Shree Swami Atmanand Saraswati Institute Of Technology

Shree Swami Atmanand Saraswati Vidyasankul

Kapodra, Varachha Road, Surat-395006.
Visit us at: www.ssasit.org Email: ssasit@yahoo.in

Application Form For Teaching Staff

Advertisement No: 01/2012
.

Post Applied for

:______________________________________________

Department

:______________________________________________

Specialization

:_______________________________________________

1.

Please affix
duly signed
recent
passport size
photograph

(i) Full Name (In Block Letters) :

______________________________________________________________
(As in HSC Marksheet)
(ii) Fathers / Husband Name: ____________________________________________________________

2.

Date of Birth : _________________

Age [(as on date) completed years] ____________________

3.

Gender: Male / Female

Marital Status: Married / Unmarried

4.

Correspondence Address: ___________________________________________________________

_______________________________________________________________________________
_________________________________________________________Pin ___________________
Phone No. : Office: ________________ Res: _________________ Mobile: ___________________
E-mail ID : (i) _____________________________ (ii) ___________________________________

5.

Do you belong to (Please tick ) : SC / ST / OBC / Person With Disabilities (PWD)/ ExServiceman /
Dependent of Defense personnel killed/Disabled in war action):
____________________________________________________

6.

Post held at present:

Post held at
present *

Date of
Appointment

Nature of the Post

(Temporary /
Probation/ Permanent)

*Copy of appointment order is attached:

Name & Address of Employers

with present salary

Yes / No

Type of organization (Government / Semi Government / Grant in Aid) _____________________

[Shree Swami Atmanand Saraswati Institute of Technology]

Page 1 of 4

7.

Educational Qualifications: (From Undergraduate Onwards)

Sr.
No.

Examination
Passed

Name of the
University

Year of
Passing

Class/
Percentage
/ CGPA

No. of
attempts

*Equivalent
Percentage in
case of CGPA

1
2
3
4
* Proof of Conversion from CGPA to percentage is a must.
8.

Prizes,

Awards,

etc.:_______________________________________________________________

____________________________________________________________________________________
9.

Professional / Educational Experience: (From Present Post to Back)

Sr.
No.

Employers
Name

Post
held

Pay Scale

Total
Emolument

Length of Service
(date)
From

10.

(a) Total Experience

Nature of work

To

: _______________ Year(s)

_______________ Month(s)

(i) Teaching Under graduate : _______________ Year(s)

_______________ Month(s)

Post graduate

: _______________ Year(s)

_______________ Month(s)

(ii) Research

: _______________ Year(s)

_______________ Month(s)

(iii) Industrial

: _______________ Year(s)

_______________ Month(s)

Any Break in Service

: Yes / No

If Yes state the period of break : _______________ Year(s)

_______________ Month(s)

& reason_______________________________________________________________________

[Shree Swami Atmanand Saraswati Institute of Technology]

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(b) Research Activities: (Excluding M.Tech. Dissertation & Ph.D. Work)

Sr.
No.

Duration (Date)

Degree Registered /
Project under taken

From

To

University /
Sponsoring
Authority

Funds
Sanctions

Present Status

(c) Publication:

National Journal
Sr.
No.

Name of Journal

Volume No.

Month /
Year

Title (In Short)

International Journal
Sr.
No.

Name of Journal

Volume
No.

Month /
Year

Venue

Title

Conference / Seminar
Sr.
No.

Name of Conference/
Seminar
International Conference/
Seminar

Month /
Year

Venue

Title

National Conference/
Seminar

[Shree Swami Atmanand Saraswati Institute of Technology]

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(d) Other Activities:

(i)
(ii)
(iii)

Number of Expert Lectures Delivered: ________________________________________________

Number of Summer / Winter schools / Training Programmes: ____________________Organized
Number of Seminar / Conference / Workshop / Networking: ___________Programme Organized

Administrative & Community Services:(e.g. Dean/ Vice-Principal/ Principal/ Hostel Warden/ HOD/ Dept.
Incharge/Chairman - Board of Studies/ Self Development Programmes for community Services)
Sr.
No.

11.

Name of Assignment

Duration

Name of Responsibility Shared/Service

Offered

Member of Technical Societies : ____________________________________________________

______________________________________________________________________________

12.

Please give details of two References:

(i) Name: _________________________

13.

(ii) Name: ____________________________________

Designation: ____________________

Designation: ________________________________

Full Address: ____________________

Full Address: ________________________________

_______________________________

__________________________________________

Contact No. & Fax _________________

Contact No. & Fax ____________________________

E-mail: _________________________

E-mail: ____________________________________

Extra Curricular activities / Hobbies :___________________________________________________

______________________________________________________________________________

14.

Any other relevant information : _____________________________________________________

DECLARATION
I declare that the statements made in this application are true to the best of my knowledge and belief.
I understand that misleading or wrong information supplied may lead to immediately rejection of
application/ appointment if found subsequently.

Date:
Place:

_____________________
(Signature of Applicant)

[Shree Swami Atmanand Saraswati Institute of Technology]

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