JOB APPLICATION FORM Medi-Caps International School (To be filled in Block Letters) Near Medicaps College Campus, A.B Road, Rau, Indore - 453331 Mobile : +91-96446 00054, +91-96448 00054 email : [email protected], www.medicapsschool.com Form No. ACADEMIC EMPLOYMENT / NON ACADEMIC STAFF INSTRUCTIONS (please read and follow these carefully) 1. Copies of Degree / Certificates / Testimonial should NOT be sent with this Application Form. 2. Applicants called for interview will have to bear their own traveling expenses unless otherwise agreed in advance. 3. Application should be delivered personally at the School office or sent by Registered Post/Courier. APPLICATION FOR Date Non Academic Acacemic Post Applied For Name of the Applicant (First Name) D Date of Birth D M M Y (Middle Name / Initial) Y Y Affix Recent passport Size Colored photo (Surname / Last Name) Age as on last birthday Y Marital Status Nationality Father’s Name Spouse Name Occupation Address for Correspondence City State Country - Residential Phone No. (with STD Code) [1] Pin/Zip Code - [2] Personal Mobile No. Fax - Spouse Mobile No. Personal Email ID Spouse Email ID Number of Children (If any) S.No. Age Caste Category Gender (Male/Female) General SC School Name with Grade / Class ST Major illness(es) OBC Gender Male Female Physical handicap / disability (b) Written Knowledge of Indian Languages (a) Spoken Education and Qualification (will be verified on appointment) Exam / Degree / Diploma X Medium of Study Year Marks (%) Institute / School / College University / Board Subject th XIIth B.Sc. / B.Com. / BA / BBA Others (Specify) M.Sc. / M.Com. / MA / MBA Others (Specify) B.Ed / M.Ed Mphil PhD City Office: 201, Pushpratna Paradise 9/5, New Palasia, Indore -452003 (M.P.) Ph.: 0731-4046321, 4041435 Fax: 0731-4028148 Employment Experience - Total Working Experience (No. of Years) Academic (Teaching) Name of the Institution with complete postal address From To Period Subject Class taught Non Academic (Non-Teaching) Name of the Institution with complete postal address From To Period Proficiency in sports and activities Seminars / Courses attended S.No Name of Seminars / Courses Description Duration Do you have any substantial connection with any employee of MIS or its Units Yes No If yes please specify Current CTC (Rs. / Yearly) Expected CTC (Rs. / Monthly) Expected Joining Period Required DECLARATION I hereby declare that all the particulars stated in the application are true to the best of my knowledge and belief. I have not concealed any information likely to impair my fitness for employment. If it is revealed later that I have given false / incorrect details or concealed material information, my services are liable to summary terminated without any notice or compensation. If selected, I shall produce : n Medical Certification from recognize Hospital / Clinic / Registered Medical Practitioner (indicating, In case of ladies, If they are pregnant) n Experience certificate from my last employer duly counter signed by the Zonal Educational Officer or the competent authority. n Original certificates for verification Date Signature Place FOR OFFICE USE ONLY Selected Yes No Application Received on Form No. Call for Interview on . Interview Panel Remark . . City Office: 201, Pushpratna Paradise 9/5, New Palasia, Indore -452003 (M.P.) Ph.: 0731-4046321, 4041435 Fax: 0731-4028148