OFFICE OF ZllA PARISH AD / ~

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Ilird Grade Teacher Direct Recruitment Competitive Examination 2012/
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Application 1- Exam Details/tRllffi
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1.1 Name of Distt. For examination

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1.3 10 No. of Online Application 1.4 Post Applied For! ~ Subject for lind Levell~ ~
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A) 1st level (Class IN) IIlrd Grade Teacher! ~ «'R" (CjlIID I-V) ct QCIT<r ~ B) 1st level (Class I-V) IlIrd Grade Special Teacher! ~ «IT (q;m I-V) <5" 1. Mentally Retard 2. Visually Impaired 3. Hearing Impaired

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C) lind level (Class VI-VIII) IIlrd Grade Teacher/ ~

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Qualifying Subject details as per RTETCertificate!~ 1. Science- Maths!~-'l"fiJTfr 2. Social Studies!~
3. Language!'l1l"IT

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. c) Sanskrit/~ d) Urdu/~ g) Hindi'English!~-~ ~ ~ (q;ffi VI-VIII)

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OJ lind level (Class VI-VIII)
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lllrd Grade Special Teacher!
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1. Mentally

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Qualifying Subject details as per RTETCertificate!~
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Applicant's Applicant's Applicant's

Full Name!~ Father's Name!~ Mother's

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1. General/GBC (Creamy layerJ! SBC (Creamy layer)/~
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3 State/~. Phone with STD code/~ Mobile/~ ~ qffi ~ .. .. ~ Employee of Panchayat Samiti/Zila m rterrw wfiiFrr <t ~ ~ Patishad I rWrtrrr mw/ftJR. ST/ 3~ iJfi'fiJIlfu \i1l"R1 7....1crm) ~ fti<o'I ctI ~ 3fR 2. SBC(Non Creamy layer)/ 6. TSP ST/ ~ 8.~/~ 3. f.. . TSP SCI ~ 3~ fctfi'lq(tR ~~) 4. Hearing impairment/~ <IT ~ c) Locomotive/CP dlsorder/rrfs fcl1I<rq. Panchayat .6 4.9 .3 Other Category /~ 1. Ex Prisoner/ W $<It rp:q 5 Handpump Mistri/tu. 4.8 Home State(Bonafide Resident) /~ . 2. . Sahariya Tribe from Kishanganj ~ ~ ctI ~ & Shahbad Tehsil of Baran Distt(Raj..10 email Address/~ . 4.7 4. sportsman/.)/ wwnfi'I ~ ('F" f.- 2 Divorcee/ .fr CIi'r6 ~ 4.3.1 Other Special Categories /~ fchTcf ~ Category for disabled candidates /f.Jr rff{w 4.. Ex-servicemanl~ 2..~ sachiv/Temp. it . Widow/flh1m ~ tIf.1 Correspondance Details/~ Address/rnn <FiT fcI<RuT .r. Outstanding 3.rr Tehsil /~ City/Virrage/~/'Tf<f Post/~ PinCode/~ . 3- 3. a) Blind/Low vision/~ ~/q.rr ~ ~ ~ :a 6'1) ...'Iq...11 ~ b)...2 Specific category for Females/~3l'I 1 * ft:ril fclffre '>Mt ~'I<'IIq... ..4 4.3. Distt/ftrc.. SCI ~ 3~ ~ ~ 5.t~ 3J'1'1J2lt * ft:ril ~ qe:JTElTCl ~ ..ft 4 4.'tl<:1 .5 fitF..4 4.9 Home Distt (If Rajasthan) /T[S ftr<.. .8 4.2 4.. .

