8/12/2019 Singareni Collieries Educational Society school teacher requtment application

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APPLICATION FOR APPOINTMENT ON CONTRACT BASIS

FOR THE POST OF_____________

1. Name of the Candidate (in Block Letters) :

2. Fathers/Husands Name :

!. "ate of Birth (as #er $$C records) :

%. a) &ualifications.. 'cademic and echnical (from $$C onards)

('ttested *hotostat in su##ort of +ualifications ,ith marks memos)

&ualification

,ith

-rou#/Branch

Name of the

nstitution and

Board/ni0ersit

otal

marks

arks

$ecured

3 a-e of

arks

secured

4ear of

*assin-

() Hi-her &ualifications (.*hil/ *h"/N5 or $L5)

Name of

the

"e-ree

Name of

the

nstitution

arks

$ecured

3 a-e of

arks

secured

4ear of

*assin-

Branch

Note: -he candidates ho #ossess the #ro0isional certificate at the time of a##lin-

itself shall e eli-ile to a##l.

hose ho are #ursuin- hi-her studies shall not e considered to e #ossessin-

hi-her +ualifications unless #ossess the #ro0isional or ori-inal certificate as on the

date of sumission of a##lication.

6. 57#erience :

$l.No Name of the8r-anisation 9

'ddress ith

*hone.No

*eriod of$er0ice

otal$er0ice in

4ears and

months

easonfor

lea0in-

eference#erson address

and contact

numer

From o

;. Communit $C/$/BC

8/12/2019 Singareni Collieries Educational Society school teacher requtment application

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=. Name of the 5ducational nstitutions here studied

From Class > to ? @ enclose stud certificate/certificate of residence in the

#rescried #roforma of enclosure /A.

Name of the

$chool

4ear of $tud *lace of stud

>illa-e/on/Cit

"istrict to hich

it elon-s

. a) 'ddress for Corres#ondence ith

*in Numer

(,rite in Block Letters) :

) oile Numer :

c) Land line ith $" Code :

d) 5mail "

. 'n 8ther nformation :

he information furnished ao0e is true and correct to the est of m knoled-e and if

the information furnished ao0e is found incorrectD shall e held liale for the conse+uences

thereof:

Place:

Date: Signature o t!e Can"i"ate