SAMRAT ASHOK TECHNOLOGICAL INSTITUTE,

VIDISHA
(A Grant-in-Aid Autonomous Engineering College)

Recent
Photo

(Established in 1960)

Website: www.satiengg.org, email: sati@satiengg.org

Phone: (07592)250295, 250297, 250121, Fax: (07592) 250124
1.

Post applied for

Name of Department
Category (SC/ST/OBC/UR)

2.

3.

Name of applicant in Block

Letters.
Name of the
Father / Husband
Marital Status
Gender
Address:
Address for Communication

Pincode:
Mobile No.
Phone no. (with STD Code)
Fax No.(With STD Code)
E-Mail. ID
Permanent Address

Pincode:
4

Phone No(With STD Code)

Date of Birth

5.
6.
6.1

Place of Birth, District and State

Nationality
Details of Qualifications
General Education Qualifications :

No
.

Degree/ Std

1.

10+2/Higher Secondary

2.

B.E./B.Tech./B.Sc./
Diploma

3.

M.E./M.Tech./M.C.A./
M.B.A./ M.Sc.

4.

M.Phil.

5.

Ph.D.

6.

Other (specify, if any)

Date

Branch/
Specializ
ation/
Subjects

%age
marks/
CGPA/
Class

Month

Year of
Passing

Year

Institution
Studied

Univer
sity/
Board

Formal/
(FT/PT) /
Distance
Education

Proof
furnished
(Encl. No.)

6.2

Details of GATE/NET/SLET Qualification (if Applicable)

Subject

Percentile/Grade/Marks

Year

Valid up to

GATE
NET
Any other
6.3

Three subjects of interest for Teaching

1.

....

2.

....

3.

....

6.4

Research Experience (Excluding Ph.D/M.Tech duration)

7.

Thesis detail:
7.1 Title of thesis at Doctorate
Level Including date of
Registration and date of award

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

7.2 Whether the Ph.D. awarded through a

Process of admission, registration, course
work and external evaluation as have been
laid down by UGC regulations,
2009 (Yes/No)
If Yes attach appropriate supporting
documents

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Encl. No. -------------------------------------------------------

7.3 Title of thesis at Masters

Degree level including date of
Admission and date of completion
(FT/PT)

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

8. Details of Experience (Evidence to be enclosed)

Name and Address
of the Institution/
Organization

Post
Held

Scale
of pay/
Salary
Drawn

Period of
service

Duration

From

Y
Y

To

MM

Proof
(Encl.no.)
DD

Present
Employment
(Service Up To
July2016)
Employment
Before the
present
employment if
any

9.

Post Ph.D. experience :

10.

Publications (Attach separate sheet wherever necessary)

10.1

10.1.1

(Total Experience ______________________ years)

a. No of publications in referred
National
National & international Journals

International

b. No. of publications in conference National

International

Detail of publication as per the given order(to be given in separate sheet ) Authors, Title;, Year,
Name of the Journal , Vol.No., Page No., Mention cumulative Impact Index of Journal, if any.

10.1.2

11

No. Of Books Published

10.1.3

Detail of books as per the given order (to be given in a separate sheet) Authors, Title, Year,
Name of the Publisher

10.1.4

No of patent filed / granted

10.1.5

Details of patents filed / granted with year of approval and granting authority.

National

International

Other Activities:
1. No. of expert lectures delivered (furnish details)
2. No. of Summer/Winter school/Training programs organized/attended (furnish details)
3. No. of seminar/conference/workshop organize/attended (furnish details)
4. Administrative & communicative services (e.g. Dean/ Vice-Principal/ Principal/ Hostel warden/
HOD/ PIC/ Chairman BoS or examination committee/Self development Programme for community
services)
S.No.

5.
6.

12
a.

From

To

Position held

Responsibilities

Sponsored Projects undertaken (Give details)

Consultancy/Testing works undertaken (Give details)

Detail of supervision/Research Guidance

No. of students supervised/ guided/guiding (ME/M.Tech./ M.Phil.)
M.E./M.Tech/M.Sc/M.Phil
Co-Guided
Guiding

Guided

Co-Guiding

b. No. of students supervised/ guided/guiding (Ph.D.)

Ph.D.
Guided

13

Co-Guided

Guiding

Membership in professional Societies

14.1. Total No. of Membership in professional societies
14.2. Details of membership
in professional societies
and Country of
Incorporation

1
2
3
4

14

Prizes, Medals & other honors received, if any (Attach separate sheet)

15

Languages known
Language

16

Co-Guiding

Speak

Read & Write

Speak, Read & Write

Have you got any Research Scheme sponsored by Local or National (UGC, CSIR, ICAR, DST, etc..) or
International (UN, UNESCO, WHO, FAO) agency? Give details (grant number and other particulars)

17

18

19

Name and Address of two persons (not related by blood or marriage) to whom confidential reference could
be made.
Note: They should be in a position to report the suitability of the position you are seeking now.
1.

2.

e-mail:
Telephone:

e-mail:
Telephone:

Name and Address of two persons (who are not related) from whom you have enclosed your testimonials)
1.

2.

e-mail:
Telephone:

e-mail:
Telephone:

(a) If married, give details of employment of your spouse.

(b) Is your spouse employed in this Institute?
If yes, give details
(c) Is your spouse also applying for any of the post in the Institute?
If yes, give details

20

State minimum salary acceptable.

21

Have you been a candidate for any post advertised by the Institute?
If yes, give details

22

Give details, if any of (1) Proficiency in games, sports and athletics and (2) part taken in other extra
curricular or social activities
1.

2.

a. Details of Proficiency in games and

athletics particulars of Prizes, medals,
trophies be mentioned.
b. Details as to period and rank, if any
should be given if the candidate has
been member of
i) The university training corps of National
Cadet Corps or
ii) The Home Guard Civil Defense Force.
Details of part taken in other extra
curricular activities such as being prefect
monitor, office held in connection with
debating and other literary or scientific
societies of School, College or University.
Proof furnished (Enclosure No.)
1. At School
2. At College or University
3. Afterwards

23

Additional Remarks: Applications may mentioned here any special qualification or experience befitting for
recruitment to the service, which has not been given under the above heads, if the space below is
insufficient for the purpose. Necessary particulars may be given in a separate sheet or paper, which
should be attached to the applications.

24

Give details, if you have been at any time (a) pronounced unfit for Government Service (b) dismissed,
Removed or debarred from Government service or (c) Convicted in a Criminal Court.

25

State clearly how you satisfy the requirements of the advertisement in respect of qualification & experience.

26

DD particulars
Name of the Bank &
Branch

27

List of enclosures

Demand Draft No.

Date

Amount(Rs.)

1 .
2 .
3 .

28

Declaration
I hereby declare that all the information given in this application is true to the best of my knowledge
and belief. I understand, if any of the information furnished by me above is false, the Institute will
summarily reject/ terminate my candidature/ services at any point of time.
Date :
Place:

29

Signature

No Objection Certificate of Employer :

Forwarded the application of Shri/Smt./Ms/Dr. ....
working as a in the Deptt. ...
in (Temp/Permanent/Regular) position since .. and is drawing
salary Rs. .. in the scale of Rs. ...
Institute/Organisation has no objection if he/she join S.A.T.I., Vidisha (M.P.)

Date :
Place:

N.B.:

Signature of Head of Institution/Organization

Official Seal
Every application must be accompanied by self Attested Xerox copies of
documents in support of claims made by the candidate in respect of his date of
birth, academic qualifications, practical training, experience and caste etc., A list
of copies of certificates etc., attached to this application must be given.

SAMRAT ASHOK TECHNOLOGICAL INSTITUTE: VIDISHA (M.P)

DATA SHEET SUMMARY

Post Applied for : .Department :

Applied Category (GEN.OBC/SC/ST) : ...

D.D. No./Cash Receipt No. : ..Amount Rs. :

Name of the Candidate

Address for Communication

City : ..
Pin Code: .
e-mail ID :
Land Line No. (with STD code)

Date of Birth

Academic Qualification
No
.

Cell No.
(In words)

Degree/ Std

1.

10+2/Higher Secondary

2.

B.E./B.Tech./B.Sc./
Diploma

3.

M.E./M.Tech./M.C.A./
M.B.A./ M.Sc.

4.

M.Phil.

5.

Ph.D.

6.

Other (specify, if any)

Branch/
Specializ
ation/
Subjects

%age
marks/
CGPA/
Class

Year of
Passing

Institution
Studied

Univer
sity/
Board

Formal/
(FT/PT)
Distance
Education

Proof
furnished
(Encl.
No.)

GATE/ NET/ Other .. Percentile ...Year of Qualifying ,,,,,,.

Details of Research Publications

Journal (Accepted)
National

Seminar/Conference (Accepted)

International

National

International

Seminar Conference
Training Programme/Seminar/
Conference Organised
National

International

Training Programme/Seminar /Conference

Attended
National

International

No. of Books Written :

Projects/Consultancy/Testing undertaken

Experience

Teaching

Industrial

No. of Books Reviewed : ..

Research

Others

Total

Post Ph.D

Year
Months

No. of Awards Received

Any other useful information

DECLARATION
I, hereby, declare that all the information given above, are true to the best of my knowledge and belief and in case it
is proved otherwise, I shall be liable for dismissal.

Date : ...

Signature:

....

Place :

Name of Candidate : ..