REOs e-application
Indian Institute of Technology Kanpur

 
 
Post Details
Advertisement No. :
   Post Applied for
  Cadre
Post Code
Serial No. :
Department
 
Particulars of D.D. (Demand Draft) :
 
Demand Draft No. : For Rs:
Date:
Drawn On (Bank Name)
 
Personal Details :
 
Applicant's Name :
First Name :   Middle Name: Last Name:
 
Father's /Husband's Name :
First Name :   Middle Name: Last Name:
 
Mother's Name:  (Maximum 30 Characters)

Date of Birth (as per 10th certificate):

  Year Months Days  
*Age as on the date 18.03.2019:  
Place of Birth:
Nationality:
Category:
(attach a self-attested copy of the certificate from the authority prescribed under Govt. rules, if applicable)
Aadhaar No:
Gender :
Male Female
Present (Mailing Address) :
City :
State : Post Code/ Zip Code :  (6 digits)
Permanent Address :
 
City :
State : Post Code/ Zip Code :  (6 digits)
 
Contact Details :
 
Email ID : (Maximum 50 Characters)
Mobile Number : +91  (10 digits)
Phone Number : +91  (Maximum 11 digits)
 
Are You Related to any employees of the IITs:
Name
Designation
Name of the IITs/department where working
Relationship
Educational Qualification (Matriculation/10th onwards)
Examination Passed
Major Subjects/
Specialization
Board/University
Duration
(In words)
Year of Passing
Marks Secured
Total Marks
% of Marks
Class/
(Division
Awards and Recognitions:
1)
2)
3)
4)
5)
6)
 
Any other relevant information:
Details of professional Experience (Start from present Employer) :
Name of the Employer Post held Duration Experience in months
(months)
Nature of Job
Scale of Pay & last gross salary drawn /Consolidated Salary (Rs.)
From To
Total Relevant Experience (in months) :   
Salary/ Total Emoluments Expected at IIT Kanpur : (Maximum 7 Digit)
Area of Specializations : (Maximum 150 Characters)
Current Area of Research : (Maximum 150 Characters)
 
Details of Publications/patents, if any (attach reprints):
Scientific Journals
No. of papers
Published
Accepted
Communicated
National
International
Total:
No. of patents filed and granted:
Whether visited outside India? If so, particulars thereof:
Name of Country Visited
Duration of Visit (DD/MM/YYYY)
Purpose of visit
Passport No. & Date
From
To
Names and Addresses including Email, Fax, Tel.No., of Three Referees (at least one of them should be familiar with your work)
Referees [Name]
Referees [Address]
Email
Contact No.
Fax No.
   
I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of the information being found false or incorrect or any ineligibility being detected before or after the selection, my candidature is liable to be cancelled and action initiated against me.