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NATIONAL INSTITUTE OF TECHNOLOGY CALICUT, KERALA
NIT Campus P. O., Kozhikod, PIN !"#!$%, K&a'a
App'i(a)io* +o& )h pos) o+ Assis)a*)
P&o+sso&sagainst backlog reservedvacancies for SC, ST, OBCs
and PWDs and also under OPEN MERT P!oto
"# Post a$$lied for %ssistant Professors in PB&'
`"()**&'+"** %-P `)***
.# De$art/ent0 Disci$line
'# S$eciali1ation
2# T!e categor3 under 4!ic! a$$lication is sub/itted
5Tick4!ic!ever is a$$licable6
SC ST OBC PWD 7R
(# Na/e in B8OC9 letters
)# Date of birt! :# %ge as on "#"*#.*"' ;# Nationalit3
+# Categor3 to 4!ic! t!e a$$licant belongs 5Tick 4!ic!ever is
a$$licable6
SC ST OBC PWD 7n Reserved
"*# Co//unit3
""# Postal address
PN code
".# E&/ail address
"'# Mobile nu/ber
"2# 8and line nu/ber, if an3 4it! STD code
"(# %cade/ic ear of
$assing
Percentage
0 C-P%S$eciali1ation
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SS8C0 ?t! Std
@ig!er Secondar30 .
Bac!elor Degree B%0 BSc0 B# Tec!#
Post -raduate M%0 MSc 0
M# Tec!#
Doctorate P!#D#0 D#Sc#
Ot!er Ranks 5AEE0
-%TE0NET0-RE Score, etc#
")# E$erience in teac!ing
Particulars of 3our $ast e/$lo3/ent in c!ronological order
starting 4it! recent e/$lo3/ent %ttac!
$!otoco$ies
E/$lo3er Post !eldDate of
oining
Date of
leaving
-ross Pa3 4it!
Scale of $ra3
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":# Researc! e$erience
Post P!#D# researc! ndustrial e$erience
Nu/ber of 3ears $eriod
nstitute and ot!er details
Nu/ber of
3ears Details
Title of T!esis
P-
P!#D#
Researc! -uidance if an3
";# Researc! $ublications
S$ecif3 nternational0National n Aournals n Conferences0
S3/$osia
Past five 3ears Total Past five 3ears Total
%4ards and Recognition, if an3 obtained 5attac! $!otoco$ies6
"+# E$erience in ndustr30%d/inistration, if an3
Particulars of 3our $ast e/$lo3/ent in c!ronological order
starting 4it! recent e/$lo3/ent %ttac!
$!otoco$ies
E/$lo3er Post !eldDate of
oining
Date of
leaving
-ross Pa3 4it!
Scale of $a3
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.*# Na/es and address 4it! $osition of t4o Professional
ReferencesF
Na/e Na/e
Position Position
%ddress%ddress
Mobile Mobile
E&/ail E&/ail
."# %n3 ot!er relevant infor/ation 3ou /a3 like to furnis!F
Certified t!at t!e facts, figures and infor/ation $rovided above
are true to t!e best of /3
kno4ledge and belief and t!at if selected, 4ill abide b3 t!e
rules and regulations of t!e
nstitute and also t!e directions given to /e fro/ ti/e to
ti/e#
DateF
PlaceF
Si*a)u& o+ App'i(a*)
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