ANNEXURE - I

Proforma for aoolication for the oost of Director. llM. Shillono

1. General lnformation

2. EducationalQualification

Name of the candidate

Date of Birth (in figures & words)

Address for correspondence

Permanent address

Landline & mobile telephones

vi E-mail

s.

No

Qualification Year/Universig/

lnstitute/Board

Percentage/

Board

Subiect(s) / Specialization

i

ii Ph-D

Post Graduation

Graduation

School

3. Position Held (beginning with the present post / assignment)

t.

t

Post Doctoral

iii.

453976/2018/TS V Section35

4. Academic Posts (On full time basis)

5. Teaching Experience

Please list murses taught at differenl levels.

A. Under Graduate Level

S

NoPost Organization Duration Experience

(ln years andmonths)

From(Date)

To(DateI

I Professor or

equivalent

Associate

Professor or

equivalent

iii Assistant Professor

or equivalent

s.No

Year Title of the Course / numberof students

PGP/M,PhiUPh.DI

FPM/Others

Core or Elective

i

lt

.

B. Post Graduate Level

ii.

453976/2018/TS V Section36

S.n:

Year Title of the Course / numberof students I

FPM/Others

Core or Elective

t.

[.

.

PGP/M.PhiUPh.D

453976/2018/TS V Section37

C. Executive Education

List & describe courses or programmes of which you have been Course Director.

List & describe executive education programmes in which you have taught.

Please provide details of overseas teaching assignments undertaken.

D. Students supervised for M.Phil/ Ph.D or FPM Programme

6. Administrative Post (On full time basis)

t.

ii.

iii

Name ofthe

Programme / Year

Duration of theProgramme

Title / Contentof the Session

Overall rating ofteaching faculty

[.

S.

NoYear Number of students who have

Completed their dissertations -Direct Supervisor

Number of students whohave completed their

dissertations - Member ofThesis Commiftee

I

,

iii

Name of the Postheld /

Organization

Description of Duties Duration Experience(ln years and

months)From(Date)

To(Date)

I

s.l{o

t.

iii.

s.No

[.

iii.

iv.

453976/2018/TS V Section38

Additional pages may be appended for giving details on (i) significant recognition by learned

societies or professional associations for demonstrated achievements or leadership (ii) Positions

held over the last 5 years as Chair or Member of any Govemment of lndia or other Committee (iii)

List any public service activities engaged in by the applicant.

7. Awards Received

S

No

Name of the Award / Year of Award Awarded by

t.

[.

l

8. Research Ptojects undertaken (number) and brief description(Details to be Annexed)

9, Books Published

s.No

Name of the Book / Publisher / Yearof Publication

Subject / Description

i,

ii

iii

'10, Research Paper Published

s.*:

Subject / Title of the Research Paper Published in (Name, Year and Edition of theJoumal elc)

i.

453976/2018/TS V Section39

.

t.

ll. Applicant's Vision on how he / she proposes to develop the lnstitution.(Maximum 25{l Words)

12. Declaration

I hereby declare that all the statements / particulars made / fumished in this application are true,

complete and corect to the best of my knowledge and belief. I also declare and fully understand

that in the event of any information fumished being found false or inconecl at any stage, my

application / candidature is liable to be summarily reiected and if I am aheady appointed, my

services are liable to be terminated without any notice from the post.

Signature of the Applicant

(Name of the Applicant)

Place

Date

453976/2018/TS V Section40

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