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ON-LINE APPLICATION FOR POST GRADUATE TEACHERS (PGTs)

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Please paste your recent passport size photograph and sign across it. Please retain atleast 5 copies of same photograph with you for subsequent use.

Registration # :

89105

Full Name :

Sunita Bai

Applied for Post : Post Code : Category : If physically challenged : Type of Disability : Percentage of Disability : Do you intend to use the services of a scribe(only for OC and VIcandidates whose writing speed has been affected by cerebral palsy) : Are you applying for woman reservation : Are you a Govt.servant/NVS regular employee : Nationality : Examination City : City code : Application Fee / Postal Charges Details : Transaction ID/Journal No : Branch Name: Branch Code No.: Deposit Date : Amount :

PGT BIOLOGY 57 OBC NO NA YES NO Indian Jaipur 22

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Personal Details : Date of Birth : Age completed as on 30-11-2011 : Gender : Husband's Name/Father's Name : Mother's name : Address for Correspondence : 22-05-1987 24 FEMALE Vijay Singh Yadav Krishna Devi VPO- Sanoli Via- JatBehror Teh- Mandawar District : State : Pin : Permanent Address : Alwar RAJASTHAN 301714 VPO- Sanoli Via- JatBehror Teh- Mandawar District : State : Pin : Alwar RAJASTHAN 301714

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Contact Details: Phone Number : Mobile Number : Email ID : Qualification Details (as on 30.11.2011) : Exam Passed Graduation/Equivalent : Post Graduation : Professional Qualification : Subject /Stream BSc Master Degree Botany Bed Year of Passing 2007 2009 2010 % of Marks 70.12 68.59 74.11 01495-234234 9460162093 om.ajay007@gmail.com

Do you have two year integrated post graduate M.Sc. Course from Regional College of Education of NCERT in the concerned subject with at least 50% marks in aggregate?: Whether you possess B.Ed. or equivalent qualification from a recognized University: Proficiency in Teaching in English: Proficiency in Teaching in Hindi : Knowledge of Computer application : Details of Computer Knowledge: Post Qualification work experience details (Start from present Employer) : Name of the Employer & Nature of Employment Designation and Rank From(mm/yyyy) To(mm/yyyy)

NO

YES YES YES YES Basic MSoffice Internet surfing

Nature of Duties Performed NO NO

Reason for Leaving

Years of Service (YY/MM)

Total Experience (in months) : Are you having an Experience of working as TGT in a recognized institution in the concerned subject: Are you having an Experience of working in a residential school :

DECLARATION:
I hereby confirm and declare that all the statements made and information provided by me in this Application are true, correct and complete to the best of my knowledge and belief. In the event of any information or the part of it being found false or incorrect before or after the recruitment process, action can be taken against me by the competent authority and my candidature/appointment will automatically be cancelled/terminated.

Place: Date: 06-01-2012 Signature of Applicant

Sunita Bai

Please retain your Registration No. and Password emailed to you carefully for further reference NOTE: Please DO NOT SEND application print-out to the Bank