FERTILIZER PUBLIC SCHOOL

Kribhco Shyam Nagar, Piprola, Shahjahanpur

TEACHER APPLICATION FORM

GRADE APPLIED FOR: PGT TGT PRT NTT

SUBJECT APPLIED FOR: ___________________________________

PASTE A
INSTRUCTIONS FOR CANDIDATE: PASSPORT SIZE
1. Please fill this application form in clear words.
2. Where Boxes are provided, write in capital letters only inside them and leave one RECENT
Box blank between two words. COLOURED
3. Submission of any false information will make you liable for summary rejection PHOTOGRAPH
at the time of interview or, if appointed, termination without notice. HERE
4. In the column for academic information, please fill in only recognized and
completed qualifications.
PART - A: PERSONAL INFORMATION
A1. NAME

A2. SEX MALE FEMALE

[Please tick (√ )]

A3. DATE OF BIRTH

DAY MONTH YEAR

A4. PLACE OF BIRTH

A5. NATIONALITY

A6. MARITAL STATUS UNMARRIED MARRIED WIDOWED

DIVORCED SEPERATED
[Please tick (√ )]

A7. RELIGION

A8. CASTE

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A9. CONTACT ADDRESS STREET

VILLAGE
POST
DISTRICT
PINCODE

TELEPHONE NO.
STD CODE TELEPHONE NO.

MOBILE NO.
(Don’t add ‘0’ before number)

E-MAIL ID

A10. PARMANENT ADDRESS STREET

VILLAGE
POST
DISTRICT
PINCODE

TELEPHONE NO.
STD CODE TELEPHONE NO.

A11. FAMILY PROFILE

NAME AGE OCCUPATION ADDRESS
A. FATHER

B. MOTHER

C. SPOUSE

D. CHILDREN:
NAME SEX AGE CLASS

1.

2.

3.

A12. PHYSICAL STANDARDS:

HEIGHT FEET INCH (ES)
WEIGHT KGS.

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 PART - B: ACADEMIC/ PROFESSIONAL INFORMATION
B1. ACADEMIC QUALIFICATIONS

BOARD /
PRIVATE / SCHOOL / PASSIN % OF DI
QUALIFICATION SUBJECTS UNIVERSIT
REGULAR COLLEGE G YEAR MARKS V.
Y

HIGH SCHOOL

INTER/ +2

GRADUATION

……………………

POST
GRADUATION

……………………

B. Ed.

N.T.T.

ANY OTHER

…………………….

B2. DETAILS

SCHOLARSHIPS/ AWARDS/ HONOURS

RESEARCH WORK/ PUBLICATION

SEMINARS AND COURSES ATTENDED

NAME OF THE SEMINAR/

CONDUCTED BY DURATION
COURSE
(ORGANIZATION/ INSTITUTE)

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 PART - C: CO-CURRICULAR INFORMATION
C1. CO-CURRICULAR
ACTIVITIES

C2. SPORTS/ GAMES/

OUTDOOR ACTIVITIES

C3. PROFICIENCY IN LANGUAGE LANGUAGE READ WRITE SPEAK

[Please tick (√ )]
1.HINDI READ WRITE SPEAK

2 ENGLISH READ WRITE SPEAK

OTHER: ……READ WRITE SPEAK

C4. PROFICIENCY IN COMPUTER OPERATION

DO YOU HAVE COMPUTER AT HOME YES NO

DO YOU REGULARLY WORK ON A COMPUTER? YES NO

IF YES, WHAT SOFTWARE CAN YOU USE PROFICIENTLY?

