Azim premji university

AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

1. Position Applied For: 2. Name: Mr./ Ms/ Mx. 3. Address for Correspondence:

4. Residential Address:

5. Telephone number: 6. Email id: 7. Date of birth: 8. Nationality: 9. Have you been earlier interviewed by the Foundation (Field/University/Philanthropy)?

If yes, when and for what role?

10.Language Proficiency: Please tick (√) against the language mentioned Languages Known

Speak

Read

Write

11. Educational Qualification Educational Qualification

Institution

1.

2.

2016

Page 1

Year of Qualifying

Distinction (if any)

AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

3.

4.

5.

12.Work Experience: Work Experience

Institution

Duration Position (in “mm-yyyy to mm – yyyy” format)

Salary Drawn

1.

2.

3.

4.

5.

6.

Expected Salary:

13.Teaching Experience Courses taught

Institution/s

1.

2.

3.

4.

2016

Page 2

Number of Years

Level: UG / PG / School / Other

AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

5.

6.

14.Research Experience Research Experience

Name of Publication *

Year

Distinction (if any)

1.

2.

3.

4.

5.

6.

7.

*Publication could include article, op-ed, research paper, book chapter, book, monograph, consultancy report (should be identified as such)

2016

Page 3

AZIM PREMJI UNIVERSITY - INFORMATION SUMMARY SHEET

Give three references under whom you have either worked / received education from or who knows you professionally.

Sl. No

Name

Nature of Acquaintance

1

2

3

2016

Page 4

Position

Address

Contact Number

E Mail Id