` 20/-

APPLICATION FORM FOR TEACHING AND NON-TEACHING STAFF

UNDER EKLAVYA MODEL RESIDENTIAL SCHOOLS

Passport size
photo to be
attached

1. Name of Post applied for : ______________________________________

2. Name of candidate : ______________________________________
3. Father’s/Mother’s Name : ______________________________________
4. Permanent Address : ______________________________________
______________________________________
______________________________________
6. Contact No. (Official No.) : ______________________________________

7. Date of Birth (attach self-attested : ______________________________________

Photocopy of Birth Certificate or
HSLC or Aadhaar)

8. Sex : Male/Female

9. Educational Qualification : ______________________________________

10. Mandatory Documents to be enclosed to support the application:

i) Educational Certificates and Mark Sheets from HSLC onwards/as prescribed in

the advertisement (self attested)
ii) Attested copy of Tribal Certificate (For SC/ST applicants)
iii) Birth Certificate as Proof of Age (Attested copy)
iv) Two copies of Passport size Photographs
v) Work Experience Certificate (Government/Non-Government), if any.

DECLARATION

I hereby declare that the information given and in the enclosed documents is true to the
best of my knowledge and believe and nothing has been concealed therein. I understand that if
the information given by me is proved false/not true, I will have to face punishment as per the
law. Also all the benefits availed by me shall be summarily withdrawn.

Place :
Date : ( Signature of the Candidate )