Application Form
Last Date: 10-02-2015
KENDRIYA VIDYALYA No. 3 JAIPUR
APPLICATION FORM FOR PART TIME CONTRACTUAL TEACHER / DOCTOR / NURSE FOR THE SESSION 2015-16
1. Post applied with subject:-___________________
Paste a recent
passport size
color
photograph
with signature
2. Name of Candidate:-_________________________
3. Father’s /Husband’s Name :-__________________
4. Address in full:-____________________________
_______________________________________
_______________________Pin________________
5. Telephone No. with STD Code:_________________ Mobile No:_________________
6. Date of Birth: Day
Month
Year
7. Nationality_________________________________
8.Do you belong to SC
□ / ST □/ OBC□ / Ex-Servicemen□/ PH□ (Tick appropriate Box)
9. Particulars of all Examinations/Degrees passed (Attach Attested Copies of Certificates)
Examination
Subject
Marks obtained
Max.
Marks
% of
Marks
Year
Board/
University
Higher
sec./Intermediate/+2
I Yr
Graduation
II Yr
III Yr
Total
B.A/B.Sc./B.Com./MBBS/
Diploma in Nursing
M.A./M.Sc./M.Com./
M.S./M.D.
B.Ed.
M.Ed.
M.Phil /P.Hd.
Any Other
10. Whether CTET qualified or Not, If yes mention Year:
Roll No.:
11. Teaching experience in recognized school (Attach Attested Copies of Certificates)
Name of School
Post held
Period of service
From
To
Years
Months
Class &
Subject
Taught
Actual Pay
12. Co-Curricular Activities/Sports & Games/NCC/Scouts &Guide (Attach Attested Copies of Certificates)
Name of Activity
District Level
State Level
National Level
DECLARATION
I certify that the above information is true to the best of my knowledge and belief and I am liable to be disqualified if any information given is found to be
incorrect or incomplete.
Date:
Signature of Candidate
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