University

FACULTY
APPLICATION FORM

(Karunya Institute of Technology & Sciences)

(Estd. Under sec. 3 of the UGC Act 1956)
Karunya Nagar, Coimbatore 641 114
[CHRISTIAN MINORITY INSTITUTION]

Position applied for

Department

Have you applied for a post at

Karunya earlier; if so,
for what post and when

Please affix
recent Passport
size Photograph

(Application should be complete in all respects, Incomplete applications will not be considered)

A) PERSONAL DATA

Email id: .

1.

Name in full (in block letters) Mr./Mrs./Ms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Mailing Address (In block letters)

Tel. No.

STD Code

Mob.No.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
Permanent Address (in block letters) Tel. No.

STD Code

Mob.No.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pin Code . . . . . . . . . .
3.

Date of Birth . . . . . . . . . . . . . . . . . 4. Religion . . . . . . . . . . . . . . . .5. Caste . . . . . . . . . . . . ..

(Certificate to be enclosed)

OC/BC/MBC/SC/ST

(For Official purposes only)

Remarks of the Selection Committee

Date of Interview:

1. . . . . . . . . . . . . . . . . . . . . . .

2. . . . . . . . . . . . . . . . . . . . . . . . .

3. . . . . . . . . . . . . . . . . . .

........................

..........................

....................

4. . . . . . . . . . . . . . . . . . . . . . .

5. . . . . . . . . . . . . . . . . . . . . . . . .

6. . . . . . . . . . . . . . . . . . .

........................

..........................

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6.

Marital Status

: Married / Single

7.

Children & Other Dependents

Name

Relationship

Age

___________________________________________

______________________

______

___________________________________________

______________________

______

___________________________________________

______________________

______

8.

Fathers / Guardians Name ________________________________________________________

9.

In case of emergency the person to be notified:

Name: __________________________________________ Relationship: ___________________
Address: _______________________________________________________________________
_____________________________________ Pin Code ________________ Tel No.___________

B) PHYSICAL DATA
10. a) Height: ______________ Cm

b) Weight: ______________ Kg

c) Eye sight (Wearing spectacles) Yes/No. If yes, power __________________

d) Blood group: _____________________
11. Have you any physical handicaps?
a) Sight (

b) Hearing (

c) Feet (

d) Hand (

If so, kindly provide details with regard to the extent it has hampered your normal working
_______________________________________________________________________________
12. Have you had any major operations/illness during the past 3 years? If so, give details
_______________________________________________________________________________
C) ACADEMIC QUALIFICATIONS
13. Kindly start with your highest qualification
Name of College /
School & Location

University/
Location

Degree /
Diploma*

Date of
Degree
Issued

Year of
Passing

Main Subject taken

Specialization

Percentage

Ph.D.
M.Phil
M.Sc./ M.E/
M.Tech.
B.Sc./ B.E/
B.Tech
Diploma / 12th
10th
* State whether :

Part time (P)

Full time (F)

Correspondence (C)

14. NET/SLET Completed Details.

______________________________________________________________________________

Class /
Rank

15. Kindly furnish details of Scholarship / Special merit awards?

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
16. Kindly provide details on your extra-curricular activities / hobbies / fields of interest during your
college days,
a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
d) ____________________________________________________________________________
17. Briefly describe in about one hundred words why you choose or desire to choose teaching as a
profession, detailing your strengths and weaknesses as a teacher.
(You may attach a separate sheet of paper)
D) PROFESSIONAL INFORMATION
18. PREVIOUS TEACHING EXPERIENCE (Enclose copies of Certificate)
Name of Institution &
Place

Duration
From
To
Date
Date

Designation

Degrees
Handled

Reasons for
Leaving

19. PREVIOUS WORKING EXPERIENCE (Enclose copies of Certificate)

Name of Institution & Place

Duration
From
To
Date
Date

Total Experience: ___________________

Designation

Reasons for Leaving

Teaching : ____________ Industry : _____________

PG :

_____________ UG

: _____________

20. RESEARCH EXPERIENCE

a) ____________________________________________________________________________
b) ____________________________________________________________________________
c) ____________________________________________________________________________
21. PUBLICATIONS
Kindly furnish list of Papers/Reports/Articles published by you. (Use additional sheets, if necessary)
a) ____________________________________________________________________________

b) ____________________________________________________________________________
22. SALARY STRUCTURE
Your present salary structure or last pay drawn (Last pay certificate may be produced at time of Interview)
a) Basic
b) Dearness Allowance
c) Additional D.A.
d) H.R.A.
e) C.C.A.
f) Any other

: Rs.
: Rs.
: Rs.
: Rs.
: Rs.
: Rs.
_________________
Total Salary per month
: Rs.
_________________
Expected Salary:
Basic Rs. ________________
Total Rs. ________________

Any other benefits

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

E) GENERAL INFORMATION:
23. Languages which you are proficient with:
Speak
_________________

Read
_________________

Write
________________

_________________

_________________

________________

24. Are you a member of any Professional Body / Institute / Society? YES/NO
_________________________________________________________________________________
25. Have you traveled abroad for training or studies? YES/NO
_________________________________________________________________________________
26. Do you (a) Smoke

Yes/No

(b) Consume Alcohol

Yes/No

(c) Other habits

27. If offered the post, time required to join _______________________________________________

F) REFERENCES
28. Please give the names of two references acquainted with your attainments. If related give details of
relationship
a) Name

: __________________________________________________________________

Address
b) Name

: __________________________________________________________________
: __________________________________________________________________

Address

: __________________________________________________________________

c) Additional information, if any (attach separate sheet)

: _________________________________

22. I hereby certify that the above information furnished by me is true and that I agree to appear for an
interview/test if required to do so

Date:

SIGNATURE

ANNEXURE TO BE FILLED BY CANDIDATES AS APPLICABLE

Karunya University, besides imparting vocational guidance also aims to inculcate in its students the
values and discipline. To enable us in this our endeavour, we would like to elicit the following
information from you which may be filled up prayerfully.
A) Your Church affiliation

B) Are you a member of any Christian organization? If so, could you please describe your role in the
organization?

C) Have you had a personal experience of salvation? If yes, please describe briefly.

D) What do you know about different aspects of the Jesus Calls ministry? How have you been associated
with it? Are you or your family members Partners?
(a) JCP - Yes/No (b) KET Yes/No (c) BETHESDA Yes/No (d) Young Partner? Yes/No.

K) Would you be willing to uphold the aims and objectives of the Karunya University, if you are appointed to
a faculty position at the University?

Date:

SIGNATURE