16.
Academic & Professional Qualifications (Attested copies of certificates to be attached)
Examinations Subject Name of % Univ./ Medium of External or Year
Passed School/ Marks Board Instruction regular
College & Div. student
attended
Secondary
Sr. Secondary
Graduation
Post-Graduation
[Link]./ equivalent
Any other
17. Name of the School where practice teaching was conducted (Attach proof)
………………………………..………………………………………………….…………………………….….
18. Experience in recognized school (Attested copies of certificate ( s ) from Head of the Institution should be
attached :
Name of the Period: Duration Classes and Subjects taught Medium
Institution through which
From/ To
where worked taught
Classes Subject
19. Name of the employer, date and reason for leaving- beginning with the most recent.
Name of the Date of Date of resignation/ Post held Reason for leaving
Institution where appointment termination
employed
20. Total number of years of teaching
experience……………………………………………………………………………………….…
21. Participation in Summer Institutes, Orientation Courses, Workshops, Seminars, In-service Training etc. (
use separate sheet if necessary)
Name of the Course Institution/ Organization Period: Duration
& Place
From/ To
22. Achievement in Games/Sports/Athletics/NCC/Scouting/ Girl Guide etc. Give
details………………………………………..…………………………………………………………………….
………….………………………..…………………………………………………………………………………
…………………………………………………………………………..…………………………………………..
………………………………………………………………………………………………………………………
23. Interest in co-curricular activities : Give self – assessment of competency level on a 5 – point scale in the
brackets. (The highest number corresponds to the best)
Community Work ( )
Environment activities ( )
Art ( )
Dance ( )
Dramatics ( )
Recitation ( )
Debates ( )
Elocution ( )
Music ( )
Participation in Tours, Camps etc. ( )
Reading ( )
Self Defense / Martial Arts ( )
24. Hobbies: Please specify extent of proficiency / seriousness
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………..…………………………………………………………………….
25. Which subjects besides the area of your specialization, would you like to teach? Please mention them in
order of preference:
Classes Subject Medium of Classes Subjects Medium of
Instruction Instruction
Primary Secondary
(IX & X)
Middle Senior Secondary
(XI & XII)
(VI-VIII)
26. How much time are you willing to spare, beyond the formal school hours, for the following?
Remedial teaching ……………………………………………………………………
Teaching the gifted ………………………………………………………….…………
Co - curricular activities ..………………………………………………………………..…
Tours / Excursions ……………………………………………………………….…..
Children’s personal / emotional problem………………………………………………………..……
Any other, specify ……………………………………………………………….…..
27. Language proficiency.:
Languages Reading Writing Speaking
28. Grades / salaries and other emoluments currently / last drawn (Attach proof)
Other
Basic Pay Grade Pay H.R.A. D.A. Conveyance allowances if Total P.M.
any
29. Grade / Salary expected……………………………………………………………….………………………
30. If selected , when can you join …………………………………………………………………...................
31. REFERENCES (at least two) : Certificates from persons not related to you are to be attached.
1. Name ………………………………. Professional status ………………………………..
2. Address…………………………………………….……………………………...........................................
Phone no. ( Res.)…………………………………. (Office)………………………………………………
1. Name ………………………………. Professional status ………………………………
2. Address…………………………………………….……………………………..............................................
Phone no. ( Res.)…………………………………. (Office)……………………………………………………
32. On a separate sheet of paper, in your own handwriting describe briefly:
(i) Three best things that you like in your own schooling – experience.
(ii) Two aspects of the Indian school system that you would like to correct urgently and how?
33. Places you have traveled to with purpose, duration and date :
Place Visited Purpose Duration & Date
34. Have you any dependents? Yes No. If yes, please indicate name, relationship
and age.
Name of dependent(s) Relationship Age
35. List any major illness, if any…………………………………………………………………..……….………
36. Physical disability, if any …………………………………………………………………………………..…
37. List any paper (s) published by you , any honor, awards etc. received…………………………………..……
……………………………………………………………………………………………………………..
38. Have you been arrested, indicated, or summoned to court as a Defendant in any criminal proceedings or
convicted, fined for imprisoned for
violation of law? Yes No.
If yes please give full particulars below:
……………………………………………………………………………………………………..……………..
39. Any remarks you might like to make, thoughts you would like to share or views you would like to express.
(Please write in your own language. Use a separate sheet if you wish)
I certify that the information given by me in this application form is true, complete and correct to the best of my
knowledge and belief. I understand that any misrepresentation or omission made herein or in any other
documents submitted to the school renders me liable to termination or dismissal.
Date:………………………… Signature of candidate………………
Place: ……………………….
FOR USE BY THE OFFICE OF THE SCHOOL
1. Attested copies of Degree / Diploma Certificates and Statements of Marks, Experience Certificate and Salary
Certificate, Address Proof, Aadhar Card and PAN Card as specified below:
Attested Secondary Sr. Graduation Post- [Link]./ Experience Salary Any Address PAN Aadhar
copies of Secondary Graduation equivalent Certificate Certificate other Card
Proof Card
Certificates
Statement
of Marks