MANIPUR UNIVERSITY: CANCHIPUR

(A Central University Established by the Parliament)

Application Form for Assistant Professor

Post applied for :
Department/Centre :
Specialization of the post :

Category of the post applied for ☐

:UR OBC ☐SC☐ ST☐PWD☐ EWS☐
(Tick the applicable)
If applying for more than one posts, give details :
If applied for a post/posts earlier in response to
previous advertisements of the University, give details :
(For office use only) Manipur University
Date of Receipt: Website: www.manipuruniv.ac.in Paste your recent
passport size
No. of Enclosures Claimed Advertisement No. photograph here
and sign across the
Attached photo so that part
of signature should
be on form
(Signature)

Details of fee payment (The requisite fee has to be remitted e-transfer to HDFC MU Fee Account No.50100302970582 IFSC
Code HDFC0001999).
Transaction ID Date Amount Mode of Payment Name of Bank and Branch
(attach receipt) (Online/Cash at Bank Counter)

1. Name First Name Middle Name Surname

(In Capital Letters)

2. Date of birth Day Month Year Age as on last date of Years Months
advertisement

3. Place of birth City/Village State Country

4. Father's Name:
5. Mother's Name:
6. Nationality:
7. Gender:
8. Community/ Category If SC/ST/OBC/PWD/EWS, give details:
(Please strike out whichever
options are not applicable) S. No. of proof enclosed :
9. Marital status:
10. If differently abled (PWD), indicate the Yes/ No Percentage of S. No. of proof of
relevant particulars disability enclosure
a. Blindness or low vision:
b. Hearing impairment
c. Locomotor disability or cerebral palsy (includes
all cases of Orthopedically handicapped)
11. Details for contact

(a) Mailing address: (b) Permanent address:

(c) E-mail: (d) Mobile/Telephone:

12. Educational qualifications (Add additional sheets in the same format, if required)
Name Name of Year Divis CGPA % of Marks Subjects S. No. of
of the Board/ passed ion (if grading is (pl. indicate studied proof of
course University applicable) equivalent to enclosure
CGPA also)
(a) (b) (c) (d) (e) (f) (g) (h)
10th Class /
equivalent
10+2/Hr. Sec.
equivalent
Bachelor's
degree
Master's degree

M. Phil. Title:

Ph. D./D.Phil. Title:

Subject Roll No. Year

NET with JRF
NET
SLET/SET

13. Teaching experience (Add additional sheets in the same format, if required)
Design Scale of pay & Name & address of Period of Experience S. No. of proof
ation present Basic & AGP employers From To Duration of enclosure
(a) (b) (c) (d) (e) (f) (g)
14. Details of Post-Doctoral Experience (Add additional sheets in the same format, if required)
Agency Host Institution Period of Experience S. No. of proof
of enclosure
From To Duration

15. Awards/Fellowships (Add additional sheets in the same format, if required)

Name of the Awarding Body/Organization Name of the award Level: S. No. of proof of
International/National/State enclosure

16. RESEARCH PUBLICATIONS AND ACADEMIC CONTRIBUTIONS

16(A). Research Papers in Peer-Reviewed or UGC listed Journals (Add additional sheets in the same format, if required)
†
S. Title of the paper Journal with volume, ISSN/ Impact Whether you S. No. of
No. page nos. and year ISBN factor are the first or proof of
No. corresponding enclosure
author

†
Impact factor to be determined as per Thomson Reuter list.
16(B). Publications other than Research papers
16(B)(i). Books authored/edited and published by International/National Publishers (Add additional sheets in the
same format, if required)
S. Book Title Name of the Publisher Whether ISSN/ Whether you are S. No. of
No. International ISBN No. the first proof of
or National author/editor enclosure

16(B)(iii). Chapters authored in edited Books and published by International/National publishers (Add additional
sheets in the same format, if required)
S. Chapter Book Title Name of the Whether ISSN/ Whether S. No. of
No. Title Publisher International or ISBN No. you are the proof of
National first author enclosure

