PERSONAL INFORMATION

Advertisement Reference : __________________________________

Post Applied : __________________________________ Affix Recent

Name in Block Letters : __________________________________ Pass Port
Size Colour
CONTACT ADDRESS : __________________________________ Photograph
__________________________________

__________________________________

__________________ Pin_____________
Tel (With STD Code) : __________________________________

Cell/WhatsApp No. : __________________________________

E mail : __________________________________

ADHAAR NUMBER :

PAN NUMBER :

PERMANENT ADDRESS : __________________________________

__________________________________

__________________________________
_____________ Pin__________________
Tel (With STD Code) : __________________________________

Cell/WhatsApp No. : __________________________________

E mail : __________________________________

State of Domicile : __________________________________

D D M M Y Y Y Y
Date of Birth In Words
_______________________________________

Y Y M M D D
Age as on Date

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 Unmarried Married Widow (er) Separated
Marital Status

SPOUSE / FATHER’S NAME _____________________________________________________________________

Tel / Cell / WhatsApp & email _____________________________________________________________________

Y Y M M D D
Age as on Date Occupation / Profession _____________________________

Name, Address with Pin code, Tel. No. & email of the Organization

_______________________________________________________________________________________________

_______________________________________________________________________________________________

DETAILS OF CHILDREN

Name Age Sex Class Institution

ACADEMICS

Subjects Offered School /

Board Medium of
Exams Passed Year Other College / % Division
Language /University instruction
subjects Institute
Secondary/
Matric
Hr. Secondary/
Inter
B.A / B. Com/
B.Sc /Any other
M.A / M.Com/
M.Sc /Any other
NTT/ B.Ed/
B.P.Ed/
BTC/DL.Ed

M.Ed/M.P.Ed

CTET/TET

M. Phil / Ph. D

Other, If Any

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LANGUAGE

Speak at Home Speak Read Write

SEMINAR / WORKSHOP / IN SERVICE TRAINING

Name Organizer Date/s No. of Hours Description / Venue

EMPLOYMENT RECORD

Organization / Board Medium Main/Core Subjects &

Designation of Period
institution (CBSE/ICSE/State) Classes Taught
Instruction
From To Total

Total No. of Years & Months

Mention the areas where your talent and interest can help the school

Administration Academics Co – Curricular’s Games & Sports

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Details of Computer Course / Hands on experience in computer

Details of Scholarship / Awards / Honours

Details of Research work / Publication

Membership in Professional / Social / Cultural Institutions & Organizations

Are you under service bond? (If Yes, Give Details)

Do you have any plan to proceed on long leave after joining, during the first year of service? (If Yes, Give Details)

Have you ever been involved in any court proceeding? (If yes, give details)

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Write five most important accomplishments in your professional record. Highlight their impact too.

What are the three most innovative ideas you have about school education that you would like most?

How can you best contribute to Dewan Public School, Meerut ?

If selected, state the tentative date and exact notice period after which you can join.

REFERENCES

Cell/
Name Designation Organization Address Tel E mail
WhatsApp

DETAILS OF EMOLUMENTS INCLUDING PERKS DRAWN AT PRESENT

Designation ___________________________ Pay Commission, if any : State /Central / None

Scale ____________________________ Basic _________________

Grade Pay ____________________________ Pay in Pay Band _________________

CCA ____________________________ HRA _________________

Dearness Allowance ____________________________ Dearness Pay _________________

Provident Fund (Employee) ____________________________ Provident Fund (Employer) ___________________

Perks ____________________________ Any Other _________________

Total Gross (Monthly) ____________________________ Total Take Home (Monthly) ______________

MINIMUM TOTAL EMOLUMENTS EXPECTED PER MONTH

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 DECLARATION

I hereby certify that all statements made and information given conscientiously by me in this form

are true, complete and correct to the best of my knowledge and belief. In the event of any

information or part of it being found false or incorrect before or after the interview or appointment

action can be taken against me by the school and my candidature / appointment shall automatically

be stand cancelled / terminated.

Place ___________________ Date __________ Full Signature of Applicant

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 OFFICE USE
Checklist of Certificates

Heads Mark sheet Degree Remarks, if any

Original Submitted Shown Submitted
Shown Self attested copy

Secondary/ Matric

Hr. Secondary/ Inter

B.A / B. Com/ B.Sc

M.A / M. Com/ M.Sc

NTT / B.Ed./ BTC/

B.P.Ed / DL.Ed.

M.Ed/ M.P.Ed.

M. Phil / Ph. D

Any Other

Last Salary Slip

Relieving Order

Experience Certificate

Fitness Medical
Certificate

Voter Identity Card

PAN Card

Pass Port

Driving License

Aadhaar Card

______________________________
Verified by: Name & Signature
A.K.DUBEY
Date: ___________________________ PRINCIPAL

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