Panipat City

77 Mile Stone, G.T Road, Panipat (Haryana) Ph: 0180- 3058100/ 3058101

APPLICATION FORM

Post Applied For _____________________________________________

PERSONAL INFORMATION

1. Name in block letters _________________________________

Miss/Mrs./Mr. _______________________________________

2. Date of Birth(in figures)_______________________________

(in words)_____________________________________________

Age(in years/months/days)_______________________________

3. Contact Address with telephone number(s)

4. Place of birth_____________________________ 5. Nationality____________________

6.Marital Status_____________________________ 7. Number of children____________

8. Languages spoken at home 1.__________ 2. _________________ 3. _______________

9. Name of father/mother/spouse ______________________________________________

10. Occupation of father/mother/spouse ________________________________________

Address & telephone no. __________________________________________________
__________________________________________________

11. Detail of foreign travel ___________________________ Year ___________________

___________________________ ___________________
___________________________ ___________________
ACDEMIC INFORMATION
S.NO. Qualification Discipline/Subjects Name of school/ Year of %of Div
College/University Passing Marks

Professional Qualification:

DETAILS OF SCHOLARSHIP/AWARDS/HONOURS
DEATAILS OF RESERCH WORK/PUBLICATIONS

PROFICIENCY IN LANGUAGES (WRITE MOTHER TOUNGE AT S.NO.1)

PARTICULARS OF PRESENT JOB

1. Name & full address of present organization with contact numbers:

2. Present designation _________________________________________________

3. Date of Joining _____________________________________________________

4. Present place of posting ______________________________________________

5. Total emoluments ____________________________ Salary details: Basic_______

Allowances _____________
Other benefits___________

6. Are you under Service Bond _____________________________________________

(if yes, give details) _______________________________________________________

7. Exact period after which you can join if selected ____________________________

OTHER INFORMATION

I.SEMINARS AND COURSES ATTENDED

S.NO. Seminar/course Duration Date Description

II. NAMES OF THREE BOOKS RECENTLY READ WITH NAMES OF AUTHORS:

S.NO.
TITLE AUTHORS

INTEREST
From the following list indicate the areas in which you have on interest , in order of
preference

ACADEMICS EXTRA CURRICULAR SPORTS AVTIVITIES

Accountancy Advertising Athletics

Art History Art Galleries Basket Ball
Anthropology Archeology Badminton
Ancient Civilizations banking Cricket
Business Administration Dramatics Foot Ball
Computer Science Film ,TV,Journalism Gymnastic
Economics Fine Arts Horse Riding
Environmental Relations International Organisations Judo
Literature Interior Designing karate
Languages literacy Activities lawn Tennis
Mathematical Sciences Music & Dance Shooting
Natural Science Museum Table Tennis
Physical / Applied Sciences NCC/Scouts/Guides Volley Ball
Social Science Photography Physical Fitness
Undecided Social Service Any other recognized game

1.__________ 1._________ 1._________

2.__________ 2._________ 2._________
3.__________ 3._________ 3._________

DETAILS OF WORK EXPERIENCE

S.NO. Name of institution From To Position Held Subject & classes

taught

Total experience (in years)

Teaching
Administration
Any other

PERSONAL STATEMENT
Please write a one page account of yourself, your experiences and your interests based
on the following guide lines: Childhood experiences, homelife, educational &
professional experiences, people who have influenced you, hobbies and future goals.
This essay is an important part of your application and must be written by you in your
own writing. Please do not type.
(II) Do you suffer from any major ailments/ medical problems? Yes/No
If Yes, give details:

(III) Have you ever been convicted by any court of law or any disciplinary
proceeding/enquiry is pending against you or any penalty has been imposed upon you?
Yes/No
If yes, give details:

(IV) Give details of two references (other than relatives) in the field of education or
from members of Delhi Public School Society.
 Name Occupation Address(Official) Tele. No.

I hereby certify that the information provided above is true to the best of my knowledge
and belief. If any information is found to be false / incorrect it will disqualify me for
employment in any of the schools of Delhi Public School Society.

Date Signature of the Candidate