TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY
APPLICATION FORM
(For Technical Posts Only)
Application Number
(For Office Use Only)
Advertisement Number :
Date :
D D M M Y Y Y Y
Application Fee details:
DD / Pay Order No. :
Date :
Affix a recent passport
Bank : size (5 x 3.5” cm)
colour photo. Do not
Amount (Rs. / USD) : staple.
Application for the post of Assistant Professor (Academic Level 10) in the subject of
_____________________________
1 Name of the Applicant
(in BLOCK LETTERS)
2
Father’s Name
Mother’s Name
Spouse Name
3
D D M M Y Y Y Y
Date of Birth
Age (as on cutoff date) Month
Years Days
(Attach Evidence) s
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4 Place of Birth and Nativity
(Attach Evidence) (District) (State)
5 Gender (√ mark) Male Female Transgender
6 Nationality
7 OC BC BCM MBC DNC SC SCA ST
Community (√ mark)
Caste
(Attach Evidence)
8 Marital Status (√ mark) Married Single
9 Permanent Address
(Door No., Street Name,
Village / Town, District, State,
Pin Code)
10 Address for Correspondence
(Door No., Street Name,
Village / Town, District, State,
Pin Code)
e-mail Address (mandatory)
Mobile Number (mandatory)
Alternate Mobile Number
Aadhaar Number
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11 Mother Tongue
12 Vernacular Language in
School/College
13 Other Languages Known
To Read To Write To Speak
14 Educational Qualifications (Attach Evidence)
Name of School/ Period Part Degree/ OGPA/
Name of the qualifying Specialization
College/ Time / Diploma Marks/
examination From To
University Full time Received Percentage
X or SSLC -
XII or HSC -
Graduation
Post Graduation
[Link]. -
Ph.D. -
Post Doctorate
Additional qualification
(relevant)
15 Details of NET passed (if applicable)
Subject
(Attach Evidence) (√ mark)
Yes No
Y Y Y Y
Year of Passing
16 Membership in Veterinary Council State in which Registered:
(Attach Evidence)
Registration No.
Valid up to D D M M Y Y Y Y
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17 Details of previous and present employment (Attach Evidence)
If employed,
a. Present designation :
b. Name and designation of the present employer :
Period Duration Reason for
Employer Post Held Pay Drawn
From To Y M D leaving
Note: Period spent on study for Masters’ / Ph.D. degree should not be included except the part time study period.
Use a separate sheet if required
18 Experience (Teaching / Research / Extension) (Attach Evidence)
Place of Period Duration
Experience in Post Held
Work From To Y M D
Teaching
Research
Extension
Note: Use a separate sheet if required
19. Research Publications (in the Peer-Reviewed NAAS Rated or UGC/AICTE listed / SCI Journals) details
(Attach first page of the publications for evidence)
[Link] Author1 (s) Title Journal Name / NAAS Rating /
. Year / Vol. / Issue & Impact Factor2
Page No.
20 Awards (Academic) (Attach Evidence)
1
Indicate your position in bold, underlined format.
2
Follow NAAS Ratings / NAAS Score of Scientific Journals in the respective year of publication. For non-NAAS rated journals, impact factor
(Thompson Reuter) etc. of the Journal will be considered. The screening committee with the approval of the Vice-Chancellor shall decide
the marks.
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Name of the award Year Award given Award given for
(Reputed Institution / Organization) by (Purpose of award)
(Organization)
International Level
National Level
State Level
University Level
(awards for UG / PG programme)
College Level
(awards for UG / PG programme)
Professional Societies / Bodies
(Best presentation (as first author), etc.)
Note: Use a separate sheet if required
21 Patent / Innovation / Technology Transferred (Attach Evidence)
22 Extracurricular Achievements (NCC / NSS / Sports and Games) (Attach Evidence)
Activity Period Level
From To
Note: Use a separate sheet if required
23 Scale of Pay in the Present Post and Basic pay drawn:
24 Are you willing to accept the basic pay in the scale applicable for the Yes / No
post?
If No, what is the minimum pay you request for?
Give reasons in support of the request:
25 Is there any commitment to serve any organization? Yes / No
If yes, furnish details:
26 Countries visited, if any and the duration and purpose of visit
Country visited Duration Purpose of visit
Note: Use a separate sheet if required
27 List three referees known to you who can certify your professional competency
[Link] Name and Designation Address with Contact details (Phone number,
. email)
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Note: Original testimonial from referees to be produced at the time of interview
28 Any other information in support of satisfying the eligibility conditions:
Note: Use a separate sheet if required
29 List of Professional Societies in which you are a member, if any
Professional Society Position
Note: Evidence to be produced at the time of interview
30. DECLARATION
I solemnly and sincerely affirm that all information furnished in the application are true and correct to
the best of my knowledge and belief.
Should there be any incorrect or false information having been furnished that may come to light in due
course, I bind myself for such action as the University may decide.
I understand that I am liable for criminal prosecution and the University has the right to cancel my
candidature/selection as the case may be and I would forego my selection and the application fee.
I further undertake to submit all the required originals at the time of interview process, as per the Tamil
Nadu Veterinary and Animal Sciences University rules, failing which I would forego my interview.
Place:
Date:
Signature of the candidate
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