FERTILIZER PUBLIC SCHOOL
Kribhco Shyam Nagar, Piprola, Shahjahanpur
TEACHER APPLICATION FORM
GRADE APPLIED FOR: PGT TGT PRT NTT
SUBJECT APPLIED FOR: ___________________________________
PASTE A
INSTRUCTIONS FOR CANDIDATE: PASSPORT SIZE
1. Please fill this application form in clear words.
2. Where Boxes are provided, write in capital letters only inside them and leave one RECENT
Box blank between two words. COLOURED
3. Submission of any false information will make you liable for summary rejection PHOTOGRAPH
at the time of interview or, if appointed, termination without notice. HERE
4. In the column for academic information, please fill in only recognized and
completed qualifications.
PART - A: PERSONAL INFORMATION
A1. NAME
A2. SEX MALE FEMALE
[Please tick (√ )]
A3. DATE OF BIRTH
DAY MONTH YEAR
A4. PLACE OF BIRTH
A5. NATIONALITY
A6. MARITAL STATUS UNMARRIED MARRIED WIDOWED
DIVORCED SEPERATED
[Please tick (√ )]
A7. RELIGION
A8. CASTE
1
A9. CONTACT ADDRESS STREET
VILLAGE
POST
DISTRICT
PINCODE
TELEPHONE NO.
STD CODE TELEPHONE NO.
MOBILE NO.
(Don’t add ‘0’ before number)
E-MAIL ID
A10. PARMANENT ADDRESS STREET
VILLAGE
POST
DISTRICT
PINCODE
TELEPHONE NO.
STD CODE TELEPHONE NO.
A11. FAMILY PROFILE
NAME AGE OCCUPATION ADDRESS
A. FATHER
B. MOTHER
C. SPOUSE
D. CHILDREN:
NAME SEX AGE CLASS
1.
2.
3.
A12. PHYSICAL STANDARDS:
HEIGHT FEET INCH (ES)
WEIGHT KGS.
2
PART - B: ACADEMIC/ PROFESSIONAL INFORMATION
B1. ACADEMIC QUALIFICATIONS
BOARD /
PRIVATE / SCHOOL / PASSIN % OF DI
QUALIFICATION SUBJECTS UNIVERSIT
REGULAR COLLEGE G YEAR MARKS V.
Y
HIGH SCHOOL
INTER/ +2
GRADUATION
……………………
POST
GRADUATION
……………………
B. Ed.
N.T.T.
ANY OTHER
…………………….
B2. DETAILS
SCHOLARSHIPS/ AWARDS/ HONOURS
RESEARCH WORK/ PUBLICATION
SEMINARS AND COURSES ATTENDED
NAME OF THE SEMINAR/
CONDUCTED BY DURATION
COURSE
(ORGANIZATION/ INSTITUTE)
3
PART - C: CO-CURRICULAR INFORMATION
C1. CO-CURRICULAR
ACTIVITIES
C2. SPORTS/ GAMES/
OUTDOOR ACTIVITIES
C3. PROFICIENCY IN LANGUAGE LANGUAGE READ WRITE SPEAK
[Please tick (√ )]
1.HINDI READ WRITE SPEAK
2 ENGLISH READ WRITE SPEAK
OTHER: ……READ WRITE SPEAK
C4. PROFICIENCY IN COMPUTER OPERATION
DO YOU HAVE COMPUTER AT HOME YES NO
DO YOU REGULARLY WORK ON A COMPUTER? YES NO
IF YES, WHAT SOFTWARE CAN YOU USE PROFICIENTLY?