Language!1W-IT(1)....Wf 3JUI1tr<f) '1"1?lffi" tRlm "* >f11TIlT qo.:j . 'fill Class I-V! ~~ 7..5 Educational Qualifications Name of Examination Secondary and above Year /it~ ~ ~ ~ 3fT1't Division/ Maxim um Marks Marks Obtain ed Perce ntage of Marks Obtai ned <PI Grade/ -.5 "!lfuw<I 6 Professional Qualificatjons!lrlt~ Name of Examination Year (illlqf1lfll<f» ~ Division /Grade/ Maximum Mark5~ Marks Obtained Percentage of Marks Obtained "II1'<fi<f.. 3lUm'1 a) Hindi/~ b) Eng'ish/~ c) Sanskrit/~ d) Urdu/~ e) Sindhi/fu.... Science.2 5. Maximum Marks/ Percentage of Marks Obtained! ~<Pr ~ ~ ~ ~~'I"&rr 'IiT~ ~ ~~ fit!m 1st Level 7.2 lind Level Class VI-VIII! ~ VIII «R <lim VI- Qualifying Subject in lind level (Class VI-VIII) as per Rajasthan Teachers Eligibility Test Certificate / \'fiJW.! Year of Examination! lJ&rr <fiT If'f Qualifying Subject as per RTEl ~ Certificate / W1f1'Ttrn 3'[U!Tq"<f> qr:.A/ <mT I-V "iiIT'I.3 6....4 7 Details of Qualifying Rajasthan Teacher's Eligibility Test!~ Details of Qualifying Teacher's Eligibility Test! Roll No... (2) 2..... Social Studies!~ .Jffi" <RIm <tt &t<rr Marks Obtained/ "<fiT ~.1 5....( 3r:p!N ~ ~ <fl&TT VI-VIII ~ 3It<t>" fctq..4 5.1 6..3 5...1 N....2 6..Maths/ftrsfR-TffU"ril 3.R\1m 'liT <I'f <ITt / Name of Board/ University ~tij~Eiiiilll 'liT "'WI -W>'it/n ~ VJ1<rt<ti ~ 5. 1..'r'IiT "<!"fum 'liT <I'f <ITt Name of Board/ University I ~~Q~tlIiiI<l 'liT ~ -W>'it/n ~ lIfflmr 6..>JT f) Punjabi/~ g} Gujrati/~ .

of eligibility training regarding age limit."".mT 1:f1"4 VIA" lIT fuR.r "" ""'""""""""""""""""""""""""""""""' . mxr ~ Tf ~ "mT «m <rt <fiT ~ ~ 3lTf W{ m "* mer tt t Place/~.8 Details of Special Training Programme Institute in elementry and State/~ education /l!T~'fil>. ~ ft:nll'f \3~W.rr ~ ~ q}'( ~." Date/~ .rm t I ~ ~ ~ xfuft'lmf $ ~ "lIT 'ITG T{ ~ IORT ~ WRT 7fillf / 3ffit1l / "lIT 3fCIT"'."""""""""""". ~ urr ffi1I_ "9"tt ~ <IiTC ~ 2.:rnFI 'Iltl fiI>it "GfI"U I "Ifr ~ <'fll1"m ~ I (0) . """"""""""""""" Left Thumb J11'!jl!jf impression ql') of iW-1" Signature of Applicant/'3fRIUi ~~ Applicant/ • ir \#l ~ f. ~ 3. in the event of my information being found false or incorrect or ineligibility before or after the Third Grade Teacher Direct Recruitment Competitive Examination. I further declare that I fulfill all the conditions Examination.'i ~ ~ if lPT f.. Rajasthan Teacher's Eligibility Test qualifications Competitive and required etc.""""""".![tAT 'l?l ~ ~ "ffi.1 Name of NCTE recognized B. """"'"" 8. ~~ -melt fc.rr.mr-fI I <ITii *r "'llc :- 1.J ~ T'f ~ oil "f1ift "f1ift ">R I ~ <liT ~ 3lJ<'IR ~ 'l?l ~ . ~1HfllTcI> ~ ~ tRTl$ qfr 3Ttm ~ ~ "Qftr1:f'1T ~ tpT <nmT /~ I T{ ~ <ff ~ <rt 'Wffil ~ iR ~ ~ ~ 3lTf fcmrm <5 ~ 1'( 101<\ ~. 1 have read the provisions of the relevant rules and the Advertisement carefully and I hereby undertake educational to abide by them..2 Details of Special Training 8. if ~ 'lfi'1T ~ tRTlffi T{ ~fA1fcld ft:nl "tfRill qfr ~ <mr ~ ~. I hereby declare that all information my knowledge made in this application are true. Body Mark/wfu Disclaimer/~: 'R f-'rm.l<!> ~ ~ ~ IIf(pnr1r ~ <m '1Jl1 ' lPT~.3 &RT "Il"Rrill Wi'! lPT mw 1:[<i ~ Programme /f<tm >If1r1:1"( ~ /~ ~T ~ Ftm"oT Period of Special Training Programme ql') 3Jqfu "" 9 10. ~ ..I41 ~ /~ I ~ ~ '4T tWrarr "Cf>ffiT /~ f<l. complete and correct to the best of being detected and belief. for qualifications. action can be taken against me by the Zila Parishad. prescribed admission to the Third Grade Teacher Direct Recruitment CfRffi/~ ~I~ ~ ~ t fcp anm ~ frnr1:l'r / ~ ~ ~tRIlffi 'lfu\'r ~ ~.

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.e. __ • _ •••• __ ••••••••••••• w •••• ~ •• _ •• ~ •••••••••••• _ •••••• 4.{ 6.::..i' uf '. Lane/Street and Road. Father's (a) name in full with aliases.ATTESTATION FORM Affix 5. . Thana and Distt. Lane/ Street and Road) ••• _ ••• _ •• _ ••••••• _r .ph) r..sbantJ (d) Wife (li) Place of birth of: (a) Husband (b) 'Nite I. Village. Name block (2. j 3.. .. give last address).e.. .'.i lecent pi1ologr. Particulars of places where preceding five years. 2. if any. •. (b) Permanent Home Address... you have resided for more than one year durtnq tile I From l ro Residential a'ddress in full No. (jistnct.._II!".I) (b) (r) ContcJ . (a) Home address in full (i. (a) (b) (c) (tl) (c) (a) (b) (e) HU.. Present address in full (i...) with ahaser..ittl!~. (3) EXile! date of GIrth (b) Present age (e) Age at matriculation tri (d) (il) (t) ) (.. (a) Present postal address (if dead.. or house . 2/ .. trIana. Vill.c. ) ·. (e) Profession (d) jf in service give designation (i) Nationality of : (a) Father (b) r-lother & Official address. Lane/Street and Road) in full (in Name Roll No .. ViiI. 11 '-"': (Place indicate If you have added or dropped in any stage any part of your name or surname.jji \... or House No.. )~.Igned passport size I_i !A / \.. (i. .. 5..Thana and Dist..·'i~ Ii. Or House No. 1 -i i •.

!l '" ._~. (a) Place of birth.JJiJiiiI[. . 1·. I fr£f. . __. .1 ! 12._ ... Educational Qualification showing place of education '" with years Date of entering in School and Colleges since r~a~..__ ...-._ _. _.. __~. ---1.._ for the last months and that to the best of my knowledge and belief furnished by him/her are correct._._ . I 1'--.. J I lull address of Firm the! J i ]2V~---_-'- f ._ -_ .. ... Years ! he [JiJ I rticulars Signolure Place Date ..... COllege_Wi~~_~~1I ad~ress Dale of ICi:l'!ing ! passed I 1 I Examination I· ' .._.. School/ . -._. (a) (IJ) (a) (h) 9..be~n emptoyed Designation of post held or description work..j._ . _ . . . . _.. __ .. at any time . I am not aware of any circumstances which mlg~ll irnpatr my fitnf!Ss for employment under Government.... .'JlC : (' . . or ».._. '" .__ .il/! __.Of I fuea~?_o!~.n. J . _ . (Certificate to be Signed by a Gazetted Officer or fv1cmbus Legislative or other authority prescribed by the Appointing Aurhotirty) Certified that I have known Shri/SmL/Kurn Sori/vvif'e/dauqnter ()f ~. Name of two responsible two references to whom 1 you persons of your localily are known.... Signature aJltif'" of the CdnilllJal Place: D.-. 13. If you have.._ '" '. '" _ ..e_..Dist and State in which it is situated (b) District & State of which you belong (a) State your religion (b) Are you a member of a SC/ST ? Answer 'Yes' or 'No' and if the answer yes Stale the name thereof. 1'0 I 1 nsrttuuon or: 1 ._. 1 certify that the foregoing information is correct and complete to the best of my knowledge and belief.[2] 8.. _1l. _. i' 1-0.. _. .._. .--. g!V~ _getails: Of Period I Office.__ _..-. ._. -~-_..- I' -. .-. Have you ever been convincted by a Court or any Officer? of the convications If the answer is 'Yes' the full particulars & the sentences should be given._+ ..g_e .._..

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