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VIVEKANANDA KENDRA VIDYALAYAS IN NORTH - EAST (For office use only) () APPLICATION FORM FOR THE POSTS OF TEACHERS IN Name ofthe Vidyalaya Centre where the application i deposited. Regn. No. Application for the post of (Please y in the appropriate box) (1 1 Senior Secondary Teacher 11 2. Secondary Teacher OD 3. Primary Teacher 0 4. Librarian 0 5. Physical Education Teacher 0 6. Music Teacher (Vocal) 1 7. School Counsellor O 8 Others (Specify) (For posts 1, 2 & 3 candidates may tick in more than one box if they are to be considered for more than one level) 1. Name ofthe candidate (In BLOCK Letters) : 2, Father’s/Guardian’s Name 3.Sex 4. Marital Status 5, Date of Birth 6.Age as on I* January 2019 7. Nationality 8, Religion 9. Permanent Address Eligibility Checked Sign. of Principal/Official Place of Interview: (Refer Pt. Yin the Insctions fr candidates of iuidelines) Preference of posting in the state : O Assam O Nagaland Subject ...... 7 Major | Honours or in Master Degree. Candidates without ‘major or honours in graduation should keep this space blank, Male / Female Married / Unmarried Affix Passport Size photograph Tel. No.(with STD Code) PIN 10, Present Address (Adatress for Communication) Tel.No. e-mail PIN. 1. Academic Qualifications (ftom H.S..C./ Matriculation onwards) = (Do not Enclose Photostat copies of Marksheets / Certificates) SL] Name of the oe Division/ Percentage! Ye x ; No. { ExampDegree | Ye" ]SshoolCotegetnsttuiontUniversty) Subjects |G. | “Cpa 1 2 3 4 5 12. Other Qualification() : i 13. 14, Aptitude: wards won. Details : a) Teaching (Specific Subjects ) - b) Other areas - ©) Proficiency in Games - a) Hobbies 15. Family: a) Members in your family - b) Occupation of Father/ Mother’ Husband/Wife- 16. Work Experience (ifany) 17.a) Monthly Salary Last drawn (gross)...........000 secesssssb) Expected salary (p.m.)....sccsscssssesesse 18. 19. 20. Whether you are involved in any police case, or any criminal cas ending against you with any court oflaw : Yes/No IF yes’, give details : Aspiration (which you believe will be valuable to this institution) I solemnly state that all the above particulars / statements are true to the best of my knowledge and belief. | also understand that in case any particular given above is found to be false at any later date, my services are liable to be terminated without any prior notice. Date Place: (Signature of the Applicant) Notes- This form is to be submitted in duplicate by post or by person in any of the Vivekananda Kendra Vidyalayas in Assam’ Nagaland or Vivekananda Kendra Shiksha Prasar Vihhag, S.C. Goswami Road, Near Shukreswar Temple, Panbazar, ‘Guwahati-781001 or in the addresses at Agartala, Alipurduar, Dharmanagar, Imphal, Jorhat, Lakhimpur given inthe last page of the Guidelines for Applicants. We will try to call you for interview to the place which you have opted in the application forms. Application will be rejected in case at any stage itis found that the candidate is not meeting the minimum laid down criteria or has furnished false information. aaaeane