Application Form for Post of Vice Chancellor

Name of the Post Applied for

First Name

Middle Name

Last Name

Gender

Email ID

Father / Husband's Name

Upload Photo (.jpg/.png format and maximum size 700KB)

Present Address of Residence

City

State

PIN code

Permanent Address of Residence

City

State

PIN code

Mobile Number

Phone Number

Adhar Card Number

Date of Birth (enclose the mark sheet of high school examination or birth certificate in certificates section)

Upload Aadhar Card (.jpg/.png format and maximum size 700 KB)

Age of applicant as on 27.11.2024

Day

Month

Year

Applicant's Marital Status

Date of Marriage

Category (upload photocopy of certificate issued by competent authority for reserved category in certificates section)

Involvement in Quality Assurance

Visits Abroad

Registration Number and Name of the Council and Date

Council	Name of Council	Registration Number	Registration Date

Educational Qualifications

(upload attested photo copies of certificates and marks sheets in certificates section)

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Examination Name	Name of Degree	Board Name / University Name	Year	Subject	Marks Obtained	Total Percentage	Attempts

Teaching Experience

(upload experience certificate in certificates section)

Designation	From Date	To Date	Duration	Institute Name

Positions Held

Period	Position Held	Name of Institute

Awards and Honours

Award / Honour	Month/Year

International Conferences / Workshops

Event Name	Event Dates	Event Location (City, Country)	Participation Type	Presentation Title (if applicable)

Administrative Experience

Period	Position Held

Membership/Fellowship of Prestigious National/International bodies

Period	Position Held

Number of students guided for MD / MS / DNB / DM / MCh / Ph.D. / Equivalent students

Number of students guided for MD / MS / DNB / DM / MCh / Ph.D. / Equivalent students

Research

Research Projects

Title of the Project	Name of the Funding Agency	Duration	Outlay (In Rs.)	Status Completed/Ongoing

Experience in Clinical Research

Experience in making Health Policies and Strategies

Experience regarding NAAC Accreditation pertaining to research

No. of International Publications

No. of National Publications

Scopus ID

Citation Index

H Index

Research Publications

(Attach Photo Copy in certificate section)

Research Publication (Title)	Author	Publisher	Date (Month/year)	Remove

Books / Book Chapter Written

Book / Book Chapter Detail

Any other relevant information/ experience related to the post.

(Attach Photo Copy in certificate section)

Particulars	Remove

Referees

Referee Name

Position/designation

Contact No.

Email ID

Referee Name

Position/Designation

Contact No.

Email ID

Certificates / Annexure

List of attach certificates(.jpg/.png/.pdf format and maximum size 5 MB each file)

Certificate Name	Certificate

1) I certify that the above information given by me is complete and true. In the event of information being false, my application form / appointment letter can be canceled.
2) I certify that I have not been found guilty by any court of any offense of moral decimation nor is there any such case against me in any jurisdiction.

Declaration: I Agree