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CHECK LIST FOR PROMOTION FORM SGT / LP / PET TO SCHOOL ASSISTANT ZILLA PARISHAD / GOVERNMENT 1 2 3 4 5 6 7 Name of the Teacher

Designation(Subject) Present place of working Date of birth Caste Whether SSC Passed or not List: _____ : : : : : : YES / No S.No.in Seniority

8 9 10 11 12 13 14 15 16 17 18

Academic Qualification : B.A., / B.Sc., / B.Com., / M.A., / M.Sc., / M.Com, / Bhashapraveena, / Vidwan Subjects in Graduation / Post : Graduation University, Year of passing, Hall Ticket Professional course and duration of course B.Ed., M.A., Edn., Pandit Trg Methods of teaching University, Year of passing, Hall Ticket Date of First Appointment, cadre and District Date of Joining in Rs 398/consolidation pay Rs 398/Date of acquiring requisition qualification i.e TTC/BED to held the post of SGT Date of implementation of regular pay at Rs 1010/Year of DSC, Marks and Rank Whether the individual joined in the District on Inter District Transfer or transferred on 610 G.O. Date of joining in the District on Inter District Transfer Date of regularization of services in the cadre Date of relinquishment / drop, if he / she relinquished the promotion earlier Whether any charges pending : : : : : 1) 2)

19 20 21 22

: : : : YES / No

I declare that, the above information furnished by me is true. If any deviation in this regard, I will held responsible for the disciplinary action taken by the competent authority Signature and address of the individual

Certified that, the above particulars are verified with the service register and original certificates of the individual and he is eligible for promotion.

Signature of the Verification Officer