APPLY FOR TEACHING STAFF

Post Applied for *

---Assistant ProfessorAssociateProfessorDirector

Discipline *

---Applied Sciences & HumanitiesEngineeringManagementComputer ApplicationPharmacy

1. Applicant Details

Title *

---Dr.Mr.Miss

Name in Block letters *

Date of Birth *

Place of Birth

Nationality

Gender *

---MaleFemaleOther

Blood Group

Identification Marks

PAN No

Driving License No

Passport No

Aadhar Card No

Bank Account No (HDFC Bank Only) *

IFSC Code (HDFC Bank Only) *

2. Present Postal Address ( in block letters)

Country *

Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo The Democratic Republic Of TheCook IslandsCosta RicaCote D'Ivoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFiji IslandsFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambia TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernsey and AlderneyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMan (Isle of)Marshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands AntillesNetherlands TheNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory OccupiedPanamaPapua new GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent And The GrenadinesSaint-BarthelemySaint-Martin (French part)SamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe

State *

Select State

District *

Select City

City *

Address Line 1 *

Address Line 2

Pincode *

Email Address *

Mobile Number *

Alternate Mobile Number

---

Is Permanent Address Same As Address For Communication?

3. Other Details

Father's Name *

Mother's Name *

Name of Husband/wife (if married)

Details of Family

4.

Category

--Select Category--GENSCSTBCOBCPHESM

5.

Present designation & name of employer (if employed)

Grade and consolidated salary being drawn

6.

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.

7. Educational Qualification:

Institute Name *

Board / University *

Year of Passing *

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks *

Class / Division *

---1st2nd3rd

Regular/Correspondence/Part time *

---RegularCorrespondencePart time

12th / Diploma Academic Details

Institute Name *

Board / University *

Year of Passing *

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks *

Class / Division *

---1st2nd3rd

Regular/Correspondence/Part time *

---RegularCorrespondencePart time

Graduation Details

B.A./B.Sc./ B.Com./B.Tech. (Branch) *

---B.A.B.Sc.B.Com.B.Tech.(CSE)B.Tech.(IT)B.Tech.(ECE)B.Tech.(CE)B.Tech.(Textile)B.Tech.(NE)

Institute Name *

Board / University *

Year of Passing *

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks *

Class / Division *

---1st2nd3rd

Regular/Correspondence/Part time *

---RegularCorrespondencePart time

Post Graduation Details

M.A./M.Sc./M.Com/MBA/MCA/M.Tech. (Branch) *

---M.A.M.Sc.M.Com.M.Tech.(CSE)M.Tech.(IT)M.Tech.(ECE)M.Tech.(CE)MCAMBA

Institute Name *

Board / University *

Year of Passing *

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks *

Class / Division *

---1st2nd3rd

Regular/Correspondence/Part time *

---RegularCorrespondencePart time

Higher Degree Details

Ph.D.

Institute Name

Board / University

Year of Passing

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks

Class / Division

---1st2nd3rd

Regular/Correspondence/Part time

RegularCorrespondencePart time

M.Phil

Institute Name

Board / University

Year of Passing

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks

Class / Division

---1st2nd3rd

Regular/Correspondence/Part time

RegularCorrespondencePart time

Any other Exam

Detail of Exam

Institute Name

Board / University

Year of Passing

---1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014

% age of Marks

Class / Division

---1st2nd3rd

Regular/Correspondence/Part time

RegularCorrespondencePart time

8.

Topic of M. Tech./ M.Phil Dissertation

9.

Topic of research for Ph.D

Field of specialization

Please upload the copies of certificates duplicate

Recent Passport Size Photograph *

10th Marksheet *

12th/Diploma Marksheet *

Graduation Marksheet *

Post Graduation Marksheet *

Higher Graduation Marksheet *

Upload Your Resume *

10. Experience:

Experience A: Academic

Employers Name & Address

Institute/Industry

Duration

From

To

Total Period

Nature of Duties

Emoluments & Scale etc.

Reason For Leaving

Total Experience

Experience B: Academic (After M.Tech)

Employers Name & Address

Institute/Industry

Duration

From

To

Total Period

Nature of Duties

Emoluments & Scale etc.

Reason For Leaving

Total Experience after MTech/MBA/MA/MCA

Experience C: Discipline and Moral
 
Discipline

Self Discipline Explanation

Student Discipline Explanation

Department’s Discipline Explanation

General Discipline Explanation

Moral

Commitment Explanation

Service to Humanity Explanation

Social Awareness Explanation

Scales

A-80% and Above

B-60% T0 79%

C-35% TO 59%

Note: Attach Extra page for Experience B, if necessary
Please specify whether you have ever worked in Panipat Institute of Engg. & Technology.

Total experience (in Yrs.)

Under Graduate Classes

Post graduate Classes

Results of classes taught by you:-

Subject/Paper

Pass %age

Any Other Exam

NETGATE

--Year of Passing--200020012002

11.

A. Paper published in Journals

National

FreePaid

ISSN No

Impact factor/references if any

International

FreePaid

ISSN No

Impact factor/references if any

Attach extra sheets if required

B. No. of Conferences attended (National/International)

C. Papers presented/published in Conferences (National/International).

National

Nos.

ISSN No. of proceedings

International

Nos.

ISSN No. of proceedings

Attach a list of publications is respect of each category mentioned above.

D. No. of books published

Detail of publishers

ISSN No

E. Detail of Patents (if any)

12. Extra Curricular Activities (Sports, Social, Literary Activities, N.C.C./N.S.S.) etc.

Name of Activity

Level/Name of the Competition

Year

Position Achieved

13. Conference/Seminar organized by you: (Attach list).
 National Conference

Name of Conference

Place

Date

Sponsored/Faculty

International Conference

Name of Conference

Place

Date

Sponsored/Faculty

14.

Any other achievement you would like to mention:

15.

Have you ever been connected with any political party? If so give details

Do you have any contract/ bond with your present employer? If yes, give details

Do you consume liquor?

Yes/NoYesNo

Are you used to gambling?

Yes/NoYesNo

o you have any relative working in PIET or any relation with any member of the Managing Committee (if yes, furnish details)

D.

Please state whether you are pursuing any course of studies at present? If yes, give details

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. You will not undertake any part-time job including coaching/tuition etc.

If selected, when can you join?

Salary Acceptable

Name & Addresses of two references, not relatives:

Name

Address

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 given by me may result in termination of my services ipsofacto.

Place *

Date *

(APPLICANT’S SIGNATURE) *