8/8/2019 AppForm_16008285
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KENDRIYA VIDYALAYA SANGATHAN18, Institutional Area, Shaheed Jeet
Singh Marg
New Delhi - 110602
RECRUITMENT OF POST GRADUATE TEACHERS IN KVS FOR THE YEAR
2011-2012
1 . Candidate Name
2 . Father's/Husband's Name
3. Choice of Examination City
Name of City
I Preferrence II Preferrence
5. Sub-Category
SUB-CATEGORY-IIIf Physically Challenged, please
indicate whether Guide/Scribe is
required at the Examination
Centre (write : Yes/No)
Visually
Challenged
Hearing
ChallengedLocomotor/Orthopaedically
challenged
Resident of State Of J&K
(Domiciled During 1.1.80
to 31.12.89)
Ex-servicemen
In Govt.
Regular
Service
KVS Regular
Employee
7. Candidate Address
Name
Father/Husband
Address
City
State Pin Code
Signature of Candidate
Please affix one recentphotograph
:
:
:
:
: :
ROOPA RAMACHANDRAN
N.RAMACHANDRAN NAIR
City Code
KOCHI 16 BANGALORE 03
NoNo No No No No No
RAMACHANDRANROOPA
N.RAMACHANDRAN NAIR
SUBJECT OPTED IN
PGT
POST CODE QUALIFICATION
CODE
CATEGORY DATE OF BIRTH GENDER AGE AS ON
SC/ST/OBC)(DD/MM/YYYY) (Male/Female)
Name of City City Code
4. Area Code (For remote area and Abroad)
YES/NO
if Yes,
Name of Area Code
SUB-CATEGORY- I (Physically Challanged)
Self Dependent
To be filled only if candidate himsellf/herself is
Ex-Servicemen
Joining Date Retirement Date Total Service
Contact Details : STD Code Tel. No.
Email ID. Mobile No.
UTR No./Journal No. Date Name Of Bank Branch Address Branch Code
Amount(Rs.)
8. Details of fee paid through Electronic Transfer
ROOPA SREEKUMAR
SREE NILAYAM
KOIPPADU
CHATHANNOOR
KOLLAM
691572KERALA
COMMERCE 16 06 GENERAL 15/5/1973 FEMALE
(First Name) (Middle Name) (Last Name)
NOTAPPLICABLE 00No
NoNo
[email protected]
04742 594103
0
Registration Number : 16008285
Are you able to teachthrough English & Hindi, both
Yes
6.
------ ------ ------
YEAR MONTH DAYS
6 1537
(GENERAL/
8/8/2019 AppForm_16008285
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Name of
Examination
Name of
Examination
Passed(write
complete name of
course passed as on
30.11.2010)
Year of
passing
Aggregate marks
Max. Marks Marks
Obtained
%age of
marks
Subjects Studied
Duration of
course (in
months)
Board / University
Graduation/
Post
Graduation
Other if
any(specify)
9. Academic Qualification
199336
1200 701 KERALA UNIVERSITY58.42B.COM
51.66 241999 620 M.G UNIVERSITYM.Com. 1200
Note of Column 9:
(a) If code/numeral are indicated in the mark sheet in place of
subject(s) studied, please attach necessary details for such
de-codification along with Computer
Generated Application Form.
(b) If grades are given in lieu of marks, write equal percentage
of marks in the relevant columns and attach the gradation list
along with Computer Generated
Application Form.
10. Teaching Experience
11. Permanent address
:
Address
:
:
Pin Code
Name
Father/Husband
:
:
:
State
City
Please affix one recent
passport size
Photograph withattestation
*********************************************************************************************
DECLARATION TO BE SIGNED BY THE CANDIDATE
I hereby certify and declare that (i) I am an Indian National,
(ii) I have read the provisions given in the Advertisement,(iii)
All
statements made and information given by me in this application
are true, complete and correct to the best of my knowledge and
belief. In the event of any information or part of it being
found false or incorrect before or after the exam./interview or
appointment,
action can be taken against me by the KVS and my
candidature/appointment shall automatically stand
cancelled/terminated, (iv) I
further declare that I fulfil all the conditions of eligibility
regarding age,educational, professional qualifications, etc.
prescribed for
the post applied for as on 30.11.2010. The essential
qualifications prescribed are possessed by me, the proofs of which
have been
enclosed, (v) In case my application is not received by KVS
within the stipulated date due to postal delay or otherwise, KVS
will not
be responsible for such delay, (vi) I will not lay any claim for
refund of non-refundable application fee from KVS under any
circumstances.
Signature of Candidate
Place :
Date :
A Separate Experience sheet is attached in next page (in case of
any experience).
Senior
Secondary
ROOPA RAMACHANDRAN
N.RAMACHANDRAN NAIR
ROOPA SREEKUMAR
SREE NILAYAM
KOIPPADU
CHATHANNOOR
KOLLAM
691572KERALA
ACCOUNTING
Financial Accountancy
65.67 241990 COMMERCE KERALA UNIVERSITY900.0PREDEGREE 591.0
16008285Registration Number:
Diploma
(Class-XII)