16(B)(ii). Books translated and published by International/National Publishers (Add additional sheets in the same
format, if required)
S. Book Title Name of the Publisher Whether ISSN/ Whether you are S. No. of
No. International ISBN No. the first author proof of
or National enclosure

16(B)(iv). Chapters (translated work) in Books and published by International/National publishers (Add additional
sheets in the same format, if required)
S. Chapter Book Title Name of the Whether ISSN/ Whether S. No. of
No. Title Publisher International or ISBN No. you are the proof of
National first author enclosure
16. Invited lectures/Resource Person/Paper presented in Seminars/Conference/full paper in Conference Proceedings
(Paper presented in Seminars/Conferences and also published as full paper in Conference Proceedings will be
counted only once) - Mention only up to a maximum of Ten [10]
S. Title of the Title of Conference / Name of the Level: S. No. of proof
No. Paper Seminar etc. Organizer & Date International/ of enclosure
National/State
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

17. Names and complete postal addresses of 2 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)
Referee-1 Referee-2

Names:

Complete postal address:

Email:

Phone (Landline) with STD code

Mobile:

Fax:

18. Please tick the enclosures attached

S. No. Check List S. No. of No. of sheets
enclosure
i. Matriculation certificate & mark sheet
ii. Intermediate certificate & mark sheet
iii. B.A./ B.Sc./ B.Com. certificate & marksheet
iv. M.A./ M.Sc./ M.Com. certificate & marksheet
 v. L.L.B. certificate & marksheet
vi. L.L.M. certificate & marksheet
vii. MTech /L.L.M./ M. Phil. Certificate & marksheet
viii. Ph.D./ D. Phil. Degree certificate
ix. D.Litt., D.Sc., L.L.D. degree certificate
x. NET-JRF, NET, SLET, SET award certificate
xi. OBC/SC/ST certificate issued by the Competent Authority
xii. PWD certificate
xiii. Teaching Experience certificates
xiv. Post-Doctoral Experience certificates
xv. Proofs of Awards (for academic distinctions)
xvi. Research Papers in Peer-Reviewed or UGC-listed Journals
xvii. Publications other than Research Papers
xviii. Invited lectures/Resource Person/Paper presented in
Seminars/Conference/full paper in Conference Proceedings
xix. Any other supporting document

Total number of sheets enclosed: (please give sequential number to each sheet and signature
with date).

19. Have you been reprimanded ever? Yes/No Give detail if yes

20. Any other information/ qualification relevant to the post applied for:

21. Declaration

I, son/ daughter of hereby declare that all

the statements and entries made in this application are true, complete and correct to the best of my knowledge
and belief. In the event of any information found false or incorrect or ineligibility being detected before or after the
Selection Committee and Executive Council meetings, my candidature/ appointment may be cancelled by the
University.

I have never been convicted or contemplated for any unlawful activity.

*Signature of the Applicant

(Full Name in candidate’s handwriting)

Date : *Application not signed by the candidate is liable to be rejected
 22. Endorsement by the EMPLOYER

a) In case of in-service candidates in Government/ Semi-Government organizations/ Public Sector

Undertakings
/ Autonomous Organizations, the endorsement form must be signed by the employer.

b) In case of in-service candidates from Private Sector, acceptance of resignation and relieving letter
from the employer must be submitted at the time of joining.

Forwarded to the Registrar, Manipur University, Canchipur, Imphal-795003

The applicant Dr./Mr./Mrs/Ms. Who has submitted this application for the post of in
the Manipur University, has been in employment post of in temporary/
contract/ permanent capacity with effect from in the Scale of Pay of Rs. .
He/She is drawing a basic pay of Rs. . His/Her next increment is due on .

Further, it is certified that no disciplinary/ vigilance case has ever been held or contemplated or is
pending against the said applicant. There is no objection for his/her application being considered by
the Manipur University, and in the event of selection, he/she will be relieved to join Manipur
University as per rules.

Signature of the
forwarding officer Name :