GOVERNMENT OF PUDUCHERRY DIRECTORATE OF SCHOOL EDUCATION Perunthalaivar Kamarajar Centenary Educational Complex, 100 Feet Road, Anna Nagar, Puducherry – 605 005 *** APPLICATION FOR THE POST OF PRIMARY SCHOOL TEACHER – 2015 (Note : i) Read instructions before filling in the application ii) To be filled in by the Candidate in BLOCK LETTERS iii) Put  mark against the relevant box wherever necessary iv) Self Attested Copies of relevant certificates should be enclosed Affix a recent passport size photograph attested by a Gazetted Officer 1. Name of the Applicant 2. Father’s / Husband’s Name 3. Date of Birth 4. Age as on : DD/MM/YY 17.06.2015 : 5. Sex : Years Months Male Female Days 6. Educational and Professional Qualifications : Sl. No. Name of the Total Total Board maximum marks Year of marks in obtained in passing all all subjects subjects Month & Qualification 1. S.S.L.C. 2. H.S.C. 3. D.T.Ed Name of TET Month and Year of passing Maximum marks 7. Language Studied up to Secondary Level: 8. Employment Registration Code No: Number of Percentage attempt(s) of marks Marks obtained in TET Percentage :2: DD 9. Date of Registration MM YYYY : SSLC : H.Sc : D.T.Ed : Date of Next Renewal 10. Nationality : : INDIAN OTHERS 11. Whether Native / Resident of U.T.of Puducherry : 12. Religion : HINDU YES MUSLIM NO CHRISTIAN OTHERS 13. Community : GEN OBC 14. If belongs to SC, whether he/she is declared SC as per the Constitution (Pondicherry) Scheduled Castes Order, 1964 : 15. Whether differently abled Person : Yes Yes SC No No 16. Address for Communication: Pincode Phone No Mobile No. DECLARATION I have carefully read the instructions contained in the prospectus. I hereby declare that the information furnished above by me is true and correct to the best of my knowledge and I understand that my application is liable to be rejected if any information given above is found to be false. SIGNATURE OF THE APPLICANT DATE: PLACE: