Government of Karnataka Bangalore Application form for the Post of Assistant Teachers in Government Primary Schools at District Level

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Notification No & Date

AS:3[1]C:P:15:2011-12, AUg, AP: 02 sj, 2013

3017770 GULBARGA General Teacher in Urdu Medium Schools Priority 1, English Teacher in Kannada Medium Schools - Priority 2, Science Teacher in Urdu Medium Schools - Priority 3 Urdu SAJEEDA FIRDOUS Female

01. 02. 03.

Application No In Which District do you wish to apply for the Teacher Post Post(s) Applied

04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14 15

Medium opted for the Competitive Examination Applicants Name (in Capital letters - as in SSLC or equivalent exam marks card) Gender Mothers Name Fathers Name Marital Status Name of the Spouse Date of Birth (as in SSLC Marks card) Category Sub Caste Are You Physically challenged ? Do you require the Assitance of Scribe in the examination. (The Examining Authority will provide the scribe) Name and Postal Address

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16.a. Pin code 16.b. STD Code 16.c. Telephone Number 16.d. Mobile Phone Number 16.e. Email 17. Permanent Address

17.a. Pin code 17.b. STD Code 17.c. Telephone Number RESERVATION DETAILS 18. Do you come under Rural candidate reservation ?

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UnMarried 2B MUSLIM No Null 585104 08472 585104 08472 No

ZEENATH BEGUM MD KHALEELUDDIN

25 Feb 1989

H.NO:7-195 MIJGORI MOMINPURA GULBARGA.

9986787393 sumeeranausheen@yahoo.com H.NO:7-195 MIJGORI MOMINPURA GULBARGA.

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19. 20.

Have you studied in Kannada Medium from 1st to 10th Std? Do you come under Ex-Service Men reservation?

No No --No --No --0 No No No ---

20.a. Specify No.of Year of Service 21. Do you come under Dependents of Ex-Service Man?

21.a. Specify Relationship 22. Are you a project displaced person ?

22.a. Property Aquired Year 23. 24. 25. 26. If served as Honorary/Part time teachers in Govt. Schools (No.of Completed years in two digits) Posses any Kannada Eligible Exams ? Posses any Hindi Eligible Exams Are you Government Employeed ?

26.a. If yes, you have to furnish orginal permission letter at the time of verification. QUALIFICATION DETAILS 27. 28. Type of Teachers Training Year of Admission to Tch/D.Ed ( Specify year in Four digits)

Tch / D.Ed 2009

SSLC DETAILS 29.a. Medium Studied in SSLC 29.b. Languages studied in SSLC 29.c. Total Marks Obtained 29.d. Total Maximum Marks in SSLC Marks Details of II PUC/ Equv 30.a. Qualifying Exam Passed 30.b. II PUC/ Equv Exam Board affiliated to 30.c. Year of Passing ( Specify year in Four digits)
Urdu

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30.d. Registration Number 30.e. Combination Studied in II PUC/Equv 30.f. If Studied Science in II PUC have you studied Mathematics ? ( Yes/No) 30.g. Medium Studied in IIPUC/Equv 30.h. Languages studied in II PUC/Equv 30.i. Elective subjects studied in II PUC/Equv 30.j. Total Marks Obtained 30.k. Total Maximum Marks 30.l. Marks Obtained in English Subject 30.m. Maximum Marks for the English Subject TCH/DEd Details 31.a. Reg.Num. 31.b. Medium Studied in TCH/D.Ed 31.c. Languages studied in TCH/D.Ed

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425 625 II PUC Karnataka 2008 559126 Arts No English 389 600 100 2010440766 Urdu Urdu, None

Urdu, Kannada

English, Urdu History, Economics, Sociology , Political Science

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Urdu, None

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Marks Details of I Year TCH/D.Ed 31.d. Internal Marks Total Internal Marks Obtained in I Year TCH/DEd Total Maximum Internal Marks in I Year TCH/DEd 31.e. External Marks Total External Marks Obtained in I Year TCH/DEd Total Maximum External Marks in I Year TCH/DEd Marks Details in KSEEB-OTHER Examination (Tch / D.Ed) 31.f. Internal Marks Total Internal Marks Obtained in II Year TCH/DEd Total Maximum Internal Marks in II Year TCH/DEd 31.g. External Marks Total External Marks Obtained in II Year TCH/DEd Total Maximum External Marks in II Year TCH/DEd
399 500 298 350 368 500 313 370

[ For Candidates with PUC Ed with Internship Educational Qualifications] 32. SSLC Details

32.b. Languages studied in SSLC 32.c. Total Marks Obtained 32.d. Total Maximum Marks in SSLC PUCEd Details 33.a. Year of Passing ( Specify year in Four digits) 33.b. Registration Number 33.c. Medium Studied in PUCEd 33.d. Languages studied in PUCEd 33.e. Total Marks Obtained 33.f. Total Maximum Marks Payment Details 34. 35. 36. 37. 38. 39. Payment Amount Journal Number Date of Payment Bank Name Branch Code Taluk Details

Urdu, Kannada

I solemnly declare that the information provided are true. In case any information is found to be false or incorrect, I shall forfeit the claim to be considered for selection. Date : 19-Feb-2013 05:49:32 PM
103.5.16.2

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Declaration

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------------400 732300 19 Feb 2013 State Bank of Mysore 40383 ALAND - Priority 1, JEVERGI - Priority 2, SEDAM - Priority 3, CHINCHOLI - Priority 4

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625

425

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Signature of the Applicant

32.a. Medium Studied in SSLC

Urdu

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