Form A

KENDRIYA VIDYALAYA, AFS, Uttarlai (Barmer) 344001

APPLICATION FORMFOR PART TIME CONTRACTUAL TEACHERS/INSTRUCTORS/COACHES.

Important notes: 1. Allentries should bemadeincapital letters

2.Oneformshould beused foronepost.

3.Enclose attestedcopies oftestimonials with each form. (Ifapplied formorethanone Post).

1.POST APPLIED FOR

(Pleaseindicatewhether PGT/TGT/PRT//ComputerInstructor/ Coachesinthe box)

SUBJECTAPPLIED FOR

(In caseofPGT/TGT Only)

2. Candidate’s Name(in capital letters) (Pleasekeeponebox blank betweenFirstname, MiddlenameLastname)

3. Father’s /Husband’sName(in capitalletters)FatherHusband

(Pleasekeeponeboxblank betweenFirstname,middle nameLastname)

4. DateofBirth:

DAY


MONTH

YEAR

5.GenderMF

(PleaseTick)

6.Ageas on 31.03.2016

YearMonthDays

7.CandidateAddress(in capitals letters)

Name: Father/Husband’sName: Address:

:

:

City/Town:PIN Ph/Mobile No.:

Pleaseaffixonerecent

Photographwithoutattestation

8.Academic Qualification(Startingfrom High School level)

Signatureof Candidate

(Pleasegive information as applicable.(Attachattested copies ofMark sheets and Certificates)

Name ofExamination
(withcomplete name of coursepassed) / Write name
of
Examination passed / Year of
passing / AGGREGATEMARKS / Subjects
/Specialization / Duration
ofcourse
(inmonths) / Board/
University
Max.
Marks / Marks
obtained / %age of
marks
High School(ClassX)
Intermediate (Class XII)
Graduation
(Name ofCourse)
Post Graduation
(Name ofCourse)
Others ifany
(Specify)

9.Professional Qualification(Attachattested copies ofmarksheets &certificates)

Nameof
Examination
(with complete name ofcourse passed) / Writename of
Examination passed / Yearof passing / AGGREGRATE MARKS / Subjects
/Specialization / Duration ofcourse
(in months) / Board/ University
Max. Marks / Marks obtained / %ageof marks
JBT/B.E.ED/
(specify)
B.ED / Theory
Practical
BE/B.Tech(CS)/
MBBS Degree/Diploma
in Nursing
Otherifany
(specify)

10. Experience (Attachseparatesheet, ifcolumns areinsufficient)

Post
held / Nameof
Institution / Periodofservice / No.of
completed
years &months / Class
taught / Subjects taught / Scale of pay
andsalary permonth
From / To

11.Areyouable to interactthroughEnglishandHindi,both?

(Pleasemark(√) tick intheappropriatebox) For teaching posts

12.Do you haveknowledge ofcomputerapplication?

(Pleasemark(√) tick intheappropriatebox) For teaching posts

YESNO

YESNO

UNDERTAKING

Iherebycertifythatalltheinformationgivenaboveistrueandcorrecttothebestofmyknowledge.I haveattachedattested copies ofmytestimonialsinsupport ofthe entriesmadeabove. Ialso agreethat mereeligibilitydoesnotconferrighttobecalledforinterview/selection.Mycandidaturemaybe cancelledincase any informationis foundto beincorrect on verification.

Place

Date

Contact No.

Signature

Name