///////////////////////////////////////////////////////////////////////////////////////////////ANNEXURE-V ​JAWAHAR

NAVODAYA VIDYALAYA ___________________ Distt.___________________

FORMAT OF APPLICATION FOR PGTs/ TGTs/ Music/Art / Librarian/ PET(M/F)
ETC. FOR EMPANELMENT OF ​TEACHERS
PURELY ON CONTRACT BASIS FOR THE SESSION 2018-2019
PART-I
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2. Tel.No. (​ with STD Code​)/Mobile no.:
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3. E-Mail Address : ____________________________
Paste Latest ​4. Name : __________///////////////////////////////////////////////////////////////////__________________
passport size
5. Father’s Name : ____________________________ ////////////////////////////////////////////////////////////////////
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////////////////////////////////////////////////photograph of applicant
6. Date of Birth
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///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////YYY) :
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As on 15.06.2018 ​___________Yrs._________Months___
7. Full Address for : ____________________________
Communication
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8. Home District : ______________________________________
9. Category to which belong :- : ______________________________________
Gen/SC/ST/PH/OBC/Navodaya Spouse
10.In case of Navodaya Vidyalaya Spouse, give full details:
A. Name of spouse : ______________________________________
B. Post Held : ______________________________________
C. Place of Posting : ______________________________________
11. Choice place of posting : (1)-----------------------(2)---------------------------(3)---------------------------
12. Education Qualification : ​S.No. Course of Study Max. Marks Marks
Obtained

% age of marks ​A) FOR PGTs/TGTs ​1 ​10​th ​SSC (For all the candidates) 2
​ ​12​th ​HSC (For all

​ ​Graduation
the candidates) 3
(Please Specify) ​4 ​Post Graduation in the subject
(Mention Subject) ​5 ​B.Ed. (Theory & Practical)
B.P.ED./D.P.ED. 6 ​CTET conducted by CBSE (Mention
if qualified only ) (Only for TGTs) ​7 ​M.Phil/Ph.d. (For all)
(Kindly enclose proof in respect of conversion of grades into marks) Specify Graduation/Post Graduation etc.
with subjects, if requiring in the additional rows.
(B) Co-Scholastic achievement: ​(In a Govt. Semi.Govt., Aided Schools only)
1. Representing National/SGFI in Sports and Games Attach copy of certificate 2.
Representing State/University/Region in Sports and Attach copy of certificate
Games 3. Representing Distt. in Sports and Games Attach copy of certificate 4. NCC „ C‟ /
„ B‟ / „A‟ Certificate Attach copy of certificate 5. NSS Attach copy of certificate 6. Scout &
Guide President award/Governor‟s Attach copy of certificate
Award. 7. Certificate of performance awarded by Govt. Attach copy of certificate
Institution in Art/Music/Literature at “National level” 8. Certificate of performance awarded
by Govt. Attach copy of certificate
institution in Art/Music/Literature at State Level 9. Teaching experience in day
school/Residential Attach copy of certificate
A. Only for TGT(Mathematics)
Ist year IInd year IIIrd year Total Maxi Course Marks mum ​Total %

of marks in degree ​Of Subject

​ %age ​offered of Remarks
​ ​Subject %age of Subject %age ​offered marks Offered of ​obtained Marks study ​marks

obtaine marks ​(all years allowe

obtaine d obtain ​together) d (all ​d ed ​years
togeth er) ​B.Sc. 1 ​Maths Maths Maths ​Attach copy of
2​ Physics ​ Physics ​ Physics ​
3​ Chemistry ​ Chemistry ​ Chemistry

mark sheet of B.Sc-I,II & III ​Total

B. Only for TGT (Science)
Ist year IInd year IIIrd year Total Maxim Course ​Of Subject
​ %age of Subject ​offered marks offered Marks
​ um ​Total %

of marks in degree ​%age of Subject ​Remarks ​marks Offered ​%age of ​marks ​obtained Marks ​study ​obtained obtaine obtaine ​(all years
allowe
d d ​together) d (all years togethe r) ​B.Sc. 1 ​Chemistry Chemistry
​ Chemistry ​2 ​Botany Botany Botany

3 ​Zoology Zoology Zoology ​Attach ​mark B.Sc-I,II sheet copy

​ ​ ​Total
​& of III of
C. Only for TGT (Social Studies​)
Ist year IInd year IIIrd year Total Maximu Course ​Of study Subject
​ %age of Subject %age of Subject %age ​offered marks offered marks Offered

of obtaine obtaine marks d

​ d obtain ed

Marks m Marks ​Total % Remarks ​obtained (all years ​together) ​allowed (all years
together)
 of ​marks in degree
​ ​B.A. 1 ​History History History ​Attach copy of
2​ ​ Geography ​ Geography ​
3 Geography
​ Economics ​ Economics ​ Economics

mark sheet of B.A. I,II & III ​4 ​Pol. science Pol. science Pol. Science
Total
D. Only for TGT(English​) ​Course S​ ubject ​Ist year IInd IIIrd Total Maximum Of (all ​study year
​ year ​%age of %age of %age of

Marks ​obtained ​Marks ​years together)

Total ​
of ​in degree
%​
marks ​ Remarks

marks marks marks ​(all years ​ obtained obtained ​together) ​Elective

B.A. 1 ​Eng. obtained
​

Attach mark copy of

sheet of B.A.-I, II and III
E. Only for TGT(Hindi​) ​Course ​Subject ​Ist year IInd IIIrd Total Maximum (all ​Of study year year Marks Marks ​%age of %age of
%age of ​obtained years
marks marks marks ​(all years together)
Total ​ %​
of ​in degree marks
​ ​ Remarks ​B.A. 1 ​Hindi obtained
​ obtained obtained ​together) ​Elective

Attach mark copy of sheet

​ ​B.A.-I, of
​ ​II and III
F. Only for TGT(Gujarati​) ​Course S​ ubject ​Ist year IInd IIIrd Total Maximum ​Of (all
​ ​Study ​year year Marks Marks
%age of %age of %age of ​obtained years ​marks marks marks ​(all years together)
Total ​ %​
of ​in degree marks
​ ​ Remarks ​obtained obtained obtained ​together)
B.A. 1
Attach ​
Gujarati Elective ​ mark
copy of ​
sheet of B.A.-I, II and III
H. Only for TGT(Marathi​) ​Course ​Subject ​Ist year IInd IIIrd Total Maximum
Marks (all years together)
Remarks ​Of year year Marks ​Study ​%age of %age of %age of ​obtained
Total ​of in degree marks %
​ ​marks marks marks ​(all years ​B.A. 1 ​Marathi obtained
​ obtained obtained ​together) ​Elective

Attach mark copy of sheet

​ of B.A.-I, II and III
% S.Course of Study Max.
Marks

age ​No
Marks
Obtaine of .
d

marks
% age of marks

I) ​FOR PET (MALE/FEMALE) ​1 ​Bachelor degree in Physical Education ​(B.PEd.) 2

​ ​Post
Graduation in Physical Education
(M.PEd.) ​3 ​BA/B.Sc./B.Com. ​4 ​D.P.Ed. (one year) ​J) ​FOR ART TEACHER ​1 ​5 years
recognized Diploma in Fine Art ​2 ​Graduate with Fine
Arts/Drawing/Painting/Sculpture ​3 ​B.Ed. (Theory & Practical) ​4 ​MA (Drawing and Painting,
Fine Arts
from a recognized University ​K) ​FOR MUSIC TEACHER
1B​ A with Music ​2 P
​ ost Graduation in Music ​3 B
​ .Ed. (Theory & Practical) ​4 S
​ angeet
Visharad/Sangeet Bhushan.Nritya
Visharad or the recognized equivalent in Southern states ​5 ​Sangeet Bhaskar/Nritya Bhushan Nritya
Visharad or the recognized equivalent in Southern States ​6 ​Graduation.
13. ​Experience in Govt. Residential/Day Schools, Semi Govt. Aided School/Unaided.
In case of private recognized/unaided schools, experience certificate should be counter signed by
DEO.
S.No. Name of the
Institution
Duration Total Period
From To Years Months
Total Experience : ___________ Years. (to be rounded off in completed years and months should
be ignored)
I solemnly undertake that in the event of my appointment on contractual basis in the Samiti,
my services are liable to be terminated without notice if any of the foregoing information
furnished by me in my application form is found to be wrong or suppressed. I further
understand that this appointment is purely on contract and does not confer the right for
regularization. Date:
SIGNATURE OF CANDIDATE
PART – II ​CERTIFICATE (For office use)
Certified that I have scrutinized personally the information in Part – I above with originals
and found it to be in order. Candidate is eligible for the post.
SIGNATURE OF THE OS/DEALING ASSISTANT/VERIFYING COMMITTEE Name & Designation Date: