KENDRIYA VIDYALAYA HPCL,JAGIROAD

APPLICATIONFORMFORAPPOINTMENTONCOTRACTUALBASISFOR2017-18.

Importantnotes:

All entries should be made in capital letters

 One form should be used for onepost.

This form is to be submitted without enclosing any documents. Supporting documents are required at the timeofInterview.

1.

2.Candidate’sName(incapitalletters)(PleasekeeponeboxblankbetweenFirstname, MiddlenameLastname)

3.Father’s /Husband’s Name (in capitalletters)FatherHusband(Please keep one box blank between First name, middle name & Lastname)

4.Date ofBirth:

6. Age as on31.03.2O16

DAY

MONTH

YEAR

5.Gender

(PleaseTick)

7.Candidate Address (in capitalsletters)

8.Academic Qualification (Starting from High Schoollevel)(Please give information asapplicable.

Signature ofCandidate

Name ofExamination(with completenameof coursepassed) / WritenameofExaminationpassed / Yearofpassing / AGGREGATEMARKS / Subjects/Specialization / Durationofcourse(inmonths) / Board/University
Max.Marks / Marksobtained / %ageofmarks
High School (ClassX)
Intermediate(ClassXII)
Graduation(Name ofCourse)
PostGraduation(Name ofCourse)
Others ifany(Specify)

9.ProfessionalQualification.

NameofExamination(withcompletename ofcoursepassed) / WritenameofExaminationpassed / Yearofpassing / AGGREGRATEMARKS / Subjects
/Specialization / Durationofcourse(inmonths) / Board/University
Max. Marks / Marksobtained / %ageofmarks
JBT/B.E.ED/
(specify)
B.ED / Theory
Practical
BE/B.Tech(CS)/MBBS
Degree/DiplomainNursing
CTET

10. Experience (Attach separate sheet, if columns areinsufficient)

Postheld / NameofInstitution / Period ofservice / No. ofcompletedyears &months / Classtaught / Subjectstaught / Scale of payandsalarypermonth
From / To

11.Are you able to teach through English and Hindi,both?

(Please mark (√) tick in the appropriate box) For teachingposts

12.Do you have knowledge of computerapplication?

(Please mark (√) tick in the appropriate box) For teachingposts

UNDERTAKING

Iherebycertifythatalltheinformationgivenaboveistrueandcorrecttothebestofmyknowledge.Ialsoagreethatmereeligibilitydoesnotconferrighttobecalledforinterview/selection.Mycandidaturemaybecancelledincaseanyinformationisfoundtobeincorrectonverification.

Place_

Date ContactNo.

Signature Name