Application for the post of* Position Applied for* Select Professor Associate Professor Assistant Professor Visiting Faculty Adjunct Faculty Area of Specialization* Select Communication Economics Finance & Accounting Humanities and Social Sciences Information Systems Marketing Operations Management & Quantitative Techniques Organizational Behaviour & HRM Strategic Management Psychology Sociology Mathematics English Language Managerial Accounting Have you applied before to IIM Indore* Select Yes No If Yes, provide date of application Personal Details Name* E-mail* Date of Birth * Aadhar No. Mobile No. * Tel. No. Fax No. Mailing Address* Gender (M/F)* Select Male Female Marital Status * Select Unmarried Married Widow Widower Divorcee No. of dependents * Select 0 1 2 3 4 5 6 7 8 9 10 Family Details Details of Family * Name Relation with Employee Age Profession X Add Row Nationality * Select Indian Others Category* Select General SC ST OBC PWD Teaching Interests * Areas of Research Interests * Objectives for applying at IIM Indore* Educational Qualifications recognized by AIU/UGC/any other statutory body or parity (in reverse chronological order) * Examination Passed University/Institution Subjects Year Of Passing %Age Of Marks Class/Division Part-Time Fulltime X Add Row Detail of Ph.D/ Equivalent recognized by AIU/UGC/any other statutory body or parity * University/ Institution Passing Year Topic of Ph.D/ Equivalent Part time/ Full time X Add Row Courses (Subjects) Taught * Course (Subject) Title Organization/ Institution Level (UG/PG) Participants'Feedback (If Available) X Add Row Full time Work Experience (in reverse chronological order)* Name of the Employer Pre Ph.D. Post Ph.D. Period of Service Position/Designation Scale of Pay & Basic Pay Reason for leaving From To X Add Row Total work experience Total work experience in years* Select Years 012345678910111213141516171819202122232425 Total Work Experience as Assistant Professor/Associate Professor in years* Select Years 012345678910111213141516171819202122232425 Total Post-Ph.D. Teaching Experience at P.G. level in years Select Years 012345678910111213141516171819202122232425 at U.G. level in years Select Years 012345678910111213141516171819202122232425 any other (please specify) in years Select Years 012345678910111213141516171819202122232425 Publications A. Article published in FT50/ABDC /ABS/AMS ranked journals Authors Year Title Journal Name FT50 / ABDC / ABS / AMS Journal details* SelectFT50ABDC ABS AMS X Add Row *The impact factor of the journal and its inclusion in CABEL/Web of Science/ Scopus databases may be indicated here. B. Conference Papers Authors Year Title Conference Name Conference Details X Add Row Details of others publication and Research Works MDPs/Workshops/Seminars/Consultancy conducted Experience of Administrative Responsibilities in Academic Institutions Any other information you may wish to add Professional References (1) * Professional References (2) * Declaration I declare that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed/distorted. If I am found to have concealed/distorted any material information, my appointment shall be liable to summarily termination without any notice. If offered appointment, I will join on specified date and subsequently take up IIM Indore's assignment anywhere as and when required.