Beruflich Dokumente
Kultur Dokumente
Date: 15/03/2015
1.
2.
(b)
(c)
Nationality: INDIAN
(d)
(f)
Sex: MALE.
Driving License No: NA
Passport No: NA
Present Postal Address ( in block letters): H.NO 16/1, SHARDA COLONY, PATOLI
5.
Category: GENERAL
7.
Have you ever been prosecuted, kept under detention, fined, convicted by a Court of Law
for any offence or debarred/disqualified by any University, Public Service Commission
from appearing at its examinations/selection? Is any case pending against you in any
Court of law at the time of filling up of this application form? If the answer is Yes full
particulars of the case, detention, fine conviction, sentence etc. should be given.
NO
9.
Sr.
No
.
Exam. Passed
1.
2.
3.
Matric
10+2/Diploma
B.Tech.Chemical engg
4.
JKBOSE
JKBOSE
DCRUST
IIT
M.Tech. Chemical engg Guwahati
Year of
Passing
Marks %
Regular/Cor
respondence
/Part time
MIER Jammu
MIER Jammu
DCRUST
2006
2008
2012
90.4
84.66
69.25
REGULAR
REGULAR
REGULAR
IIT Guwahati
2014
86.5
REGULAR
10.
11.
12.
Experience:
NA
Institute/
Industry
Duration
From
To
Total
Period
Nature
Duties
of Emoluments
& Scale etc.
Reason
For
Leaving
Please specify whether you have ever worked in any Mukand Lal Institution.
NO
Total experience: Under Graduate Classes..Yrs.
13A.
Semester :
Year:
Subject
%
Semester :
Year:
Subject
%
Semester :
Year:
Subject
%
National
International
Free
Paid
Free
ISSN No.
Impact
factor/references if any
0165-2370
3.070
Paid
2
B.
National
International
Attach a list of publications is respect of each category mentioned above.
C.
D.
Detail of Patents..
14.
Name
Activity
1
Year
Position Achieved
2014
NA
3RD
NA
POSTER PRESENTATION AT
REFLUX- THE ANNUAL
2
3
MUMBAI
15.
Conference
Name
Conference
of Place
Date
Sponsored/Faculty
National
International
16.
CERTIFIED COURSES
17
Have you ever been connected with any political party? If so give details NO
Do you have any contract/ bond with your present employer ? if yes, give details NO
Do you consume liquor ?
: Yes/No
NO
: Yes/No
NO
Do you have any relative working in Seth Jai Parkash Mukand Lal Institutions of Knowledge
and Service for any relation with any member of the Managing Committee (if yes, furnish
details)
..
NA
3
Please state whether you are pursuing any course of studies at present? If yes , give details
.NA
Please note that:
(a)
You will not be allowed to undertake any further studies during your employment without
prior written permission of the competent authority.
(b)
You will not undertake any part-time job including coaching/tuition etc.
If selected, when can you join ?
: YES
Salary Acceptable
: 45 k
IIT Guwahati
Guwahati- 781039
pin: 131039
I declare that the information given above is true and correct to the best of my knowledge and
belief & nothing has been concealed therein. I am aware that any false or incorrect information
by me may result in termination of my service with the institute. I have no objection, if you
enquire from any of my previous employers on any matter pertaining to me, if I join your
institute.
Place: Surat
Date: 15/03/2015
Mithelesh Koul
(APPLICANTS SIGNATURE WITH DATE)