[Please tick (√ )]

MS WORD MS EXCEL MS POWER POINT

INTERNET E-MAIL LIBRARY SOFTWARE

C5. CO-CURRICULAR ACTIVITIES IN WHICH YOU ARE REALLY INTERESTED AND CAN
TRAIN STUDENTS
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MUSIC DANCING

DRAMATICS NCC/ SCOUTS/ GUIDES

YOGA/ AEROBICS KNITTING AND DARNING

HANDICRAFT MAKING CLAY MODELLING AND POTTERY

SIGN BOARD PAINTING & CARTOON MAK GARDENING

FRUIT PRESERVATION COOKING

OTHER: ………………………………………. OTHER: ……………………………………

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PART - D: WORK EXPERIENCE
D1. WORK EXPERIENCE DETAILS:
(Starting from the present/ last job)
TO POSITION SUBJECT(S) CLASSES
SL. NAME OF INSTITUTION FROM
(DD/MM/YYYY) HELD TOUGHT TOUGHT
NO. (DD/MM/YYYY)

D2. TOTAL EXPERIENCE YEARS MONTH(S)

D3. BREAK-UP OF TOTAL EXPERIENCE YEARS MONTH(S)

TEACHING

ADMINISTRATION

OTHER …………………………………………………………

OTHER …………………………………………………………

OTHER …………………………………………………………

D4. TOTAL EMOLUMENT IN PRESENT/ LAST JOB RUPEES

D5. BREAK-UP OF TOTAL EMOLUMENT BASIC (IN RS.)

IN PRESENT/ LAST JOB ALLOWANCE (IN RS.)

OTHER BENEFITS:

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 PART - E: OTHER INFORMATION

E1. DO YOU SUFFER FROM ANY MAJOR AILMENT/ YES NO

MEDICAL PROBLEM
[Please tick (√ )]

IF YES, PLEASE GIVE

DETAILS

E2. HAVE YOU EVER BEEN CONVICTED BY ANY COURT OF LAW OR YES NO
IS ANY DISCIPLINARY PROCEEDING/ ENQUIRY PENDING AGAINST
YOU OR HAS ANY PENALTY IMPOSED ON YOU ?
[Please tick (√ )]

IF YES, PLEASE GIVE

DETAILS

E3. GIVE DETAILS OF TWO REFERENCES (OTHER THAN Y OUR RELATIVES) IN

THE FIELD OF EDUCATION

NAME (MR./MS.) DESIGNATION OFFICIAL ADDRESS MOBILE NO.

REFERENCE1

REFERENCE2

E4. THE EXACT PERIOD AFTER WHICH YOU CAN JOIN, IF SELECTED

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 PART - F: GETTING TO KNOW MORE ABOUT YOU
F1. PROFESSIONAL EXPERIENCES

F2. WHAT ARE YOUR STRENGTHS ?

F3. WHAT ARE YOUR AREAS FOR IMPROVEMENT ? WHAT ARE YOUR ACTION
PLANS FOR IMPROVEMENT IN THOSE AREAS ?

F4. HAVE YOU EVER ADAPTED A NON-TRADITIONAL APPROACH TO MANAGE

OR HANDLE A STUDENTS RELATED SITUATION?
DESCRIBE YOUR APPROACH AND THE OUTCOME

I hereby certify that information provided above is true to the best of my knowledge and belief.
If any information is found to be false / incorrect, it will disqualify my continuation in Fertilizer
Public School, Shahjahanpur.

SIGNATURE OF CANDIDATE:

DATE:

PLACE:

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 FOR OFFICE USE ONLY

DATE OF INTERVIEW
DDMMYYYY

RESULT SELECTED WAITING LIST POSITION 1 WAITING LIST POSITION 2

[Please tick (√ )]
WAITING LIST POSITION 3 REJECTED

INTERVIEW COMMITTEE
NAME DESIGNATION SIGNATURE

CHECKING OF
CERTIFICATES &
MARKSHEET

NAME OF DOCUMENT CHECKED REMARKS (IF NOT OK)

HIGH SCHOOL CERTIFICATE & MARKSHEET

10 +2 CERTIFICATE & MARKSHEET

GRADUATION CERTIFICATE & MARKSHEET

POST GRADUATION CERTIFICATE & MARK SHEET

B. ED. CERTIFICATE & MARK SHEET

N.T.T. CERTIFICATE & MARKSHEET

OTHER:

OTHER:

OTHER:

SIGNATURE OF OFFICE INCHARGE SIGNATURE OF PRINCIPAL

DATE: SCHOOL STAMP DATE: