es_formsG

FORM-G

COUNCIL OF SCIENTIFIC AND INDUSTRIAL RESEARCH

Human Resource Development Group

(Extra Mural Research Division)

CSIR Complex

Library Avenue, Pusa, New Delhi-110012

APPLICATION FORM FOR JUNIOR/SENIOR RESEARCH FELLOWSHIPS/ ASSOCIATESHIP UNDER CSIR RESEARCH SCHEME

1. Title of the scheme:

2. Emeritus Scientist name, designation and place of work:

3. Sanction number of the scheme and duration:

4. Full name of Applicant in block letters (surname is to be under-lined):

5. Present address:

6. Permanent address:

7. Whether belonging to SC/ST/OBC? Yes/No (If yes, the name of Caste/Tribe may be mentioned and certificate enclosed):

8. Date of birth:

9. Nationality:

10. Father's/Husband's name:

11. Educational qualifications (bachelor degree onwards):

a) Degree/Diploma

b) University/Institute

c) Subject(s)

d) Year of passing

e) Division/Grade

f) Marks Percent

12. Are you registered for a higher degree? Yes/No

(a) If 'yes' please indicate

              (i)Title of the degree
              (ii) University
              (iii) Date of registration

(b) If 'no' please indicate whether you propose to register for a higher degree? Yes/No

13. Have you any research/teaching experience? Yes/No

If yes, give details about the institution, duration of work, emoluments and work done

14. Have you been a recipient of a research fellowship before? Yes/No

            If 'yes', please give details of the dates, and amount of award, duration and names of  the concerned Scheme, Principal Investigator, Institution and Supporting Agency.

15. Publications (attach reprints of published work and copies of papers communicated and give list of published papers in terms of name(s) of author(s), title, journal, year and volume and page numbers):

16. DECLARATION

I am willing to work as a Junior/Senior/Research Fellow/Associate in the research scheme entitled ............. …...………………………………If the Fellowship/Associateship is awarded to me, I undertake to engage myself whole time for research under the guidance of the Emeritus Scientist of the scheme. I have read 'Terms and Conditions of CSIR Research Grants' and accept and agree to abide by these. I have noted that the Fellowship/Associateship is co-terminus with the Scheme.
I certify that, to the best of my knowledge and belief, the particulars given in this application are correct.

Signature of the Candidate

Date:

17. ATTESTATIONS (by the Emeritust Scientist and Head of the Institution):

I certify that the information given by the applicant, including that in Columns 8 and 11 is correct. On the advice of the duly appointed Selection Committee the candidate is recommended for the award of aJunior/Senior Research Fellowship/Research Associateship for the duration of the Scheme from ________________________________________.

Signature, Name and Designation

Emeritust Scientist

Date:

Necessary facilities will be provided to the Research Fellow for work on the above problem for the duration of the scheme.

Signature and Name of the Head

of the Institution with seal

Date: