ANNEXURE-V

JAWAHAR NAVODAYA VIDYALAYA

______Distt.______

FORMAT FOR PGTs/ TGTs/ Music/Art/ Librarian/ PET(M/F) & FCSA

ETC. FOR EMPANELMENT OF TEACHERS PURELY ON CONTRACT BASIS FOR THE SESSION 2017-2018

PART-I
1 Application for the post of / : / ______(on contract basis)
2. Tel.No. (with STD Code)/Mobile no.: / ______
3. E-Mail Address / : / ______
4. Name / : / ______ / Paste Latest
passport size
5. Father’s Name / : / ______ / photograph
of applicant
6. Date of Birth (DD/MM/YYYY) / : / ______
As on 15.06.2017 /
______Yrs.______Months___
7. Full Address for / : / ______
Communication / ______
8. Home District / : / ______
9. Category to which belong :- / : / ______
Gen/SC/ST/PH/OBC/Navodaya Spouse
10.In case of Navodaya Vidyalaya Spouse, give full details:
A. Name of spouse / : / ______
B. Post Held / : / ______
C. Place of Posting / : / ______

11. Education Qualification :

S.No. / Course of Study / Max. Marks / Marks Obtained / % age of marks
A) / FOR PGTs/TGTs
1 / 10th SSC (For all the candidates)
2 / 12th HSC (For all the candidates)
3 / Graduation
(Please Specify)
4 / Post Graduation in the subject
(Mention Subject)
5 / B.Ed. (Theory & Practical) B.PED/D.PED.
6 / CTET conducted by CBSE (Mention if qualified only ) (Only for TGTs)
7 / M.Phil/Ph.d. (For all)

(Kindly enclose proof in respect of conversion of grades into marks) Specify Graduation/Post Graduation etc. with subjects, if requiring in the additional rows.

(B) Co-Scholastic achievement:

1. / Representing National/SGFI in Sports and Games / Attach copy of certificate
2. / Representing State/University/Region in Sports and / Attach copy of certificate
Games
3. / Representing Distt. in Sports and Games / Attach copy of certificate
4. / NCC ‘ C’ / ‘ B’ / ‘A’ Certificate / Attach copy of certificate
5. / NSS / Attach copy of certificate
6. / Scout & Guide President award/Governor’s / Attach copy of certificate
Award.
7. / Certificate of performance awarded by Govt. / Attach copy of certificate
Institution in Art/Music/Literature at “National
level”
8. / Certificate of performance awarded by Govt. / Attach copy of certificate
institution in Art/Music/Literature at State Level
9. / Teaching experience in day school/Residential / Attach copy of certificate

(In a Govt. Semi.Govt., Aided Schools only)

A. Only for TGT(Mathematics)

Ist year / IInd year / IIIrd year / Total / Maxi
Course / Marks / mum / Total % of marks in degree / Remarks
Subject / %age / Subject / %age of / Subject / %age
of / offered / of / offered / marks / offered / of / obtained / Marks
study / marks / obtaine / marks / (all years / allowe
obtaine / d / obtain / together) / d (all
d / ed / years
togeth
er)
B.Sc. / 1 / Maths / Maths / Maths / Attach copy of mark sheet of B.Sc-I,II & III
2 / Physics / Physics / Physics
3 / Chemistry / Chemistry / Chemistry
Total

B. Only for TGT (Science)

Ist year / IInd year / IIIrd year / Total / Maxim
Course / Marks / um / Total % of marks in degree / Remarks
Subject / %age of / Subject / %age of / Subject / %age of
of / offered / marks / offered / marks / offered / marks / obtained / Marks
study / obtained / obtaine / obtaine / (all years / allowe
d / d / together) / d (all
years
togethe
r)
B.Sc. / 1 / Chemistry / Chemistry / Chemistry / Attach copy of mark sheet of B.Sc-I,II & III
2 / Botany / Botany / Botany
3 / Zoology / Zoology / Zoology
Total

C. Only for TGT (Social Studies)

Ist year / IInd year / IIIrd year / Total / Maximu
Course / Marks / m Marks / Total % of marks in degree / Remarks
Subject / %age of / Subject / %age of / Subject / %age
of / offered / marks / offered / marks / offered / of / obtained / allowed
study / obtaine / obtaine / marks / (all years / (all years
d / d / obtain / together) / together)
ed
B.A. / 1 / History / History / History / Attach copy of mark sheet of B.A. I,II & III
2 / Geography / Geography / Geography
3 / Economics / Economics / Economics
4 / Pol. science / Pol. science / Pol. science
Total

D. Only for TGT(English)

Course / Subject / Ist year / IInd / IIIrd / Total / Maximum / (all / Total % of marks in degree / Remarks
of / year / year / Marks / Marks
study / %age of / %age of / %age of / obtained / years together)
marks / marks / marks / (all years
obtained / obtained / obtained / together)
B.A. / 1 / Eng. / Attach copy of mark
sheet of
B.A.-I, II and III
Elective

E. Only for TGT(Hindi)

Course / Subject / Ist year / IInd / IIIrd / Total / Maximum / (all / Total % of marks in degree / Remarks
of / year / year / Marks / Marks
study / %age of / %age of / %age of / obtained / years
marks / marks / marks / (all years / together)
obtained / obtained / obtained / together)
B.A. / 1 / Hindi / Attach copy of mark
sheet of
B.A.-I, II and III
Elective

F. Only for TGT(Gujarati)

Course / Subject / Ist year / IInd / IIIrd / Total / Maximum / (all / Total % of marks in degree / Remarks
of / year / year / Marks / Marks
study / %age of / %age of / %age of / obtained / years
marks / marks / marks / (all years / together)
obtained / obtained / obtained / together)
B.A. / 1 / Gujarati
Elective / Attach copy of mark
sheet of
B.A.-I, II and III

H. Only for TGT(Marathi)

Course / Subject / Ist year / IInd / IIIrd / Total / Maximum Marks (all years together) / Total % of marks in degree / Remarks
of / year / year / Marks
study / %age of / %age of / %age of / obtained
marks / marks / marks / (all years
obtained / obtained / obtained / together)
B.A. / 1 / Marathi / Attach copy of mark
sheet of
B.A.-I, II and III
Elective
S.No. / Course of Study / Max. Marks / Marks Obtained / % age of marks / % age of marks
I) / FOR PGT (IT)
1 / BE or B.Tech.(Computer Science/IT)
2 / BE or B.Tech. (any stream) and Post Graduate Diploma in Computers from any recognized University.
3 / M.Sc. Computer Science/MCA
4 / B.Sc. Computer Science/BCA and Post Graduate Degree in any subject from a recognized university
5 / Post Graduate Diploma in Computer and Post Graduate Degree in any subject from a recognized University.
6 / ‘A’ level from DOEACC & Post Graduate Degree in any subject.
J) / FOR PET (MALE/FEMALE)
1 / Bachelor degree in Physical Education (B.PEd.)
2 / Post Graduation in Physical Education (M.PEd.)
3 / BA/B.Sc./B.Com.
4 / D.P.Ed. (one year)
K) / FOR ART TEACHER
1 / 5 years recognized Diploma in Fine Art
2 / Graduate with Fine Arts/Drawing/Painting/Sculpture
3 / B.Ed. (Theory & Practical)
4 / MA (Drawing and Painting, Fine Arts from a recognized University
L) / FOR MUSIC TEACHER
1 / BA with Music
2 / Post Graduation in Music
3 / B.Ed. (Theory & Practical)
4 / Sangeet Visharad/Sangeet Bhushan.Nritya Visharad or the recognized equivalent in Southern states
5 / Sangeet Bhaskar/Nritya Bhushan Nritya Visharad or the recognized equivalent in Southern States
6 / Graduation.
M) / FOR LIBRARIAN
1 / BA/B.Sc./B.Com
2 / Degree/Diploma in Library Science

12. Experience in Govt. Residential/Day Schools, Semi Govt. Aided School/Unaided.

In case of private recognized/unaided schools, experience certificate should be counter

signed by DEO.

S.No. / Name of the Institution / Duration / Total Period
From / To / Years / Months

Total Experience : ______Years.

(to be rounded off in completed years and months should be ignored)

I solemnly undertake that in the event of my appointment on contractual basis in the Samiti, my services are liable to be terminated without notice if any of the foregoing information furnished by me in my application form is found to be wrong or suppressed. I further understand that this appointment is purely on contract and does not confer the right for regularization.

Date:

SIGNATURE OF CANDIDATE

PART – II CERTIFICATE (For office use)

Certified that I have scrutinized personally the information in Part – I above with originals and found it to be in order. Candidate is eligible for the post.

SIGNATURE OF THE OS/DEALING ASSISTANT/VERIFYING COMMITTEE

Name & Designation

Date:

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