Z.O : Venus Royal Hyda, Plot No.: 66, Block – C/423, Rasulgarh, Bhubaneswar-10, Khordha, Odisha, www.odishasishumandir.org, Mob : 0674 – 6555502 Please affix recent passport size photograph here (Do not staple) FOR OFFICE USE ONLY Form No.: Area : Date of form submission : Application form for the post : A. PERSONAL INFORMATION 1. Name (in capital) : 2. Father / Husband Name : 3. Address : MEDIUM : ODIA 4. Date of Birth : B. ACADEMIC/PROFESSIONAL QUALIFICATION Examination Medium of Year Marks (%) Study School/College Attended ENGLISH 5. Nationality : 6. Mob : 7. Gender : M Board/University F Subject C. DETAILS OF TECHING EXPERIENCE IN RECOGNISED SCHOOLS ONLY (start with recent one) Name of the institution From To No. of years Subject(s) & classes taught with complete address Month and year Month and year DECALRATION : Certified that details given above true and correct to the best of my knowledge Place : _________________________ Date ____________________ Signature of the Applicant Enclosures : Demand Draft : Passport Photo : Note : (a) Please confirm if you have your present employer’s consent to apply for this post if yes, please attach No. objection certificate. (b) In case you are applying in strict confidence, do state if you will be able to submit No objection Certificate from your current employer, in case you are selected. (c) Please produce original and attested copies of testimonial and certificates at the time of interview. For office use only : Mr./ Ms. / Mrs. ________________________________ has been selected / rejected after interview / demo dated ______________ for the post of _______________. He / she shall join his / her duties from____________. He/ She shall be paid basic salary @ Rs. ______________ p.m in the scale of _____________________________. OR He/She shall be paid Gross Salary of Rs. ________________________________________ p.m. Signature of the Principal Member 1 Member 2 Remarks of the Chairman : Approved/Not Approved Signature : __________________________