Indian Institute of Management Rohtak
M.D University Campus, Rohtak - 124 001 Application Format for Faculty Position Post applied for: Associate Professor Nature of position applied: Regular/Contract/Guest Name of the Candidate (full name)* First Name: Middle Name Surname: Fathers/husbands name* Nationality* State of domicile Place of birth (district) Date of Birth* Marital status Present job Employer Present Pay Scale: Present Basic Pay: Gross Salary: Day Month Year
Area:
Marketing Regular
Satyendra Udaynath Patnaik Satyendra Udaynath Patnaik Udaynath Patnaik
Address for communication House Name/No.* Place* City/District/Post Office* State* Pin Code* Permanent Address* (Same as above House Name/No.* Place* City/District/Post Office* State* Pin Code* Phone Number Mobile Number E-mail ID Educational Qualifications (Start with your present or most recent degree and work backwards)
Exam./Degree Institution From To Name of Board/Univ. %Marks Class/Div Year of Completion Specialization
PostDoctoral Ph.D* P.G I P.G II U.G I U.G II
12th 10th
State clearly if Ph.D thesis is not submitted as on date: Additional degrees:
Scholarships/ Honours & Awards (Best Three)
Employment History (Start with your present or most recent position and work backwards) Academic (a)Teaching
Name of Employer Position Nature of position Years worked From To (dd/mm/yy) (dd/mm/yy) Courses taught Pay Scale Gross salary
(b) Research
Name of Employer Position Years worked From To (dd/mm/yy) (dd/mm/yy) Areas of research Pay Scale Gross salary
(c) Administration/ Management
Name of Employer Position Years worked From To (dd/mm/yy) (dd/mm/yy) Areas of work Pay Scale Gross salary
(d) Industrial (Manager level & above)
Name of Employer Position Years worked From To (dd/mm/yy) (dd/mm/yy) Areas of work Pay Scale Gross salary
Academic Guidance Year Thesis Title Type
Remarks if any: Courses/Subjects would like to offer:
Research Publications (Top Five) (Research papers, cases, books, working papers and Articles) (Start with your most recent publication and work backwards)
Core Title of the paper/article/book/case Year of publication Publishing country Authors Name of the Journal/Book with volume and issue* Publishers Name
* Attach copies of your two best publications, of which at least one should be a journal paper.
Research Projects Undertaken (Top Five)
Whether Research/ Consultancy Project Whether coordinated by self or others Period of the Project From To (dd/mm/yy) (dd/mm/yy) Amount of funding
Title of the project
Funded by
Training Experience (Top Five)
Year From To (dd/mm/yy) (dd/mm/yy) Training Programme Title Institution Whether coordinated by self or others Area of sessions handled
Conferences & Seminars (Top Five)
Year From (dd/mm/yy) Title To (dd/mm/yy) Organized by Whether co-ordinated by self or others Details of Your Participation
Any other interest:
Reference 1* (Give full details with name, contact number, e-mail, mobile number etc.) Reference 2* (Give full details with name, contact number, e-mail, mobile number etc.)
* Names of those who are familiar with your professional work may be included Declaration I hereby declare that the information/data given in this application are true and correct to the best of my knowledge and belief, that I have understood the general conditions of service at IIM Rohtak and that, if selected, I will abide by all the rules, policies and norms governing my service at IIM Rohtak.
(Signature) Date: Day Month Year