[Please tick (√ )]
MS WORD MS EXCEL MS POWER POINT
INTERNET E-MAIL LIBRARY SOFTWARE
C5. CO-CURRICULAR ACTIVITIES IN WHICH YOU ARE REALLY INTERESTED AND CAN
TRAIN STUDENTS
[Please tick (√ )]
MUSIC DANCING
DRAMATICS NCC/ SCOUTS/ GUIDES
YOGA/ AEROBICS KNITTING AND DARNING
HANDICRAFT MAKING CLAY MODELLING AND POTTERY
SIGN BOARD PAINTING & CARTOON MAK GARDENING
FRUIT PRESERVATION COOKING
OTHER: ………………………………………. OTHER: ……………………………………
4
PART - D: WORK EXPERIENCE
D1. WORK EXPERIENCE DETAILS:
(Starting from the present/ last job)
TO POSITION SUBJECT(S) CLASSES
SL. NAME OF INSTITUTION FROM
(DD/MM/YYYY) HELD TOUGHT TOUGHT
NO. (DD/MM/YYYY)
D2. TOTAL EXPERIENCE YEARS MONTH(S)
D3. BREAK-UP OF TOTAL EXPERIENCE YEARS MONTH(S)
TEACHING
ADMINISTRATION
OTHER …………………………………………………………
OTHER …………………………………………………………
OTHER …………………………………………………………
D4. TOTAL EMOLUMENT IN PRESENT/ LAST JOB RUPEES
D5. BREAK-UP OF TOTAL EMOLUMENT BASIC (IN RS.)
IN PRESENT/ LAST JOB ALLOWANCE (IN RS.)
OTHER BENEFITS:
5
PART - E: OTHER INFORMATION
E1. DO YOU SUFFER FROM ANY MAJOR AILMENT/ YES NO
MEDICAL PROBLEM
[Please tick (√ )]
IF YES, PLEASE GIVE
DETAILS
E2. HAVE YOU EVER BEEN CONVICTED BY ANY COURT OF LAW OR YES NO
IS ANY DISCIPLINARY PROCEEDING/ ENQUIRY PENDING AGAINST
YOU OR HAS ANY PENALTY IMPOSED ON YOU ?
[Please tick (√ )]
IF YES, PLEASE GIVE
DETAILS
E3. GIVE DETAILS OF TWO REFERENCES (OTHER THAN Y OUR RELATIVES) IN
THE FIELD OF EDUCATION
NAME (MR./MS.) DESIGNATION OFFICIAL ADDRESS MOBILE NO.
REFERENCE1
REFERENCE2
E4. THE EXACT PERIOD AFTER WHICH YOU CAN JOIN, IF SELECTED
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PART - F: GETTING TO KNOW MORE ABOUT YOU
F1. PROFESSIONAL EXPERIENCES
F2. WHAT ARE YOUR STRENGTHS ?
F3. WHAT ARE YOUR AREAS FOR IMPROVEMENT ? WHAT ARE YOUR ACTION
PLANS FOR IMPROVEMENT IN THOSE AREAS ?
F4. HAVE YOU EVER ADAPTED A NON-TRADITIONAL APPROACH TO MANAGE
OR HANDLE A STUDENTS RELATED SITUATION?
DESCRIBE YOUR APPROACH AND THE OUTCOME
I hereby certify that 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 my continuation in Fertilizer
Public School, Shahjahanpur.
SIGNATURE OF CANDIDATE:
DATE:
PLACE:
7
FOR OFFICE USE ONLY
DATE OF INTERVIEW
DDMMYYYY
RESULT SELECTED WAITING LIST POSITION 1 WAITING LIST POSITION 2
[Please tick (√ )]
WAITING LIST POSITION 3 REJECTED
INTERVIEW COMMITTEE
NAME DESIGNATION SIGNATURE
CHECKING OF
CERTIFICATES &
MARKSHEET
NAME OF DOCUMENT CHECKED REMARKS (IF NOT OK)
HIGH SCHOOL CERTIFICATE & MARKSHEET
10 +2 CERTIFICATE & MARKSHEET
GRADUATION CERTIFICATE & MARKSHEET
POST GRADUATION CERTIFICATE & MARK SHEET
B. ED. CERTIFICATE & MARK SHEET
N.T.T. CERTIFICATE & MARKSHEET
OTHER:
OTHER:
OTHER:
SIGNATURE OF OFFICE INCHARGE SIGNATURE OF PRINCIPAL
DATE: SCHOOL STAMP DATE:
