AFFIX LATEST PASSPORT SARDAR PATEL VIDYALAYA PHOTOGRAPH APPLICATION FOR THE POST____ HERE 01. NAME (underline surname). 02, DATE OF BIRTH 03. PLACE OF BIRTH 05, HEIGHT. em — WEIGHT___ kg 06. MARITAL STATUS : Single C1; Married [1]; Separated(]; widowed C1 07. MOTHER TONGUE 08, OTHER LANGUAGE(S) KNOWN 09. ADDRESS FOR COMMUNICATION (04. NATIONALITY 10. PERMANENT ADDRESS — Tel. No. (Resi) _______ (Off.) E-mail Mobile 11. EDUCATIONAL HISTORY (Starting from final year at school) Year of Marks % | Medium of Schoolcollage -| University or Board TEnty [leaving Melor Subjects |g pivision | Instruction T ‘SCHOOL GRADUATE. POST-GRADUATE PROFESSIONAL, DIPLOMA OTHER 12. DETAILS OF ANY TRAINING UNDERGONE DURING THE LAST 5 YEARS ITEM QESCRIPTION FROM DATE & DURATION=2 EMPLOYMENT RECORD 13, DETAILS OF EXPERIENCE (Starting with your present employment and working downwards). Year & Month From, Te Name & Location of Institution Designation Brief Description of Duties, Reason for Change14, PRESENT EMPLOYMENT Name and Address af Organisation No of Employees Date of Joining Designation on Joining. Present Designation Date of Appointment to Present Position Present job responsibilties ‘Organisation Chant indicating (in brien) reporting relationships IMP : If you have held your present appointment for less than one year, please describe your previous appointmentin as much details as possible, on a separate sheet. 45. REMUNERATION PARTICULARS (Present employment) as on. Particulars. ‘Quantum, Remarks PayScale Basic Salary Dearness Allowance House Rentallowance Other (Please Specify) Total (Gross Salary) 46. WHATIS YOUR SALARY EXPECTATION? ———————— 17. IF SELECTED, HOW SOON CAN YOU JOIN? ————————18. ade ‘SPECIAL SKILLS (relevant to the job applied for) THAT YOU POSSESS 19. ACHIEVEMENT IN GAMES / SPORTS / ATHLETICS / NCC / SCOUTING / GIRL GUIDE ETC. GIVE DETAILS. 20. 24 INTEREST IN CO-CURRICULAR ACTIVITIES : Give self-assessment of competency level on S-point scale in the brackets. (The highest number corresponds to the best.) Art (specify) ( ) Crafts (specify) ( ) Dramatics ( ) Public speaking ( ) Dance (specify) ( ) Recitation/Elocution/Debate ( ) Music (specify) ( ) Participation in Tours/Social Service Camps ETC. ( ) PLACES YOU HAVE TRAVELLED TO WITH PURPOSE, DURATION AND DATE Place Visited Purpose Duration From / To 22. HOBBIES AND SPECIFIC INTEREST Hobbies / Interests Remarks, including achievements 23. MEMBERSHIP OF LITERARY, SOCIAL, CULTURAL, RELIGIOUS OR POLITICAL ORGANISATIONS Name of Organisation Nature of Association 24, DETAILS OF PHYSICAL DISABILITIES, SERIOUS ILLNESS, IF ANY Disability / ines Consequence 25. HAVE YOU BEEN ARRESTED / INDICATED, OR SUMMONED TO COURT, CONVICTED, FINED. OR IMPRISONED FOR CRIMINAL OFFENCE? Yes [—] No(—1 ifyes, give full particulars and preset status.a5 26. ANY COMMUNITY WORK DONE BY YOU 27. DETAILS OF SPOUSE : Name Age Occupation 28. ~ EDUCATIONAL QUALIFICATION OF SPOUSE Educational Qualification Special Skills Other Diplomas / Certificates Other Interests 29. PRESENT EMPLOYMENT DETAILS OF SPOUSE Organisation Designation Income PA. 30. DETAILS OF CHILDREN Name Sex| Age Education ‘School / College 3t DETAILS OF PARENTS Father Mother Name Age Education Occupation 32. DETAILS OF PARENTS Name Sex [Age Education ‘School / College28s 33. GIVE BELOW THE NAMES OF TWO REFEREES, NOT RELATED TO YOU, WHOM WE CAN CONTACT. BOTH SHOULD BE HOLDING RESPONSIBLE POSITIONS. AT LEAST ONE OF WHOM SHOULD BE IN YOUR LINE OR OCCUPATION. SI. No. Name of Referee ‘Occupation Address & Phone No. 34. QUESTIONAIRE Please submit in your own hand, on standard Ad size paper, your responses to the following. Limit yourself to an appropriate titled paragraph on each. 01. How did you select the career that you have had so far? 02. Whatare your political beliefs living ina country like India? 03. In your opinion what problems should you be prepared to face if you adopt a participatory mode of teaching /administration? 04. In your view whatis the role of periodic meeting of the faculty? How often should itbe scheduled? 05. Give 2 examples of (a) initiatives taken by you in your present job and (b) personal drive demonstrated by you in achieving yourjob goals. 06. Please write briefly why you cosider yourself the most suitable for this job. 07. Inyour view what three changes are urgently needed in our Educational System? 35. ANSWERS TO QUESTIONAIREATTACHED ? YES NO“7 DECLARATION | certify that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed. | am not aware of any circumstances that may impair my fitness for emptoyment. fat any time | am found to have concealed or misrepresented any matereial information or given any fales detalls, my appointment shall be liable to summary termination without notice or compensation. Date Place Candidate's Signature STRICTLY CONFIDENTIAL FOR OFFICE USE ONLY REMARKS ON APPLICATION Date Signature REMARKS FOLLOWING BOARD INTERVIEW Date Signature INTERVIEW PANEL Date Signature