Institute for Post Graduate Teaching & Research in Ayurveda, GUJARAT AYURVED UNIVERSITY, Jamnagar APPLICATION FORM yhsãkºkf

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1 Institute for Post Graduate Teaching & Research in Ayurveda, GUJARAT AYURVED UNIVERSITY, Jamnagar APPLICATION FORM yhsãkºkf Paste your recent Passport size Photograph Advt. No. Date : Name of Department: here and sign (ònuhkík Lktçkh) (íkkhe¾) (rð¼køklkwt Lkk{ ) across Application for the post of : (su søþk {kxu yhs fhðklke nkuþ íku søþklkwt Lkk{) : To, The Registrar, Gujarat Ayurved University C/o. Office of the Director, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar Full Name (Surname First) In Block letters (Ãkqhwt Lkk{, yxfúke þyykík fhðe) 1.1 Father s / Husband s Name - For married women only) (rãkíkklkwt / ÃkríkLkwt Lkk{ - Võík Ãkherýík eyku {kxu) 2. Present Address (nk Lkwt MkhLkk{wt, xur VkuLk Lktçkh, E-{uR MkkÚku) Tele. No : Mobile: Permanent Address (fkþ{e MkhLkk{wt, xur VkuLk Lktçkh, E-{uR MkkÚku) Tele. No : Mobile: 3. Date of Birth Place of Birth Sex : Male /Female (sl{íkkhe¾) (sl{múk ) (òrík) ÃkwÁ»k/ Mºke Age Years Months Marital Status : Married/Unmarried (ô{h) (ð»ko) ({kmk) ðiðkrnf ÂMÚkrík : (Ãkherýík/yÃkherýík) Religion Nationality Domicile (Ä{o) (hk»xùeþíkk) (hnuxký) - 1 -

2 4. Whether you belong to any reserved category mentioned below. If so, endorse certificate from competent authority. (ík{u rlkblkr r¾ík ylkk{ík ðøkolkk Aku? òu nk, íkku ÞkuøÞ Mk kkr½fkhelkwt «{kýãkºk hsq fhðwt.) SC ST OBC/SEBC NT NT (y.ò.) (y.s.ò.) (yku.ƒe. e.qyumk.e.çke.mke.) (yu.xe) 5. Are you physically handicapped.? If yes, endorse certificate from competent authority. Yes / No (ík{u þkherhf ¾kuz¾ktÃký Ähkðku Aku?òu nk, ÞkuøÞ Mk kkräfkhelkwt «{kýãkºk hsq fhðwt.) nk / k 6. Mother tongue ({kík]¼k»kk) 7. Sr. No. { Other Languages known çkes ¼k»kkLke òýfkhe Speak çkku íkk Read ðkt[íkk Write ¾íkk 8. Educational Qualifications (Attach separate sheet for more details, if required) (þiûkrýf kþfkík. syh sýkþu ðäkhklke {krníke y øk ÃkkLkk{kt hsq fhðe) Sr. No. { Exam. passed ÃkkMk fhu Ãkheûkk Board/Uni./ Institution çkkuzo/þwrlk./mktmúkk Stream «ðkn Principal subjects {wïþ rð»kþku Year ð»ko Percentage xfkðkhe Remarks LkkUÄ 8.1. Typing and Computer knowledge? Yes / No (If yes, attach certificate) (xkr Ãkøk ylku fbãþqxh kklklke rðøkík) nk/lkk (òu nk, íkku «{kýãkºk hsq fhku) 1. Typing (WPM): Gujarati Hindi English xkr Ãkøk («.r{.ízãk) : økwshkíke rnlëe ytøkúus 2. Computer : CCC CCC + PGDCA fbãþqxh : Mke.Mke.Mke. Mke.Mke.Mke.+ Ãke.S.ze.Mke.yu. 9. If you have published articles or research papers or books, give details. ( u¾ku yúkðk MktþkuÄLk Ãkºkku yúkðk ÃkwMíkfku «rmkø fþko nkuþ íkku íkulke rðøkík) 10. Expected salary including allowances : (yu kwlmk Mkn yuftëhu fux ku Ãkøkkh { ðklke Äkhýk hk¾ku Aku.) 11. When can you join if offered an appointment? (òu Lke{ðk{kt ykðu íkku õþkhúke òuzke þfku?) 2-2 -

