क�द्र�य �वद्यालय न.-२,अमार्परु , कानपरु KENDRIYA VIDYALAYA NO-2, ARMAPUR, KANPUR APPLICATION FORM FOR PART TIME / CONTRACTUAL TEACHERS/INSTRUCTORS/COACHES EXPERTS DOCTOR, NURSE AND COUNSELOR, ETC.

Important notes: 1. All entries should be in capital letters 2. Use separate form for each post. 3. Enclose attested copies of testimonials with each form. (If applied for more than one) post) 1. POST APPLIED FOR SUBJECT APPLIED FOR (Please indicate whether PGT/TGT/PRT/

(In case of PGT/TGT)

/Computer Instructor/Coach/Experts Yoga Teacher /Doctor / Nurse/Counselor in the box)

2. Candidate’s Name (in capital letters) (Please keep one box blank between First name, Middle name & Last name) 3. Father’s /Husband’s Name (in capital letters)

Father

Husband

(Please keep one box blank between First name, middle name & Last name)

MONTH

DAY

YEAR

5. Gender

4. Date of Birth: 6. Age as on 31.03.2017

M

(Please Tick) Year

Month

F

Days

7. Candidate’s Correspondence Address Name : ___________________________________________________________ Father/Husband’s Name : ____________________________________________ Address : _________________________________________________________ _________________________________________________________________ _________________________________________________________________ City/Town : ________________________________________________________ State & PIN No. ____________________________________________________ Phone/Mobile No.___________________________________________________

Please affix one recent Photograph

Signature of Candidate

8. Academic Qualification (Starting from High School level) (Please give information as applicable. (Attach attested copies of Mark sheets and Certificates) Name of Examination (with complete name of course passed) High School (Class X) Intermediate (Class XII) Graduation (Name of Course) Post-Graduation (Name of Course) Others if any (Specify)

Write name of Examination passed

Board/ Univers ity

Year of passing

Duration of course (in months)

Subjects / Specialization

AGGREGATE MARKS Max. Marks % age Marks obtained of marks

Remarks

9. Professional Qualification (Attach attested copies of mark sheets & certificates) Name of Examination (with complete name of course passed)

Write name of Examination passed

Board/ University

Year of passing

Subjects /Specialization

Duration of course (in months)

AGGREGRATE MARKS %age Max. Marks of Marks obtained marks

Remarks

CTET JBT/B.E.ED (specify) B.ED

Theory

Practical BE/B.Tech(CS)/MBBS Degree/Diploma in Nursing Other if any (specify)

10. Experience (Attach separate sheet, if columns are insufficient) Post

Name of Institution

Period of service From

To

No. of completed months

Class taught

Subjects taught

Scale of pay and salary per month

11. For teaching posts:a. Are you able to teach in English and Hindi medium? (Please mark √ tick in the appropriate box)

YES

NO

b. Do you have knowledge of computer applications? (Please mark √ tick in the appropriate box)

YES

NO

Remarks

UNDERTAKING I hereby certify that all the information given above is true and correct to the best of my knowledge. I have attached attested copies of my testimonials in support of the entries made above. I also agree that mere eligibility does not confer right to be called for interview/selection. My candidature may be cancelled in case any information is found to be incorrect on verification.

Date: _______________ Place: ______________

Signature: _______________________ Name: __________________________ Contact No. _______________________ _______________________________________________________________________________________

For office use Eligible / Not Eligible Merit point (if any) __________ Signature of the verification committee member_____________ Experience points (if any) ___________ Name of the verification committee member _______________