SIKKIM UNIVERSITY

[A Central University established byr the Act of Parliament of India, 2007]

6th Mile, Samdur, Tadong, P. O. Gangtok‐737102
Telephone: 03592-250228/251415; Fax: 03592‐251067
Email: sikkimuniversity@gmail.com ; Website: www.sikkimuniversity.in

Application Format
[Regular Teaching Positions]

1. Advertisement No. & date ………………….

2. Application for the post of: ………………..
3. Department of:………………………………

4. Name of the Applicant (in block letters) : ………………………………………………………

5. Mother’s and Father’s names : ………………………………………………………
6. Telephone/Mobile number : ………………………………………………………
7. E-mail ID : ………………………………………………………
8. Date of Birth & Age : ………………………………………………………
9. Marital Status : ………………………………………………………
10. Whether belongs to:
a) Scheduled Caste : Yes/No
b) Scheduled Tribe : Yes/No
c) Other Backward Class* : Yes/No
d) Differently Abled : Yes/No
(Please attach a copy of certificate issued by competent authority)
*as per the list recognized and notified by the Government of India and those who do not come under Creamy Layer.

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11. Present Address for Correspondence : ………………………………………………………
……………………………………………………….
……………………………………………………….
12. Permanent Home Address : ………………………………………………………
………………………………………………………..
……………………………………………………….
13. Place of birth : District: ………………………….
State: …………… Country: …………….
14. Academic Qualification (Please attach attested copies of certificates)

Sl. Examination passed Division Subjects Year of Board/ Distinction

No. with % of passing University achieved,
marks if any

1 High School

2 Inter/Senior Secondary

3 B.A/B.Sc./B.Com/B.Pharm.

4 M.A/M.Sc./M.Com./M.Pharm

5 M.Phil.

6 Ph.D.

7 Technical/Vocational/Other
(to be specified)

8 NET/SLET for Lecturership

Title of Ph.D. and/or M.Phil. Thesis :……………………………………………………………..

15. Awards/Prizes :………………………………………………………………

16. Scholarships and Fellowships with details

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 a) At Undergraduate level : ………………………………………………………
b) At Graduate level :………………………………………………………
c) At Post-graduate level :………………………………………………………

17. Details of Employment (Starting from the present position):

Sl. Employer Designation Last pay Nature of Period

No. drawn with assignment
pay scale From To

18. Teaching and Research Experience:

a) Teaching
Courses Year/Duration
Class/Institution

Undergraduate level

Post-Graduate level

b) Research (excluding M.Phil./Ph.D. research)

Class/Institution Year/Duration

Undergraduate level

Post-Graduate level

(Note: Please ensure that the periods of teaching and research experiences claimed do not overlap.)

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 c) Supervisor for research degrees (give numbers):

Degree Submitted Number of

University/Institution Awarded/Year
Thesis/Year Research
Scholars working
under you
Ph.D.

M.Phil.

Others, if any

d) i. Details of significant contribution to knowledge: …………………………………………..

…………………………………………………………………………………………………
…………………………………………………………………………………………………

ii. Evidence of being actively engaged in research or innovation or in teaching methods or

production of teaching material: ……………………………………………………………….
…………………………………………………………………………………………………
…………………………………………………………………………………………………

iii. Experience of Industry/NGOs or Professional Field which should include innovations

and/or Research development: …………………………………………..………………..

(Use separate sheet and enclose, if necessary)

19. Publications in indexed/ISBN/ISSN numbered journals/books (Give number of publications only):

Publications Published Accepted for publication

National International National International

Research Papers

Books and
book-chapters
Policy Papers

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 Articles

Patent

20. List all your papers published in peer-reviewed and indexed journals:

(Please attach a separate sheet listing your publications in details about authors, title, year, full name of
journals, volume number and pages).

21. List books and book-chapters written or edited by you.

(Please attach a separate sheet listing your publications in details about title, authors, year, publishers, place
of publication, total pages and ISBN/ISSN number).

22. Details of visits abroad:

Sl. No. Country Period
Organization Purpose
From To

23. Seminar/Conference/Workshop attended as speaker:

Sl. No. Name of Seminar/Conference/Workshop Institute/Place Title of Date
presentation

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24. State briefly why do you consider yourself fit for the post applied for (use separate sheet and
enclose, if necessary) :…………………………………………………………………………...
………………………………………………………………………………………………………
………………………………………………………………………………………………………

25. Mention briefly your extra-curricular activities, including the administrative post held, if any,
under the following heads (use separate sheet, if necessary):

a) College/University Administration: ……………………………………………………………

………………………………………………………………………………………………..

a) Extra-curricular activities of students:………………………………………………………….

……………………………………………………………………………………………….…
b) Literary, cultural or other activities (e.g. Attainment in sports, NCC etc.) :……………………
………………………………………………………………………………………………….

26. a) Have you ever been dismissed from service? : Yes/No

b) Have you ever been arrested/prosecuted/kept in detention/bound down/fined/convicted by a
court of Law or whether any case is pending against you in a Court of Law? : Yes/No

c) Have you ever been debarred from any examination/rusticated by any University or any other
educational institution or whether any case is pending against you in any University or any other
educational institution? : Yes/No
d) If the answer to any of the above question is ‘Yes’ give details:………………………………..
………………………………………………………………………………………………………
27. Name and address of three referees, who should be responsible persons, not related to the
candidate but well acquainted with him/her work.

1. Name:……………………. 2. Name:……………………3. Name:…………….........

Address:……………………. Address:…………………… Address:……………….

…………………….. ……………………. ……………….
……………………. ……………………. ………………
Ph. No:…………………….. Ph. No: ……………………. Ph. No: ………………

E-mail:…………………… E-mail:……………………… E-mail:……………….

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 28. Particulars of Demand Draft : (a) Number & date :……………………….…
(b) Amount :……………………….…
29. If appointed, joining time required from the date of appointment:……………………….

30. For any other information not covered above, please attach additional sheet.

31. Write the exact source of advertisement from where you came to know about these opportunities
in Sikkim University : ……………………………………………………………………………...

32. DECLARATION

I ……………………………………………….. certify that the foregoing information is correct and

complete to the best of my knowledge and belief. I am not aware of any circumstance which may
impair my fitness for employment in SIKKIM UNIVERSITY and if at any point of time any entry is
found to be incorrect, suitable disciplinary action may be taken against me.

Date: Signature of the Applicant

33. Details of enclosures:

a)
b)
c)
d)

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 SUMMARY SHEET
Paste (do not staple)
For Official use only a recent passport
size photograph of
the applicant.

Post Applied For

Name
Date of Birth and Age [As on 23rd May 2011]
SC/ST/OBC/DA
Place of Birth
Qualific- Post Graduate ( subject, % of marks,
ation institution and year of passing)
M Phil or its equivalent ( Subject, % of
marks , institution and year of passing)
Ph D [Institute/University and year of
completion]
UGC NET / CSIR Exams
Area of Specialization(s)
Current Employment and Full address of the
Institution
Experience Teaching Experience
(only full- time) Research
[in yrs] Professional
Supervision of Research [MPhil, PhD or equivalent
degrees]
Book/Conference National
Proceeding * International
Book Chapter/ National
Publication Conference International
[mention Proceeding paper*
only Journal Paper/ National
numbers] Article * International
General Article National
International
Seminar/Conference/Workshop Presentation[number]
Professional Training Attended [in No]
Foreign Visits for Academic Purpose [mention the
name of the Country/countries]
Suitability of the Candidate for the post [self
declaration] #
Other Information [if any]
Remarks
*only with ISBN /ISSN No # Attach separate sheet if required

I ……………………………………………………………………………………………………………….hereby certify that the information given

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above are true to my knowledge and belief. In case at any stage it is found that the information given by me is false/
incorrect Sikkim University shall have the right to reject my application.

Signature of Applicant: