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KENDRIYA VIDYALAYA SSB GWALDAM DISTT- CHAMOLI WALK IN INTERVIEW Application for the Post of CONTRACTUAL TEACHER For the Session - 2013-14 Name of the Candidate Mr/Miss/Mrs Date of Birth Married/Single Father s/Husband s Name SC/ST/OBC/MUSLIM/MINORITY/GEN PAN No. Bank Account No Name of Bank Correspondence Address E-mail Address Contact Number Tel. No. /Mobile Photograph 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 Name of Board/ University Year of Passing Duration Of Course in Months Subjects / Specialization AGGREGATE MARKS Max. Marks age Marks obtained of Remarks High School Class X Intermediate Graduation Others if any Specify Professional Qualification Attach attested Copies of Mark sheets and Certificates Name of Examination of Course Passed CTET JBT/B. El*Ed Theory B. ED Practical BE/B. Tech CS / Degree/Diploma in Nursing in months obtained age of Whether the Candidate has previously worked in this Vidyalaya If yes specify Post and Year YES/NO If yes specify Relationship Experience S* No* Post Held Name of the Institution Recognized/ Unrecognized Period From To No* of Years/Months Completed Sub Class Taught Any Special Achievements A Short note regarding Suitability to the Post in 50 words DECLARATION correct to the best of my knowledge and belief* I will provide details of my PAN Card and Bank Account within the time of joining. I understand that income tax TDS will be deducted as per the rules of the Income Tax Department Government of India* If anything is found false I will be held fully responsible. Attach attested Copies of Mark sheets and Certificates Name of Examination with Complete Name of Course Passed Name of Board/ University Year of Passing Duration Of Course in Months Subjects / Specialization AGGREGATE MARKS Max. Marks age Marks obtained of Remarks High School Class X Intermediate Graduation Others if any Specify Professional Qualification Attach attested Copies of Mark sheets and Certificates Name of Examination of Course Passed CTET JBT/B. Marks age Marks obtained of Remarks High School Class X Intermediate Graduation Others if any Specify Professional Qualification Attach attested Copies of Mark sheets and Certificates Name of Examination of Course Passed CTET JBT/B. El*Ed Theory B. ED Practical BE/B. Tech CS / Degree/Diploma in Nursing in months obtained age of Whether the Candidate has previously worked in this Vidyalaya If yes specify Post and Year YES/NO If yes specify Relationship Experience S* No* Post Held Name of the Institution Recognized/ Unrecognized Period From To No* of Years/Months Completed Sub Class Taught Any Special Achievements A Short note regarding Suitability to the Post in 50 words DECLARATION correct to the best of my knowledge and belief* I will provide details of my PAN Card and Bank Account within the time of joining. El*Ed Theory B. ED Practical BE/B. Tech CS / Degree/Diploma in Nursing in months obtained age of Whether the Candidate has previously worked in this Vidyalaya If yes specify Post and Year YES/NO If yes specify Relationship Experience S* No* Post Held Name of the Institution Recognized/ Unrecognized Period From To No* of Years/Months Completed Sub Class Taught Any Special Achievements A Short note regarding Suitability to the Post in 50 words DECLARATION correct to the best of my knowledge and belief* I will provide details of my PAN Card and Bank Account within the time of joining. I understand that income tax TDS will be deducted as per the rules of the Income Tax Department Government of India* If anything is found false I will be held fully responsible.

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