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Executive Office : 101, Chattashory Road, Chawkbazar, Chittagong.

Phone: 031-2868800; 01715-900004

Application for the post of ........................................................................ in the Department of ........................................................................
1. Name (in Bengali) : ..................................................................................................................................... Surname : .............................................................
Name (in English) : ...................................................................................................................................... Surname : .............................................................
2. Mother’s Name : .............................................................................................................................................. Occupation : ......................................................
3. Father’s Name : ................................................................................................................................................ Occupation : .......................................................
4. Permanent address : .....................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................................................

5. Mailing address : ..............................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................................................................

6. Date of birth : ............................... Age (As on 11 Nov 2012) : ..................... Years, ............................ Months, ............................. Days
7. Nationality : .................................................................. Religion : .................................................................... Blood Group : ....................................................
8. Marital Status : ................................................................ Name of spouse (if married) : ..................................................................................................
9. National I D Card no / Passport no : ................................................................................................................................................................................................
10. Telephone no : .................................................................................................... E-mail(if any) : ......................................................................................................
11. Educational Qualifications:
Name of Exam

Group/
Subject

Institutions and
Board/University

Passing
Year

Remarks

Result
(Division/ Class/
GPA)

SSC
HSC
Bachelor Degree
Masters Degree

12. Non Govt. Teachers Registration and Certification (NTRC): No. .............................................................
Subject

Total Marks

Year

Remarks

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......... 14..................... mark sheets........................................................... Language skill: (Excellent/Good/Moderate/ None) Language Bengali English Arabic Listening Speaking Reading Writing 17....................... Training: 15.......... the school authority may reject this application or terminate my employment at any time..............................................................................................................................................13.................................. Declaration a............... All information and data given above are true.......... (tick as applicable) c.......................... Please enclose attested copies of all qualification certificates................ Nationality & Character Certificate............................................... • Spread Sheet (MS Excel) : • Presentation (Power Point) : • Any other (Acct/Database etc........................ 19....... I was / was never an active member of any extremist/terrorist group........... b................................................................................................................................................ permission letter from present employer.................................................................................. Computer Skill: • Typing Skill (MS Word) : a) Bengali.... (tick as applicable) d....... ............................. I am aware that....................................................................................................................................... ..... If parent is a Freedom Fighter: Yes / No 20......................................................... Bank Draft /Pay-order No........................................................................... I was convicted / not convicted of any criminal charges previously. Publication(s) : ................................................................................... ________________________________________________ Signature with date Note : A........... For any falsehood I may face legal actions as well......................................... ............................... Extra Academic Qualification (s): ........................................................................ Page 2 of 2 ....................): 18................................................................... Freedom Fighter Certificate etc..................... if any information provided above and documents & certificates attached are found to be untrue............................................. I am involved / not involved in any criminal charges which is/are under investigation............................... (as applicable) and use extra paper if necessary................... I am not suffering from any contagious disease..... Bank Name: .......... false or fake. Date: ........................................... 21......... b) English ..... Experience Certificate....................Amount:............... Previous experience in any field: 16...................................................................... (tick as applicable) e........................ two recent passport size photographs...............