PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGYBengal Pailan Park,Phase-I,

Amgachia Road, (off Diamond Harbour Rd.),Joka, Kolkata – 700104.

APPLICATION FORMPlease complete each and every part,( put ‘NA’ if any item is not applicable

for the applicant) of application form and submit on-line

Post Applied for :

1. Name of Candidate in full (Block Letters only)

: (First name) ( Middle name ) ( Last name )

2. Address (a) Permanent

:

PIN Phone

(b) Present :

PIN Phone

3. Contact Number (a) For applicant

: Land Line :

Mobile :

E-mail : (b) For Father / Guardian : Land Line :

Mobile :

E-mail :

4.(a) Date of Birth : / / (dd / mm / yyyy) (b) Place of birth : Dist.

State

Country

(c) PAN Number : (d) Addhar Card No. :

5. Candidate’s Nationality :

Insert Your Photo

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGYBengal Pailan Park,Phase-I,

Amgachia Road, (off Diamond Harbour Rd.),Joka, Kolkata – 700104.

6. Religion :

7. Caste : General SC ST OBC (please √ )

8. Sex : Male Female (please √ )

9. Marital Status : Married Unmarried (please √ )

10. Father’s Name & Mother’s Name :

11. Husband’s/Wife’s Name

(if married) & Occupation:

12.Children’s Age & Sex : 1. Yrs.(M/F) 2. Yrs (M/F) 3. Yrs (M/F)

13.(a) Candidate’s mother tongue

:

(b) Other language known (Speak Read & Write)

:

14. Academic Qualification

Examination / Degree**(Please specify)

Area of Specialization

Name of Institute / college

Board / Council / University

Year of passing

Division Class

(% marks)

Secondary or Equivalent

Higher Secondary Or Equivalent

Graduate level : B.E / B.Tech / B.Sc / BA/ B.Com / BCA / BBA

Post Graduate LevelME / M.Tech. / M.Sc./ M.Com / MA / Equiv.

B.Ed / M.Ed. / Equiv.

Doctoral ( Ph.D / D.Sc)

NET / GATE / SLET

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGYBengal Pailan Park,Phase-I,

Amgachia Road, (off Diamond Harbour Rd.),Joka, Kolkata – 700104.

** Degree on distance mode should be mentioned.

15. Extra Curricular Activities: 16. Experience Profile (Starting with appointment immediately before the present one)

Sl. No. Employer’s Name & Address Designation

Date of Joining / Leaving

Experience

Teaching Industry ResearchI

II

III

IV

V

17. Present Employment :

(a) Name and address of present employer:

(b)Date of joining and position held :

(c) Present remuneration details (in Rs / month) as per following:-

Basic pay DA HRA MedicalOther

ReimbursableGross Salary

(d) Expected joining time (in the event of selection)

(e) Expected salary Rs. per month.

PAILAN COLLEGE OF MANAGEMENT & TECHNOLOGYBengal Pailan Park,Phase-I,

Amgachia Road, (off Diamond Harbour Rd.),Joka, Kolkata – 700104.

1818. Academic Activities: (a) Publications : (Indicate numbers only) (i) Research papers (a) National Nos

(b International Nos

(c) Patents Nos

(ii) Books : (Edited Volumes:

19. What are your significant Professional achievements?

20. Two Referees who should be responsible persons not related to you and known to you in a professional capacity.

Sl. No. Name Designation & Organization Address Mobile No.

1

2

21. DECLARATION

I declare that the statements made in this form are true to the best of my knowledge and belief.

Date :

_______________________________ Place: (Name of the Candidate)