PSG INSTITUTE OF ADVANCED STUDIES : COIMBATORE-641 004

                                                                                                                                 

Faculty/Teaching Staff Recruitment  – PERSONAL DATA

Applied for the POSITION/ DEPARTMENT:   _____________adafgadf______________ / _______________________

1. Name              :   Dr./Mrs./Ms./Mr./

2. Gender                :   Male/Female

3. Marital Status     :  Single/Married                                                                                          

4. Name of Father:                                     Husband:        

5. Date of Birth  :  Date/Month/Year :              /          /                                             

6. Address:                                  

Permanent:

Communication:

        

        

7. Contact Details:     

     Mobile No:                                                           Email Id:  

                                                   

8. Personal Details (For Statistical Purpose Only):

     Religion:                                                              Community:                                    

     Mother Tongue:                                             Category (Please Tick (√)):   OC /BC /MBC /SC /ST

     Languages known:

Language

Speak

Read

Write

                

9. Educational Qualifications/ Academic Background:

Sl. No.

Course

Degree / Major Subject

School/ College/University

Year of Completion/ Graduation

% Marks / Class obtained

 Full time/

Part time Corres./

1

Matric/

SSLC

2

+2

3

UG

4

PG

5.

Ph.D

6.

Others

Special achievements in academics, if any, such as Best student, Gold medal, University Rank etc.

Certification Courses Completed, if any :

Arrears details :

Arrears

Total Number of  subjects

Total Number of  Attempts

UG

PG

: 2  :

10. Publications:

 Books Published:            

S No

Publisher

Title/ Co authors

Year of Publication

Journal Papers published (in reputed, refereed Journals, Numbers ONLY):

Scopus

Web of Science

Any Other

h index

Citations

11. Work Experience:

        

Teaching/ Research/Industry Experience:

S

No

Name & Address of the Institution/  Designation

Period/ Duration

Month/Year

Whether Service Certificate available: Yes/No.

Reason for Leaving

From

To

1

2

3

4

5

                                       

                                                 TOTAL

         years

  months

12. References:

S No

Name

Designation

Organization

Mobile No.

1.

2.

13. If presently employed, last drawn monthly pay      : Rs.

14. Pay expected, if selected                                            : Rs.

15. Joining time required, if selected                              :

16. In case of Close relatives/Known Persons employed in PSG Institutions, furnish full details:  

Name

Relationship

Institution

Designation, Length of Service in Years

        

17. Any other information of importance               :

I hereby declare that the information furnished herein above is correct and true to the best of my knowledge.

        

Date:                                                                                                            Signature