Post Applied for: ______________________________ Kindly affix a
(5.5 x 4.5) size
PRE PRIMARY PRIMARY SECONDARY ISC photograph
(With white background –
ACADEMIC 70% face coverage)
NON ACADEMIC
Category: (Please tick the appropriate category)
English Hindi/Mar. Physics Chemistry Biology Mathematics History
Geography Sociology Psychology Pol. Science Bus.Studies Economics Commerce
Accounts P.T. Art/Craft Music Admin Other
Personal Data:
Title: Dr. Mr. Mrs. Miss
Surname First Name Father’s / Husband’s Name
Date of Birth: D D MM Y Y Y Y Blood Group
Do you wear spectacles? Yes / No. If Yes – Lens Power L: ________ R: ________
Do you have any Medical condition? Please Specify:
_____________________________________________________________________________________________
Place of Birth:
Town/City District
State Country
Mother Tongue
Marital Status: Single Engaged Married Separated Divorcee Widowed
Permanent Address:
Bldg. Flat No. Floor No.
Street
Area Pin code
District State Country
Telephone Mobile No.
Present Address: (If same as above kindly tick the box)
State of Accommodation Owned Rented Paying Guest
Bldg. Flat No. Floor No.
Street
Area Pin code
District State Country
Telephone Mobile No.
Email Id: _____________________________________________________________________________________
Family Data:
Relation Name Age Occupation Office Name / Address
Father
Mother
Husband / Wife
Particulars of Children
Name Age School / College Class
(If any)
II
Educational Data:
Marks Medium of
Name of the Institution City University/Board Year
% Instruction
SSC / X
HSC / XII
Graduation
(B.A./B.Com/B.Sc.)
Post Graduation
(Subjects)
Diploma
Training/ Professional
Course
Special Qualification
Employment Data / Work Experience (Begin with last including current Organization)
Details of
Class & Subjects Reason for Leaving – other than
Present / Previous School/ College Salary Drawn
Taught better prospects
Employment
From To Class Subject
Details of last / current Institution:
Reporting & Exit No. of
No. of
School timings of Periods Duration of School
Name Students School Fee
Timings in a periods Strength
in a class
Staff / Faculty week
Any additional assignments and responsibilities taken up in the School?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Any Special Skills: _____________________________________________________________________________
Have you been conferred upon with any special award or recognition: YES / NO
If yes, Please give details:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
How much time would it take for you to commute from your present residence to NLDHS?
_____________________________________________________________________________________________
Please mention your 3 strengths and weaknesses:
Sr. No Strengths Weaknesses
How do you rate yourself on a scale of 1 to 10, where 1 is low and 10 is high?
o Sincerity - __________ o Team Work - __________
o Hard work - __________ o Responsibility - __________
o Punctuality - __________ o Creativity - __________
In your opinion what are the qualification of an ideal teacher?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
How will you innovate and be creative in your teaching?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Expected Salary: ___________________
If selected how soon you can join? _____________________________________________________________
Is any faculty - staff of NLDHS known to you? If yes, Please give details.
____________________________________________________________________________________
____________________________________________________________________________________
Kindly give two references of persons in responsible position whom we can refer to before or during the
course of Employment
No. of
Contact No. / Mobile
Sr. No. Name Address Occupation years
No.
known
1.
2.
*Note:
1. The information given above is true and no material information has been withheld.
2. I agree to furnish the support documents on request.
Date: _____________________
Place: _____________________ ___________________
Signature
