1 KENDRIYA VIDYALAYA No.1 AIR FORCE STATION, HALWARA-141106 Website: www.kvno1halwara.net Phone: 01624-275056 _______________________________________________________________ APPLICATION FORM FOR PART-TIME CONTRACTUAL TEACHERS FOR THE SESSION 2015-16 Note: FILL SEPARATE FORM FOR SEPARATE POSTS POST APPLIED FOR (please indicate whether PGT / TGT/PRT/Computer Instructor/Coaches/Art & Craft Teacher/Nurse/Doctor/Counsellor etc in the box) Please affix recent photograph SUBJECT (only for PGTs and TGTs) 1. Candidate’s Name (in Capital letters) (please keep one box blank between name, middle name & surname). 2. Father’s / Husband’s Name (in Capital letters) (Please mark ( ) tick in the appropriate box) 3. Date of Birth : Father Sex : DAY MONTH YEARS MONTHS Age as on 31.03.2015 : 5. 6. Employment Exchange Registration Number :-_____________ Category (Please mark ( ) tick in the appropriate box). SC M F YEAR 4. UR Husband ST DAYS OBC (Candidate Address (in Capital letters): Name :_______________________________________________________ Father / Husband Name :_______________________________________________________ 7. Address :_______________________________________________________ Pin Code :_______________________________________________________ Contact No. : (Land Line)______________________________________________ Mobile No. :_______________________________________________________ Academic Qualification (starting from +2 stage) (Please give information as applicable. Attach separate sheet if columns are insufficient). Name of Examination (Write complete name of course passed Please write name of Examination passed Year of Passing AGGREGATE MARKS Max. Marks Marks %age Obtained of marks %age in subject applied Subjects offered Board / University Senior Secondary (Class XII) Graduation (name of course) Post-Graduation (name of Course) Other, if any (Specify) Have you qualified Central Teacher Eligibility Test? ________ (If Yes, Write Roll No. ___________, Marks Obtained ______) Signature of Candidate 2 8. Professional Qualification: Name of Please write Examination (Write name of complete name of Examination course passed passed JBT/B.El.Ed/NTT etc (Specify) B.Ed. Year of Passi ng AGGREGATE MARKS Max. Marks Marks %age Obtained of marks %age in subject applied Subjects offered Board / University M.Ed/Ph.D/M.Phil Other, if any (Specify) 9. Experience (attach separate sheet, if columns are insufficient) Post Held Name of Whether Central Period of Service Institution/ Govt./State Govt. / From To Department / Autonomous Body/ Public Ministry Sector / Recognized (if applicable) 10. Are you able to teach through English and Hindi, Both (Please mark ( ) tick in the appropriate box) HINDI ONLY ENGLISH ONLY No. of completed years & months Nature of Duties Remarks, if any Both Hindi & English 11. Terms & Conditions I. Attach attested photocopies of all certificates including academic & professional qualification, experience and CTET II. Bring all Original Documents on the day of Interview for verification. III. Contractual teachers will be appointed against Leave Vacancy / as per need basis / Daily Basis on purely Part-Time Contractual Basis. If a regular teacher joins, the duty of contractual teacher will be automatically terminated with immediate effect, i.e on the same day. IV. If the candidate is selected, appointed or he/she wants to leave the job then he/she has to serve one month notice. Signature of Candidate DECLARATION TO BE SIGNED BY THE CANDIDATE I hereby certify and declare that: i) ii) iii) iv) v) I am an Indian National. I have read the provisions given in the Advertisement. All statements made and information given by me in this application is true, complete and correct to the best of my knowledge and belief. In the event of any information or part of it being found false or incorrect before or after the exam / interview or after Part-Time contractual appointment, action can be taken against me by the Vidyalaya and my candidature/ appointment shall automatically stand cancelled. I further declare that I fulfill all the conditions of eligibility regarding age, educational, professional / technical qualifications, etc. prescribed. The essential qualifications prescribed are possessed by me, the proof of which has been enclosed. I have no claim for regular appointment in KVS as this advertisement is only for this Vidyalaya temporarily arrangement and part-time contractual basis. PLACE: ___________________________ DATE :____________________________ Signature of Candidate