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FORM NO.

FAC/ 2A

NATIONAL INSTITUTE OF TECHNOLOGY, ROURKELA


SUMMARY SHEET
(To be filled by the Candidate)
1. Name ______________________________________ 2. Date of Birth _________________________________
3. Post _______________________________

4. Department / Centre ___________________________

5. Specialization & Present Research Area _________________________________________________________


6. Education:
Degree

Displine

University /

Year

Board

Division /
Grade/
Percentage
of Marks

Remarks if any
(Rank, Hons etc.)

High
School
(Class- X)
Higher
Secondary
( +2 )
Bachelors
(B.A./B.Sc.)
(B.E./B.Tech)
Masters
(M.A./M.Sc.)
(M.E./M.Tech.)
Doctorate
(Ph.D./D.Sc.)
Others (JEE
Rank, GATE
Score, GRE Score
etc.)
7.

Employment (in descending chronological order starting with the present employer):

Employer

Post

Pay Scale

Period of Employment
From

To

Previous Review,
if any, at NIT,
Rourkela

FORM NO. FAC/ 2A-1

8.

Summary of Performance:

U.G.

P.G.

Courses Developed (No.)


Research Publications

In Journals
Past five years
Total

In Conferences/Symposia
Past five years
Total

Published (Nos.)
Communicated (Nos.)
Thesis Supervised

Completed

In Progress

M. Tech./ M. Phil

Ph.D.

Sponsored Projects

Consultancy Projects

Sponsored/Consultancy
Projects
-

Completed

In Progress

Proposals under

review
Authored

Edited

Books

9.

Special Training / Assignment / Any other relevant Particulars


____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Form No. FAC/2B


Registration No. ____________________
(To be filled by NITR Office )
Signed Photo

National Institute of Technology Rourkela


Rourkela 769 008 (Orissa)
Application Form For Faculty Position

Advertisement No.______________________________Field of Specialisation __________________________


Post Applied for ______________________________Deptt./Centre___________________________________
To be returned to the Registrar, National Institute of Technology, Rourkela-769 008
NIT Rourkela is an Equal opportunity Employer
Appointments are made on the recommendations of Statutory Selection Committee
1.
2.

Full Name (including Surname)


(in block letters)
Date and Place of Birth

3.

Sex

Male / Female (Strike off whatever is not relevant)

4.

Marital Status

Married / Unmarried (Strike off whatever is not relevant)

5.

________________________________________________
________________________________________________

(a) Nationality :
(b) Category:

_______________________________________________
SC

(C) Whether belong to PH Category:


6.
7.

8.

ST
YES

OBC
NO

(a) Mother's Name and Address


(b) Father's Name and Address
Postal Address for correspondence
(any change of address should be
communicated at once to the Institute)

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Pin Code _______________________________________
Telephone No ___________________________________
Mob.No. ______________________________________
e-mail ID______________________________________

Permanent Address
(Mention Tehsil, District and State
you belong to)

_______________________________________________
_______________________________________________
_______________________________________________
Fac-2B-2

9.

Were you at any time declared medically unfit;


asked to submit your resignation; discharged or

dismissed from Govt./Semi-Govt./Autonomous


Body or Private Service ? If yes, give details
In a separate sheet.
______________________________________________
10.

Academic Qualifications: (1) Please attach Xerox copies of certificates including Date of Birth.
(2) Give particulars in a chronological order starting with High School Certificate.

Sl. No.

Degree/

Subject/ Specialization

Certificate

Division/ Grade/

Year

University

% of Marks

/Board

11.

Professional/Teaching/Research Employment (Give particulars in descending chronological order starting


with the present post. If space is insufficient, attach separate sheet)
Sl.No
Employer
Post held
Pay Scale
Basic Pay
Period of Employment
(Month/Year)
From

To

Fac-2B-3
12.(a) Title of your M.Tech./Ph.D. Thesis with name and address of Ph.D. Guide.(Enclose abstract of thesis)
Degree

Title of Thesis

Guide

University

(1) M. Tech,

(2) Ph. D.

(b)Thesis supervised
Degree

M.Tech./M.Phil (Attach separate sheet)


Ph.D.(If space is insufficient attach separate sheet)

Name of Student

Brief Title of Thesis

Year

Co-Supervisor,

Completed

if any

Ph. D.
(1)
(2)
(3)
(4)
(5)
(c ) Sponsored Research/Consultancy Projects - Completed/In progress/Proposal under review
(If space is insufficient attach separate sheet)
_______________________________________________________________________________________
Title of Project Whether
Duration
Amount of
Sponsoring
Co-Investigator(s),
Completed or
Grant
Agency
if any
in Progress
_________________________________________________________________________________________
(1)

(2)

(3)

(4)

(5)

(6)

_________________________________________________________________________________________
(i)

Sponsored Projects
(1)
(2)
(3)
(4)

________________________________________________________________________________________
Fac-2B-4
(ii)

Consultancy Projects
(1)

(2)
(3)
(4)
____________________________________________________________________________________________
(d) Publications :
(i) No. of reviewed publications. [Enclose list of publications in Reviewed Journals (mention co-authors(s),
Title, Journals, Months & Year, Page Nos.)]
(ii)

No. of research papers presented in Conferences {(Enclose list of papers presented in Conferences

(mention co-authors(s), Title, Conference, Month & Year, Page Nos.)}


(iii)

No. of research papers communicated.{(Enclose list of papers communicated (mention Co-

author(s),Title, Journal /Conference)}


(iv)

Review/Research/Degree/Feasibility Reports.

Sl.

Title

No.

No. of

Agency for which

Co-author,

Pages

prepared

if any

(e) Patents/Technology Transfer:


(1)
(2)
(3)

13.
Title
(1)

Books Published:
Publisher

Year

Edition

Level

Reference

Co-author, if any

(2)
(3)

Fac-2B-5
14.
(a)

Teaching Experience:
Teaching at University level:

(i)

Total No. of years

(ii)

Attach list of courses taught at B.E./M.E. level

(iii)

Short-term/Refresher Courses (Conducted/Attached) (attach list)

(b)

Any other teaching - No of years:

(c)

Specialized courses/laboratories developed

(d)

Innovations in teaching:
15.

Education programmes E-Learning

16.
(i)

Short term courses/Continuing Education programmes/Distance


activities undertaken. [Give Details]

Any other information relevant to the post applied for such as :


Membership/Fellowship and position of responsibility in Professional Societies :
(1)
(2)
(3)

(ii)

Prizes/Medals/Awards/Divisions:
(1)
(2)
(3)

(iii)

Scholarship received:
(1)
(2)
(3)

(iv)

Any other awards/activities:


(1)
(2)
(3)

(v)

Attainments in sports and extra-curricular activities (including N.C.C.)


(1)
(2)
(3)
(v)
(1)
(2)

Knowledge of foreign languages:

Fac-2B-6
17.

Reference

(At least names of three referees with their complete postal and electronic
addresses. Referees should be persons with, or under whom, the candidate has
worked)
_______________________________________________________________
________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

18. Copies of documents enclosed:


(i) Outline research proposal (Annexure-I)
(ii) Outline course syllabus (Annexure-II)
(iii)
(iv)
(v)
(vi)

Place :
Date :

Signature of the Candidate

Fac-2B-7
Enclose the following: (Please use clear computer print on A4 size paper only, except
where it is not feasible)
Outline of research proposal that you would like to submit to a funding agency on
joining NIT Rourkela (Annexure I) (Also applicable to internal candidates).
1.

Syllabus of a specialized course in the area that you would like to introduce on joining
NIT Rourkela (Annexure II) (Also Applicable to internal candidates).
2.

One page write-up on significant contributions/innovations through teaching, research,


design, or any other innovative/creative activity during past five years - Annexure III
3.

4.

Details of Research Publications during past five years - Annexure- IV

(a)

Journals
Author(s), Title of the Paper, Conference, Year, No. of Pages.

(b)

In Conferences/ Symposia:
Author(s), Title of the Paper, Conference, Year, No. of Pages.

(c)

Communicated (Separately for Journals and Conferences/ Symposia)

5.

Details of theses supervised: (a) M.Tech.;


Name of student:
6.

(b) Ph.D. - Annexure - V

Thesis title ; Year; Co-Supervisor, if any .

Details of Sponsored/Consultancy Projects handled during past five years -Annexure -VI

Title, Funding Agency, Amounts, Duration and Co-workers, if any.


7.

Details of technology development, transfer patents - Annexure -VII

Note:

Candidates for the posts of Assistant Professor/Associate Professor should attach copies
of grade marks in courses taken during M.Tech./Ph.D. programmes and abstract of Ph.D.
thesis.
All candidates should enclose two copies of the reprints / preprints of three most
significant recent research publications.

Form No. FAC/ 3

NATIONAL INSTITUTE OF TECHNOLOGY, ROURKELA


ROURKELA 769 008 (ORISSA)
ACKNOWLEDGEMENT

Advt. No. ____________________Registration No. __________________________________


Sub : Recruitment to the post of _____________________Deptt. /Center_____________________
Received an application from Dr./Mr./Mrs._____________________________________________
(Candidate to write his/her name above in capital letters)
for the above mentioned post. For any correspondence in future, candidate must quote the
registration number given above.

Date __________________

Office Superintendent
(Establishment/Recruitment)

To
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

(To be filled by the candidate his/her present address)

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