KENDRIYA VIDYALAYA SANGATHAN

18, Institutional Area, Shaheed Jeet Singh Marg

New Delhi – 110602

RECRTUIMENT OF TRAINED GRADUATE TEACHERS, MISCLLAENOUS TEACHING POSTS

AND PRIMARY TEACHERS IN K.V.S. FOR THE YEAR 2011-2012

Important Notes: (i) Before filling this Form, read the instructions carefully. (ii) All entries should be made in capital letters

POST APPLIED POST CATEGORY DATE OF BIRTH GENDER AGE AS ON 30.11.2010

SUBJECT OPTED
(TGT/LIB/PRT) CODE (GEN/SC/ST/OBC) DAY MONTH YEAR (Male/Female) DAYS MONTH YEAR

1. Candidate's Name (in capital letters) (please keep one box blank between name, middle name & sur name)

2. Father's/Husband's Name (in capital letters) (Please tick mark (√ ) in the appropriate box) Father Husband

3. Choice of Examination City 4. Area Code (For remote Area and Abroad)
1st Preference 2nd Preference if Yes,
YES/NO
Name of City City Code Name of City City Code Name of Area Code

5. Sub-Category (please tick mark (9) in the appropriate box)

SUB–CATEGORY – I (Physically Challenged) If Physically Challenged, SUB CATEGORY – II (please tick mark (9) )
If Physically Challenged, mark the appropriate column please indicate whether Resident of State
KVS In Govt.
Locomotor/ Guide/Scribe is required at of J&K (Domiciled
Visually Hearing Regular Regular Woman
Orthopadecally the Examination Centre During 1.1.80 to
Challenged Challenged Employee Service
Challenged (write: Yes/No) 31.12.89)

Ex-Serviceman To be filled only if candidate himself/herself

(please tick mark (9)) is Ex-Serviceman 6. Post Subject Post Qualification
(TGT/LIB/PRT) Opted Code Code
Self Dependent Joining Date Retirement Date Total Service

7. Details of fee paid through Electronic Transfer

UTR No./ Journal No. Date Name of Bank Branch Address Branch Code Amount
(Rs.)

(Candidates should attach copy of the Pay-in- Slip/Challan in Original received from the Bank)

8. Candidate Address (in capital letters)

NAME :
FATHER/HUSBAND NAME:
ADDRESS : Please affix one recent
: Photograph without
attestation
TOWN/CITY :
DISTRICT :
STATE : PIN

Contact Details: STD Code: Tel. No. :

Email ID: Mobile No:
Signature of Candidate Ç
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9. Academic Qualification (starting from class 10th )
(Please give information as applicable. Attach separate sheet if columns are insufficient)
Name of Name of Examination Year of AGGREGATE MARKS % age in Subjects/ Duration Board/
Examination Passed (write complete Passing Max. Marks %age of subject Qualification of course University
name of course passed Marks Obtained marks applied (Code) (in months)
as on 30.11.2010)
Matriculation
(Class X)

Senior
Secondary
(Class XII)

Graduation/
Diploma

Post
Graduation

Other if any,
(Specify)

10. Professional Qualification

Name of Name of Examination AGGREGATE MARKS

Year of Subjects Duration of Board/
Examination Passed (write complete
Max. Marks %age of course
name of course passed Passing Studied University
as on 30.11.2010) Marks Obtained marks (in months)

JBT/ B.El.Ed.

B.Ed

M.Ed/Ph.D./
M.Phil

Others if any
(Specify)

11. Candidates applying for TGT-Mathematics, TGT-Science or TGT-Social Studies must have studied subject combinations
as per essential qualification in Graduation/Degree Course. The details of subject combinations studied and percentage of
marks obtained must be filled in the following columns. In case the details are not provided, the application will be summarily
rejected.

Ist year IInd year IIIrd year Total marks Maximum

Post Course of Subjects %age of Subjects %age of Subjects % age of obtained Marks allowed
Applied study Studied Marks Studied Marks Studied Marks (all years (all years
obtained obtained obtained together) together)

Note of Column 9, 10 & 11 :

1. If code/numeral are indicated in the mark sheet in place of subject(s) studied, please attach necessary details for such de-codification.
2. If grades are given, in lieu of marks, write equal percentage of marks in the relevant coloumns and attach the gradation list with your mark-
sheet.
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12. Teaching Experience (attach separate sheet, if columns are insufficient)

Post Held Name of Whether Central Period of Service No. of Nature of Scale of pay and
Institution/ Govt./State Govt./ From To Completed Duties salary per month
Department/ Autonomous Body/ Public months
Ministry Sector/ Recognized/Un-
Recognized (if applicable)

13. Are you able to teach through English and Hindi, both : Yes No
(Please tick mark (9) in the appropriate box)

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DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby certify and declare that (i) I am an Indian National, (ii) I have read the provisions given in the
Advertisement, (iii) All statements made and information given by me in this application are 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 appointment, action can be taken against me by the KVS and my
candidature/appointment shall automatically stand cancelled/terminated, (iv) I further declare that I fulfil all the
conditions of eligibility regarding age, educational, professional qualifications, etc. prescribed for the post applied for
as on 30.11.2010. The essential qualifications prescribed are possessed by me, the proofs of which have been
enclosed, (v) In case my application is not received by KVS within the stipulated date due to postal delay or
otherwise, KVS will not be responsible for such delay, (vi) I will not lay any claim for refund of non-refundable
application fee from KVS under any circumstances.

Please affix one recent

Photograph with
attestation

Place:………………………

Date:…………………….. (Signature of Candidate)

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FOR USE OF THE FORWARDING OFFICE
Name of the Office …………………………………………………………………………………………….. date ……………………….. and
address ………………………………………………………………………………………………………………… Pin Code ……………………

It is certified that the applicant Mr./Mrs……………………………………..……………………………………………………………. is

working as ………………………………………….. in this Institute/Organization, which is Government/Semi Government/
State Government/ Government recognized/ Autonomous/ Aided/ Private since ………….…………… and that entries
made by the applicant have been checked and verified from the service records.
No disciplinary/ Vigilance action is pending/ contemplated against him/her at the time of application.

Place : ……………………… Signature : ………………………………………………

Date : …………………….. Name : ………………………………………………
Designation: ………………………………………………

Seal : ………………………………………………