KENDRIYA VIDYALAYA SAMBALPUR CLUSTER

APPLICATION FORM FOR PART TIME CONTRACTUAL TEACHERS

Important Notes :
(i) All entries should be made in capital letters only.
(ii) One form should be used for one post.
(iii) Enclose self attested copies of testimonials with each form.
(if applied for more than one post)
1
2

Post Applied For

(Please Specify) :
Choice of the
Vidyalaya

Candidates Name
:

4
5
6

Fathers /
Husbands Name
Date of Birth
Gender

(Male/Female)
Age(As on

Ang
ul

Year

NTPC
Kani
ha

Boud
h

Khandha
mal

Sonep
ur

Month

Paste recent
passport size
photograph

Deoga
rh

Sambalp
ur

Days

31.03.2015)
Candidates
Address(In Capital
Letters)
Name

Father/Husbands
Name
Address

City/Town
PIN
Ph/Mobile No.

9.Academic Qualification(Stating from High school

Level)
Name of
Examination

High School
(Class X)
Intermediate
(Class XII)
Graduation
(Name of

Year
of
Passin
g

AGGREGATE MARKS
Max.
Marks
%
Mark Obtain age
s
ed
of
mark
s

Subjects/
Specializat
ion

Duratio
n of
course
(in
Months)

Board /
University

Course)
Post
Graduation
(Name of
Course)
Other if any,
(Specify)

10. Professional Qualification :

Name of
Examination(Wi
th complete
name of course
Passed)

Write
name of
Examina
tion
Passed

Year
of
Passin
g

Max.
mark
s

Marks
Obtain
ed

% of
mark
s

Subjects/
Specializ
ation

Durati
on of
course
(in
Month
s

Board /
Universit
y

JBT/B.E.Ed/
(Specify)
B.Ed
B.E/B.Tech(CS)
Degree/Diplom
a in Nursing/O
Level.
OTHERS IF any
(Specify)

11.Teaching Experience (If any) :

Post
Held

Name of
Institution

Whethe
r
Recogni
zed

Period of
Service
From To

No. of
completed
Years and
months

12. Are you able to teach through English and Hindi ?

NO (

Subject
and
Class
taught

YES (

Salary
per
Month

Please mark ( )in the appropriate box.(For teaching posts only)

13. Do you have knowledge of Computer Application ?
YES ( )
NO (
)
Please mark ( )in the appropriate box.(For teaching posts only)
UNDERTAKING
I hereby certify and declare that all the information given by me in this
application form are true, complete and correct to the best of my knowledge and

belief. I have attached attested copies of my testimonial in support of the entries

made above. I also agree that my eligibility does not confer right to be called for
interview/selection. My candidature may be cancelled in case any information is
found to be incorrect on verification.
Place:_________________
Signature:_______________________________
Date:_________________
Name:__________________________________