थान राँची

INDIAN INSTITUTE OF INFORMATION TECHNOLOGY RANCHI

(An Institute of National importance under act of Parliament)
Namkum, Ranchi - 834010, Jharkhand

Advt. No. Date:

Application form for Appointment to the post of Assistant Professor Grade – II (on
Contract) at Pay Level 10 as per 7th CPC

Post Applied with Pay Level as per 7th CPC:

(i) Deapartment:
Photograph
For Office Use
(i) Registrarion No:
(ii) Signature of the receiving officer:
(iii) Date of Receipt:

1. Name in Full
(In Block Letters)
2. Father’s/
Husband/Wife
Name
3. Date of Birth: Gender: Age: Marital Status: Nationality Religion:
(dd/mm/year) :
Male/Female Married/Unmarried

4. Category
(UR/EWS/OBC/SC/ST/PH)
(Enclose proof in case of
EWS/OBC/SC/ST/ PH)
5. Present Employment with Salary Details, if any
Institute/Organization Designation Nature of Pay Band Grade Total Salary
Work Pay (Per month)
in Rs.

9. Address for
Correspondence

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 Pin Code:
Mobile Nos.

Email
12. Permanent Address

Pin Code:
13. Educational Qualifications (Please add more rows if needed)
Sl. Degree Obtained Specialization Name of the Year of % of Class/
No. University/Institute Passing Marks/ Divisi
CGPA on
(i) Ph.D.

(ii) M. Tech

(iii) B. Tech.

(iv) XII Class

(v) X Class

(vi) Other if any

21. Ph.D. Degree Details:

(i) Ph.D. Thesis Title

(ii) Research area of Ph.D. Thesis

work

(iii) Date of Submission of Ph.D.

Thesis
(iv) Date of the Award of Ph.D.
Degree
(v) Name(s) of Supervisor(s) &
Address

27. M.Tech Degree Details

(i) M.Tech Dissertation Title

(ii) Area of M.Tech Dissertation work

(iii) Name(s) of Supervisor(s) & Address

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31. Post Doctoral Fellowship Details, if any
(i) No. of years of Post Doctoral
Fellowship
(ii) Area of Specialization

(iii) Institute/ R&D Lab

35. Industrial Experience Details, if any

Industry/Organization Start Date End Date Duration Designation Nature Pay
of Scale
work

39. Teaching Experience Details, if any

Institute/Organization Start Date End Date Duration Designation Nature Pay
of Scale
work

43. R & D Experience Details, if any

Institute/Organization Start Date End Date Duration Designation Nature Pay
of Scale
work

47. Administrative Experience Details, if any

Institute/Organization Start Date End Date Duration Designation Nature Pay
of Scale
work

51. Courses Taught during last 3 years, if any

(i) Course Title Level (UG/PG) Branch No. of
Times

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55. Number of Publications (Please attach a separate sheet with all details):
Nature Published (SCI/Scopus) In-Press
(SCI/Scopus)
(i) Refereed JournalsNational
International
(iii) Conference National
Proceedings International
61. Number of Books Published:
Title of the Book Name of Name of the ISBN Year of Reprint
Author(s) Publisher No. Publicati No./
on Edition
No.

66. Number of Chapters Published:

Title of the Chapter Name of Name of the ISBN Year of Reprint
& Book Author(s) Publisher No. Publication No./
Edition
No.

71. Editor of Journals

Name of the Journal Name of the Publisher National
/International

75. Reviewer of Journals

Name of the Journal Name of the Publisher National
/International

79. Ph.D. Thesis Supervised Completed: On-going:

Title of the Thesis Research area Year Supervisor/ Compl
Co-Supervisor eted/
On-
going

84. Number of Post Graduate Dissertations Supervised:

Title of the Dissertations Specialization Year of Supervisor/
Completion Co-Supervisor

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89. Number of Patents:
Name of Patent Awarding Registration No. Date & Year of Submitted
Organization Award if any

94. Sponsored/ Industry Projects Completed: On-going:

Title of the Project Sponsored Year of PI/ Total Complet
Agency Completion Co-investigator Amount in ed/
Lakhs. Ongoing

99. Consultancy Projects Completed: On-going:

Title of the Project Organization Amount of grant in Period PI/
Lakhs. Co-
investigato
r

104. Number of Awards/ Honours/Prizes/Medals:

Awarded (Title)
Proposed, if any
107. Number of Short-Term Courses/Workshop/ Symposiums/Seminars Conducted:
Type of the Name of the Sponsoring Period of Coordinator/
Course/Workshop Course/Workshop etc. Agency Course Co-
etc. Coordinator

112. Membership/Fellowship in Professional Bodies if any

Name of the Professional Body Membership status (Life/ Annual)

117. Your immediate short-term plans for the development of research at IIIT Ranchi. Also include
research and Laboratory facilities (equipment, space, funds, manpower) that you will need for
the same
(i) Research
(ii) Laboratory Development
120. List the courses you would like to develop at IIIT Ranchi.
Course Title(s) Level (UG/PG)

124. List the courses you would like to teach at IIIT Ranchi.
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 Course Title(s) Level (UG/PG)

130. Number of Countries Visited:

Country Name Period Purpose of visit

134. Mention notice period needed for joining if offered a post

135. Name two referees with complete contact details including address, Tel. Nos., Fax Nos., Email
address
(i)

(ii)

138. Application Fee:

a. SBI Collect Transaction No & Date:

b. Amount:
139. Any other relevant information

List of Enclosures (Academic and Professional Qualifications)

(i)
(ii)
(iii)
(iv)
(v)
(vi)
DECLARATION

I hereby, solemnly declare that the information furnished in this application are true and correct to the
best of my knowledge and belief. If at any time I am found to have concealed/ suppressed any material/
information or given any false details, my appointment shall be liable to be summarily terminated
without notice of compensation.

Place:

Date: Signature of the Applicant