Photo

(Bring for pasting

at the time of
Interview)

KENDRIYA VIDYALAYA BLW VARANASI

INTERVIEW FOR PART TIME CONTRACTUAL TEACHERS: 2023-24
PROFORMA
01 Post applied for: PGT---------------------/TGT----------------………./PRT/ Computer Instructor/
Games Coach/Nurse/Educational Counsellor /Yoga Instructor/SPECIAL
EDUCATOR/………………………………………. under KVS terms and conditions.
02 Name:

(In CAPITAL Eng.) _______________________________________________

(In Hindi) ------------------------------------------------------------------------------------------

03 Date of Birth ___________________

04 Sex: Male/Female/OTHER…………
05 Whether married: Yes/No

06 Father/Mother/Husband’s Name and occupation:

07 Whether SC/ST/OBC/PH/ (If yes, specify) ____________________________

08 Nationality: ---------------------------------------------
09 Basic Qualifications __________________________________________________
10 Whether employed at present (if yes, details thereof) ________________________
___________________________________________________________________
11 Complete permanent address:
___________________________________________________
_________________________________________________________________________
__________________________________________PIN-Code___________
12 Complete address for correspondence:
____________________________________________
_________________________________________________________________________
__________________________________________PIN-Code___________

13 Police Station: -----------------------------------------

14 ACTIVE Telephone/Mobile number for contact with STD code
Mobile 1._______________________________

2. -------------------------------------------------
Active E-mail ID: ----------------------------------------

P.T.O.
 15 Academic Qualifications:

Certificate/De Board/University Year of Subject(s) offered % of

gree Passing Marks
Secondary
Hr. Sec.
Graduation
Post Grad.
B.Ed.
Any other
Any other

16 Teaching Experience:
Post Held Institute with place Pay From To

17 Any other relevant qualification like STET/CTET / experience (Specify):

_______________________
___________________________________________________________________

18 Co-curricular activities (Specify interest/achievement) _______________________

__________________________________________________________________

19 Any other relevant information (specify) __________________________________

__________________________________________________________________

I hereby certify that the above information is correct to the best of my belief & knowledge. I will render
myself unfit for selected post if anything mentioned above is found wrong at any stage. I will also be
liable for penal action as per the extant GOI/KVS laws/rules. Photocopies (self-attested) of relevant
documents have been attached.

Place: ----------------- Signature in full _____________

Date: __________ Name_____________________

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(FOR OFFICE USE ONLY)

Details as given above are verified from the original documents and found correct as per the KVS norms.
Eligible for the posts: __________________________________________________________

Date: Signature of Checker _______________ Name: ___________________

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Interviewed on ________________ and found fit for (in order of preference)

01 ______________________
02 ______________________
03 ______________________
(D D PATHAK)
PRINCIPAL