3 12. Please state previous experince or training in the follwing columns. (Attach separate sheet for more details, if required) (ylkw¼ð yøkh íkk e{ eäe nkuþ íkku íkulke rðøkík Lke[uLkk Lk{qLkk{kt ykãkku. syh sýkþu ðäkhklke {krníke y øk ÃkkLkk{kt hsq fhðe) Sr. No. { Name & Address of the employer LkkufheËkíkkLkwt Lkk{ ylku MkhLkk{wt Designation nkuæku From rlk{ýqf íkkhe¾ Left on Akuzâk íkkhe¾ Pay Scale Ãkøkkh Äkuhý Reason for leaving AkuzðkLkwt fkhý Remarks Part / Full time LkkUÄ Ãkkxo/Vw xkr{ Are you having service agreement/bond with your present employer? Yes / No If yes, please mention period etc., and give details separately. (ík{khe nk Lke Lkkufhe{kt ík{u fkue fhkh fþkuo Au? òu nk nkuþ íkku íkulke {wëík ðøkuhu y økúke ykãkku.) nk / k 14. Have you applied or been interviewed for any post in this University in the past? Yes / No If yes, please mention post, and date of interview. (yk Ãknu k yk ÞwrLkðŠMkxe{kt ík{u fkur søkk {kxu yhs fhu e yúkðk YçkY {w kfkík {kxu çkku kððk{kt ykðu k?òu nk, nkuþ íkku fe søkk {kxu ylku fe íkkhe¾u íkulke rðøkíkku ykãkku.) nk / k 15. Please mention name of two reference who are not your relative and who can certify your work and conduct. (çku «ríkrcík ÔÞÂõíkykuLkk Lkk{ku ykãkku fu suyku ík{khk Mkøkk Lk nkuþ ylku ík{khk fk{ ylku [krhºktþ rðþu yr¼«kþ ykãke þfu.) (Ph.): (M) (Ph.): (M) 16. Details of membership of any professional/academic body. (ÔÞðMkkÞe yøkh þiûkrýf MktMÚkkLkk MkÇÞ nku íkku íkulke rðøkík) 17. Any other relevant Information (Attach separate sheet for more details, if required) (çkes fkue {krníke nkuþ íkku. syh sýkþu ðäkhklke {krníke y øk ÃkkLkk{kt hsq fhðe) 18. Particulars of Fees : Name of Bank : Place : (VeLke rðøkík) (çkuflkwt Lkk{) (MÚk ) Demand Draft No.: Date: Rs.: (rz{klz zùk^x Lkt.) (íkkhe¾) (YrÃkÞk) - 3 -

4 19. List of Self attested copies of certificates/documents attached: (Mð «{krýík MkŠxrVfux/ËMíkkðusLke Lkf kulkk rçkzkýlke rðøkík) I solemnly declare that the particulars Furnished in this application are true and correct. I clearly understand that any misstatement of fact contained herein or willful concealment of any material fact will render me liable to Appropriate action as may be decided by University. (nwt...«rík kkãkqðof ònuh fát Awt fu yk yhs{kt ¾ðk{kt ykðu ík{k{ nfefík Mkk[e ylku ¾he Au. nwt Mkkhe heíku Mk{swt Awt fu ¾kuxe nfefík yøkh íkku òýeçkqíelku ¾ðk{kt ykðu ¾kuxe nfefík {kxu ÞwrLkðŠMkxe Lk e fhu íku Ãkøk kt {khe Mkk{u uþu.) Place: Date: Signature of the Candidate: (MÚk ) (íkkhe¾) (W{uËðkhLke Mkne) 21. No Objection Certificate: This is to certify that Mr./Mrs...is serving in this institute / Organization from...as This is to further certify that there is no departmental inquiry/proceeding or vigilance inquiry or contempt of court against the employee is pending. Date : Place : Signature of Employer with Seal Lkk ðktäk «{kýãkºk : ykúke «{kýãkºk ykãkðk{kt ykðu Au fu e / e {íke / fw{khe......y{khe MktMÚkk{kt......Lkk nkuæk Ãkh íkkhe¾...úke Vhòu çkòðu Au. ðäw{kt yk Ãký «{krýík fhðk{kt ykðu Au fu yk f{o[khelke rðáø{kt fkue ¾kíkkfeÞ íkãkkmk/ãkku emk íkãkkmk/fkuxolkku ríkhmfkh nk Ãkqhíkku LkÚke. íkkhe¾ : MÚk : ¾kíkkLkk ðzklke Mkne ylku rmk ku Signature of the Candidate (W{uËðkhLke Mkne) - 4 -

