CENTRAL UNIVERSITY OF PUNJAB City Campus, Mansa Road Bathinda-151 001 (Punjab) India Website: Application form for post of Research Assistant for the ICSSR sponsored Project entitled “ A Study on Women Entrepreneurship in Agro-Based Industries in Punjab: Challenges and Opportunities” Advt. No. Pro-39 (2017) Reg. No. _______________ (to be filled by the Office) Personal details 1. Name (in Capital Letters) First Name Middle Name Surname 2. Date of birth Day Month Year Age as on date of advertisement Years Months 3. Place of birth City/ Village State Country 4. Father’s name 5. Mother’s name 6. Nationality 7. Gender: 8. Marital status 9. Community/Category (delete those not applicable) 10. If physically disabled, indicate the relevant particulars If applicable, Write ‘yes’ Percentage of disability S.No. of proof enclosed a. Blindness or low vision : b. Hearing impairment c. Locomotor disability or cerebral palsy (includes all cases of Orthopedically handicapped 11. Educational qualifications (Attach additional pages, if required) Name of the course Name of the Board / University Month & Year passed Division % of Marks CGPA (if grading is applicable) Subjectsstudied S.No. ofproof enclosed 10th Class / equivalent 10+2 /equivalent Bachelor’s degree Master’s degree M.Phil. / equivalent Ph.D. Indicate specifically whether Ph.D. degree has been awarded : Yes / No Whether Ph.D. degree was with course work or not Yes / No
NET/SLET for lectureship, if any Subject Roll No Year Position Any other exam passed 12. Chronological list of experience (including current position/ employment) Designation Scale of pay Name & address of employers Period of Experience Nature of work / duties S.No. From date To date No. of years/ months (As on date of advertisement) 13. Academic distinctions S.No. ofproof enclosed Name of the Academic Course / Body Academic distinction obtained 14. Publications, if any (Mention here only numbers. The details and copies of the reprints be appended) Research Papers in SCI Journals S No Authors Title of the Paper Journal’s Name & Place of Publication Publication & ISSN Vol./ Page No/ Year Impact Factor
17. Research Projects (only externally funded) Title of projects completed Funding Agency As PI/CO-PI or Investigator Amount of grant and duration Title of ongoing Projects 18.Peer recognitions Award/honours Agency Year S.No. of proof enclosed 19.Names and complete postal addresses of 3 referees (The referee should be the last employers of the candidate or any other person having know-how of candidate’s experience/knowledge and should not be related to the applicant) Names & complete postal addresses Referee-1 Referee-2 Referee-3 Email: Phone (Landline) with STD Code: Mobile Ph: Fax: 20. Present Position Designation Name of the University / institution Basic Pay (Rs.) Pay Scale (Rs.) Gross Pay /Total Salary p.m. (Rs.) Increment date (Date/Month) S.No. of proof enclosed 21. Time Required for Joining if selected: ONE MONTH 22. Any other information/ qualification relevant to the post applied for:
13.Peer recognition (Fellowship of National/international organizations, editor of national/International journals/ Significant contribution in work place developmental Activities Present Designation Name of the University / institution Basic Pay (Rs.) Pay Scale (Rs.) Gross / Total Salary p.m. (Rs.) Increment date (Date/Month) Signature of the applicant