Application for the Award of Fellowship at the IIAS This application is divided into 6 parts: personal profile, education qualifications, doctoral work, professional experience, references and project proposal. If using the Microsoft Word version of this form, either complete the form electronically, or print the blank form and complete by hand. With the PDF version you must print out the form and complete by hand (please write clearly in black ink). Applications can also be submitted online using the online form available. Please send the completed form to the address specified in the advertisement. * Fields are compulsory All telephone numbers should include country code (e.g. 91 for India) Personal Profile Governement *Candidate Type Private Employed Retired Employed *Family name *First name *Family name at birth *Date of birth Place of birth Married/civil Widowed, separated, divorced, Marital status Single partnered dissolved *Gender Male Female *Do you belong to Schedule Caste / No ( Attach Appropriate certificate if yes) Schedule Tribe Yes Contact details *Present address Telephone Telephone Can we contact Yes No (home) (work) you at work? Fax Mobile E-mail number Please list chronological order matriculation onwards. Name of the Examination/degree. Subject(s) Division / Grade Examining University/Authority Dates Place / Country Higher education Please list in reverse chronological order the educational establishments attended and the degrees/diplomas obtained. Name of the Examination/degree. Type of degree/dipl oma Examining University /Authority Field of study Major subject(s) Dates Place / Country Please list in reverse chronological Publications uploaded / attached should be in word format (Font Arial) Publication Name Publisher Date of Publication Publication Type Name of the Publications attached [Please attach a separate sheet, giving full bibliographic information for each entry] Article Name Publisher Date of Publication Publication Type Name of the Articles (s) attached Seminars/Conferences/Symposia Attended Please list articles authored / edited in reverse chronological order Name Conference / Symposia Date Professional Experience Please give details of your employment since leaving full-time education, starting with the most recent employment Give a brief description of the main duties and responsibilities, number of staff supervised, if applicable. Dates (month/year) Location/country Position held (with Employer name/ scales of pay, if in Address service): Responsibilities Dates (month/year) Location/country Position held (with Employer name/ scales of pay, if in Address service): Responsibilities Dates (month/year) Location/country Position held (with Employer name/ scales of pay, if in Address service): Dates (month/year) Location/country Position held (with Employer name/ scales of pay, if in Address service): Responsibilities Continue on a separate sheet if necessary. References The Indian Institute of Advanced Study requires three references: May we request a reference? At any time After offer of employment Name Job title/position Telephone Fax Address Please indicate if this is a work Work reference Academic reference reference or an academic reference May we request a reference? At any time After offer of employment Name Job title/position Telephone Fax Address Work reference Academic reference May we request a reference? At any time After offer of employment Name Job title/position Telephone Fax Address Please indicate if this is a work Work reference Personal reference reference or a personal reference Continue on a separate sheet if necessary. Project Proposal Title of the proposed Research Project Synopsis of the Research Project should not exceed 2500 words. Evidence in excess of 2500 words will not be assessed. Project Proposal Research Approach Objective QuestionLocating Research Within the larger Discourse Time Line Publication Plan Declaration I declare that the information I have provided in this application form is, to the best of my knowledge and belief, correct and complete. Warning: if you include any details that you know to be false or if you withhold relevant information, you may render yourself liable to disqualification from the recruitment exercise or, if appointed, to dismissal. N.B. If you submit your application electronically, typing your name will be taken as being as binding as your signature. Your signature/name Date Designation N.B. Kindly ensure that all the required information is enclosed. It may not be possible to consider a candidate for want of complete information. (Applicant already in employment should get the proforma endorsed by his/her employer.)
