PROFORMA FOR HEAD EXAMINERS EASE ORMA FOR HEAD EXAMINERS WEST BENGAL BOARD OF SECONDARY EDUCATION NIVEDITA BHAWAN, BLOCK DJS, SECTOR, KARUNAMOYEE, SALT LAKE, KOLKATA -700 094 Application Form for appointment as Head Examiner for the Madh, amik Pariksha (Secondary Examination) (Regular & External) This application form, duly filled in, should be sent to the Administrator/President of the Board by name Please state the subject (For Head Examiner) 1 Name in full (in Block Letters) 2. a) Date of Birth b) Date of Retirement 3 Full residential address including Police Station 4 Contact Nos. a) Mobile Ph. b) Whatsapp No ¢) e-mail ID 5 Whether have a Desktop / Laptop Computer with Internet Connection Yes/No (Please tick) 6 Academic Qualification : (copies of only bachelor’s degree & master's degree certificate be attached) Examination passed (from Remarks Board / Coun vision Matindeten Madyammer | year | POUL/ESHI! | sun omens | OMclon | (ara, is equivalent & onwards use) 7 Teaching Experience in full Period of Name of the Institution Service ou Designation |Subject(s) taught] Remarks (with dates) _|_ Period 8 Experience as Head Examiner / Scrutineer / Examin ler with years and name of Examination under the Board: Name of the Examination off Years of Appointment Years of pinott elas the Board with Ref. No, discontinuance with PTO.9 Please state whether your son, daughter or an\ 'y dependant who is living with you or any pupil under your coaching @ candidate for the ensuing examination. (Please mention the year) 10 Please state whether you have acted as Hea 1d Examiner under H.S. Council / University and other than this Board Date Signature of the applicant | certify that the particulars given in the application form have been carefully verified and are correct Signature of the Head of the Institution 7 Secretary of the Institution / Administrator, where the applicant is serving at present (with office seal) FOR ATTENTION OF APPLICANTS 1 The application duly filled in should reach the office of th e West Bengal Board of Secondary Education on or before 30th September. 2 Application for Head Examinership not submitted in the prescribed form may be rejected. No application will be considered unless all the particulars required in form are fully stated. Head Examiner appointed by the Board should not accept examinership and / or head examinership for other examination under any other Board / Council without prior consent of Board. 4 Any inaccurate statement may entail summary rejection of the application. Teachers having access to Computer with Internet Connection shall be preferred 6 It is expected the Head Examiner shall com ply with the online processes involved in results / PPR / PPS processing, from time to time. N.B. : The Board reserves the right to withdraw or cancel appointment of a Head Examiner at any time without assigning any reason.