5 N.B. 1. Application with incomplete information will not be accepted. íkk.f. 1. yäqhe nfefíkðk e yhs Mðefkhðk{kt ykðþu Lknª. 2. The application should be in the s own handwriting. 2. W{uËðkhu ÃkkuíkkLkk nmíkkûkh{kt s yhs ¼hðe 3. A who is employed elsewhere should forward the application through his/her employer or should attach a certificate (No Objection Certificate) from the employer that he/she has been permitted to apply for the post in question, otherwise the application will not be considered. 3. òu fkue W{uËðkh çkes fkue MktMÚkk{kt Lkkufhe fhíkku nþu íkku íku{ýu íku{lke yhs ÃkkuíkkLkk ¾kíkkrÄfkhe {khvík {kuf ðe yúkðk íku{ýu MkËh søkk {kxu yhs fhðk {kxu ÃkhðkLkøke ykãþk çkë Lkwt «{kýãkºk (Lkk ðktäk «{kýãkºk)hsq fhðwt, Lknª íkku yhs økúkìk hk¾ðk{kt ykðþu Lknª

6 * * * (FOR OFFICE USE ONLY) WHETHER ELIGIBLE BY : (1) Name of the Applicant : (2) Post applied for : (3) Submitted through proper channel? /NOC : Yes [ ] No [ ] (4) Caste certificate produced? : Yes [ ] No [ ] (5) All other requisite certificates produced? : Yes [ ] No [ ] (6) Application fee paid? : Yes [ ] No [ ] (7) Age : Proper [ ] Over [ ] Under [ ] (8) Essential educational qualifications : Yes [ ] No [ ] (9) Possession of requisite experience : Yes [ ] No [ ] (To be indicated clearly whether eligible or not) : Overall eligibility : Application Status : Accepted [ ] Rejected [ ] If rejected, please specify the grounds (age, education, experience and computer qualification) on which candidature is rejected : 1. Age : 2. Educational Qualification : 3. Experience : 4. Computer Qualification : 5. Others (Specify) : 6. SIGNATURE OF SCRUTINY COMMITTEE :

7 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form API PROFORMA FOR PROFESSOR/ DIRECTOR BASED ON PERFORMANCE BASED APPRAISAL SYSTEM TO BE SUBMITTED BY EACH APPLICANT FOR APPOINTMENT ON THE POST OF TEACHERS AND OTHER ACADEMIC STAFF AS PER UGC REGULATIONS, 2010 Minimum API Score Required for Direct Recruitment in Professor/ Director. Minimum Essential Qualification and Consolidated API Score of 400 Points from Category III API Advertisement No. and Date: Name of the Applicant: Date of Birth: Post applied for and Subject: Page 1 of 6 Name & Signature of Candidate

8 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form S No. APIs Ayurveda /Medical Sciences Max. points for University Teachers API Score allotted Self appraisal score III A Research Papers published in: Refereed Journals 15 / publication N X 15 Non refereed but recognized and reputable journals and 10 / Publication N 1 X 10 = periodicals, having ISBN/ISSN numbers. Verified API Score III (B) Research Publications (books, chapters in books, other than refereed journal articles) Conference proceedings as full papers, etc. (Abstracts not to be included) Text or Reference Books Published by International Publishers with an established peer review system a) No of sole author book(s) = M 1 b) No of chapter(s)in an edited book(s) = M 2 10/ publication N 2 X 10 = Total of III A 50 /sole author; 10 /chapter in an edited book M 1 X 50 = M 2 X 10 = Subject Books by Other local publishers with ISBN/ISSN numbers. c) No of sole author book(s) = M 5 15 / sole author and 3 / chapter in Edited books M 5 X 15 = M 6 X 3 = No of chapter(s)in an edited book(s) = M 6 Chapters contributed to edited knowledge based volumes published by International Publishers No of chapter(s) = M 7 10 /Chapter M 7 X 10 = Chapters in knowledge based volumes by Indian/National level publishers with ISBN/ISSN numbers and with numbers of national and international directories No of chapter(s) = M 8 5 / Chapter M 8 X 5 Total of III B Note: in case three authors for one research publication, the principle author get 4 points while other authors eligible for 2 points Page 2 of 6 Name & Signature of Candidate

9 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form III (C) III (C) (i) RESEARCH PROJECTS Sponsored Projects carried out/ ongoing (a) Major Projects amount mobilized with grants above 30.0 lakhs No of Project(s) = 20 /each Project P 1 X 20 = P 1 (b) Major Projects amount mobilized with grants above 5.0 lakhs up to lakhs 15 /each Project P 2 X 15 = No of Project(s) = P 2 (c) Minor Projects (Amount mobilized with grants up to Rs. 5 lakh) 10/each Project P 3 X 10 = III (C) (ii) III (C) (iii) III (C) (iv) Consultancy Projects carried out / ongoing Completed projects : Quality Evaluation Projects Outcome / Outputs No of Project(s) = P 3 Amount mobilized with minimum of Rs lakhs No of 10 Lakh(s) = R Completed project Report (Acceptance from funding agency) a) No. of completed & accepted Major project(s) = Q 1 b) No. of completed & accepted Major project(s) = Q 2 Patent/Technology transfer/ Product/Process a) No. of national level output = O 1 b) No. of international level output = O 2 10 per every R X 10 = 20 /each major project and 10 / each minor project 30 / each national level output or patent /50 /each for International level, (output or patient) Q 1 X 20 = Q 2 X 10 = O 1 X 30 = Total of III C O 2 X 50 = Page 3 of 6 Name & Signature of Candidate

10 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form III (D) RESEARCH GUIDANCE III (D) (i) III (D) (ii) M.Phil./M.D.(Ayu) /MS (Ayu) M.Pharma(Ayu)/MSC Medicinal Plant M.Phil./M.D.(Ayu) /MS (Ayu) for co guidance PG Diploma Ph.D. Guide Ph.D. Co guide Degree awarded only No. of s = D 1 Degree awarded only No. of s = D 2 Degree awarded only No. of s = D 3 Degree awarded only No. of s = D 4 Degree awarded Thesis submitted a) No. of s = D 5 b) No. of s = D 6 Degree awarded Thesis submitted a) No. of s = D 7 b) No. of s = D 8 3 /each 2 /each 2 /each 2/each 10 /each 7 /each 5 /each 3 /each Total of III D D 1 X 3 = D 2 X 2 = D 3 X 2 = D 4 X 2 = D 5 X 10 = D 6 X 7 = D 7 X 5 = D 8 X 3 = Page 4 of 6 Name & Signature of Candidate

11 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form III(E) TRAINING COURSES AND CONFERENCE / SEMINAR / WORKSHOP PAPERS III(E) (i) Refresher courses, Methodology workshops, Training, Teaching Learning Evaluation Technology Programmes, Soft Skills development Programmes, Faculty Development Programmes (Max: 30 points) (a) Not less than two weeks duration No. of programs = T 1 (b) One week duration No. of programs = T 2 Participation and Presentation of research papers (oral/poster) in 20/each T 1 X 20 = 10/each T 2 X 10 = III(E) (ii) III(E) (iv) III(E) (v) Papers in Conferences/ Seminars/ workshops etc. Invited lectures or presentations for conferences/ symposia /RoTP/CME / TOT 3 Days Special training programs conducted by state Government / central Government agencies / institutions/ councils a) International conference 10 each C 1 X 10 = b) National 7.5 / each C 2 X 7.5 = c) Regional/State level 5 /each C 3 X 5 = d) Local University/College level 3 / each C 4 X 3 = (a) International 10 /each L 1 X 10 = (b) National level 5 / each L 2 X 5 = State level/local 3 / each L 3 X 3 = (a) National level 5/each L 4 X 5 = (b) State level or local 3/each L 5 X 3 = Total III E Page 5 of 6 Name & Signature of Candidate

12 I.P.G.T. & R.A. Gujarat Ayurved University, Jamnagar Part B of the application form Note: for the each category under III (E) (i,ii,iii,iv) maximum 2 presentation and / or participation of papers in training course, conference, seminar and workshop will be considered. Page 6 of 6 Name & Signature of Candidate