Application Form for Interview

1
KENDRIYA VIDYALAYA No.1
AIR FORCE STATION, HALWARA-141106
Website: www.kvno1halwara.net
Phone: 01624-275056
_______________________________________________________________
APPLICATION FORM FOR PART-TIME CONTRACTUAL TEACHERS FOR THE SESSION 2015-16
Note: FILL SEPARATE FORM FOR SEPARATE POSTS
POST APPLIED FOR (please indicate whether PGT /
TGT/PRT/Computer Instructor/Coaches/Art & Craft
Teacher/Nurse/Doctor/Counsellor etc in the box)
Please affix recent
photograph
SUBJECT (only for PGTs and TGTs)
1.
Candidate’s Name (in Capital letters) (please keep one box blank between name, middle name & surname).
2.
Father’s / Husband’s Name (in Capital letters)
(Please mark (
) tick in the appropriate box)
3.
Date of Birth :
Father
Sex :
DAY
MONTH
YEARS
MONTHS
Age as on 31.03.2015 :
5.
6.
Employment Exchange Registration Number :-_____________
Category (Please mark ( ) tick in the appropriate box).
SC
M
F
YEAR
4.
UR
Husband
ST
DAYS
OBC
(Candidate Address (in Capital letters):
Name
:_______________________________________________________
Father / Husband Name :_______________________________________________________
7.
Address
:_______________________________________________________
Pin Code
:_______________________________________________________
Contact No.
: (Land Line)______________________________________________
Mobile No.
:_______________________________________________________
Academic Qualification (starting from +2 stage) (Please give information as applicable. Attach separate sheet if columns are
insufficient).
Name of Examination
(Write complete name of
course passed
Please write name
of Examination
passed
Year of
Passing
AGGREGATE MARKS
Max.
Marks
Marks
%age
Obtained of
marks
%age in
subject
applied
Subjects offered
Board
/
University
Senior Secondary
(Class XII)
Graduation
(name of course)
Post-Graduation
(name of Course)
Other, if any
(Specify)
Have you qualified Central Teacher Eligibility Test? ________ (If Yes, Write Roll No. ___________, Marks Obtained ______)
Signature of Candidate
2
8. Professional Qualification:
Name of
Please write
Examination (Write
name of
complete name of
Examination
course passed
passed
JBT/B.El.Ed/NTT etc
(Specify)
B.Ed.
Year
of
Passi
ng
AGGREGATE MARKS
Max.
Marks
Marks
%age
Obtained of
marks
%age in
subject
applied
Subjects offered
Board
/
University
M.Ed/Ph.D/M.Phil
Other, if any
(Specify)
9. Experience (attach separate sheet, if columns are insufficient)
Post Held
Name of
Whether Central
Period of Service
Institution/
Govt./State Govt. /
From
To
Department / Autonomous Body/ Public
Ministry
Sector / Recognized
(if applicable)
10. Are you able to teach through English and Hindi, Both
(Please mark (
) tick in the appropriate box)
HINDI ONLY
ENGLISH ONLY
No. of
completed
years &
months
Nature of
Duties
Remarks, if
any
Both Hindi & English
11. Terms & Conditions
I.
Attach attested photocopies of all certificates including academic & professional qualification, experience and CTET
II.
Bring all Original Documents on the day of Interview for verification.
III.
Contractual teachers will be appointed against Leave Vacancy / as per need basis / Daily Basis on purely Part-Time
Contractual Basis. If a regular teacher joins, the duty of contractual teacher will be automatically terminated with
immediate effect, i.e on the same day.
IV.
If the candidate is selected, appointed or he/she wants to leave the job then he/she has to serve one month notice.
Signature of Candidate
DECLARATION TO BE SIGNED BY THE CANDIDATE
I hereby certify and declare that:
i)
ii)
iii)
iv)
v)
I am an Indian National.
I have read the provisions given in the Advertisement.
All statements made and information given by me in this application is true, complete and correct to the best of my
knowledge and belief. In the event of any information or part of it being found false or incorrect before or after the
exam / interview or after Part-Time contractual appointment, action can be taken against me by the Vidyalaya and my
candidature/ appointment shall automatically stand cancelled.
I further declare that I fulfill all the conditions of eligibility regarding age, educational, professional / technical
qualifications, etc. prescribed. The essential qualifications prescribed are possessed by me, the proof of which has been
enclosed.
I have no claim for regular appointment in KVS as this advertisement is only for this Vidyalaya temporarily arrangement
and part-time contractual basis.
PLACE: ___________________________
DATE :____________________________
Signature of Candidate