KAVITA by prashanttamburi53

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									                                 Government of Karnataka
     Application Form For The Recruitment For The Post Of Secondary School Assistant
                Masters Grade II And Physical Education Grade I 2012-2013
1    C¢ü¸ÀÆZÀ£É ¸ÀASÉå ªÀÄvÀÄÛ ¢£ÁAPÀ / Notification No. & Date               ¨ÉAUÀ¼ÀÆgÀÄ «¨sÁUÀ - ¸ÀASÉå: C1/¥Ëæ±Á²£ÉÃ/01/2012-13, ¨ÉAUÀ¼ÀÆgÀÄ, ¢£ÁAPÀ 02£ÉÃ
                                                                              K¦æ¯ï 2012




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2    Cfð¸ÀASÉå / Application No.                                              2016041

3    C¨sÀåyðAiÀÄ ºÉ¸ÀgÀÄ (zÀ¥Àà CPÀëgÀUÀ¼À°è, ¤ªÀÄä J¸ï.J¸ï.J¯ï.¹.            KAVITA SOMPUR




                                                                                                           ST
     CAPÀ¥ÀnÖ / vÀvÀìªÀiÁ£À ¥ÀjÃPÉëAiÀÄ°ègÀĪÀAvÉ) / Applicant’s Name
     (In Capital letters - as in SSLC or equivalent exam marks




                                                                                                        l(H
     card)
4    ºÀÄnÖzÀ ¢£ÁAPÀ / Date of Birth                                           20 Sep 1983

5    «¨sÁUÀzÀ ºÉ¸ÀgÀÄ (²PÀëPÀgÀ £ÉêÀÄPÁwUÉ EaÒ¹gÀĪÀ «¨sÁUÀzÀ ºÉ¸ÀgÀÄ)       Bangalore




                                                                                                 l
                                                                                              Ce
     / Division Name (In which Division do you wish to
     select for teachers post)

6    f¯ÉèAiÀÄ ºÉ¸ÀgÀÄ (¸ÀAAiÀÄÄPÀÛ ¸ÀàzsÁðvÀäPÀ ¥ÀjÃPÉë §gÉAiÀÄ®Ä EaÒ¹gÀĪÀ   Bangalore North
                                                                                    on
     f¯ÉèAiÀÄ ºÉ¸ÀgÀÄ) / District Name (In which District do you
     wish to take the Competitive Examination)
                                                                               si

7    Cfð ¸À°è¹gÀĪÀ «µÀAiÀÄ /«µÀAiÀÄUÀ¼ÀÄ (MAzÀQÌAvÀ ºÉZÀÄÑ                   1.Arts - English
     «µÀAiÀÄUÀ½UÉ DAiÉÄÌ §AiÀĸÀĪÀªÀgÀÄ DzÀåvÉAiÀÄ ªÉÄÃgÉ «µÀAiÀÄUÀ¼À£ÀÄß
                                                                    is


     £ÀªÀÄÆ¢¸ÀĪÀÅzÀÄ.) / Applying for the Post/s of (Give
                                                                   m



     attention to priority of the posts if applying for more than
     one post)
                                                          Ad




8    °AUÀ / Gender                                                            Female

9    ¥ÀæªÀUÀð / Category                                                      2A

10   CAUÀ«PÀ®gÉ? / Are You physically challenged?                             No
                                            ed
                                         iz




11   1-10£Éà vÀgÀUÀwAiÀĪÀgÉUÉ UÁæ«ÄÃt ¥ÀæzÉñÀzÀ°è ªÁå¸ÀAUÀ                  No
                                   al




     ªÀiÁrgÀªÀgÉ? / Have you studied in Rural Area from 1st to
     10th Std?
                           r
                        nt




12   1-10£Éà vÀgÀUÀwAiÀĪÀgÉUÉ PÀ£ÀßqÀ ªÀiÁzsÀåªÀÄzÀ°è ªÁå¸ÀAUÀ               Yes
     ªÀiÁrgÀªÀgÉ? / Have you studied in Kannada Medium from
               Ce




     1st to 10th Std.
13   ªÀiÁf ¸ÉʤPÀgÉÃ? / Are you Ex-military Person ?                          No

13a ºËzÁzÀ°è JµÀÄÖ ªÀµÀðUÀ¼À ¸ÉÃªÉ ¸À°è¹gÀÄ«j? / If Yes Specify               ---
    No.of Years of service
14   ªÀiÁf ¸ÉʤPÀgÀ CªÀ®A©üvÀgÉÃ? / Are you Dependents of                     No
     Ex-Service Man?
14a ºËzÁzÀ°è CªÀgÀ ¸ÀA§Azs / If Yes specify relationship                      ---

15   ºAiÉÆÃd£Á ¤gÁ²ævÀgÉÃ? / Do you come under Project                        No
     Displaced Person
15a ºËzÁzÀ°è D¹Û PÀ¼ÉzÀÄPÉÆAqÀ ªÀµÀð / If yes, Property               ---
    Acquired Year
16    ¤ÃªÀÅ UËgÀªÀ ²PÀëPÀgÁV ¸ÀPÁðj ±Á¯ÉUÀ¼À°è ¸ÉêÉøÀ°è¹gÀÄ«gÁ?     0
      ºËzÁzÀ°è JµÀÄÖ ªÀµÀðUÀ¼ÀÄ / If Served as Honorary Part
      Time Teacher in Govt. Schools (No. of Completed Years)
17    ¤ÃªÀÅ d£ÀUÀtwAiÀÄ°è ¸ÉêÉøÀ°è¹gÀÄ«gÁ? ºËzÁzÀ°è JµÀÄÖ           0
      ªÀµÀðUÀ¼ÀÄ / If Served in population census work on
      contract basis (No. of Completed Years)
18     ¥Àæ¸ÀÛvÀ ¸ÉêÉAiÀÄ°ègÀÄ«gÉÃ? / Are you currently an Employee   None
       of
19    PÀ£ÁðlPÀ ¥ËæqsÀ²PÀët ¥ÀjÃPÁë ªÀÄAqÀ½ /PÀ£ÀßqÀ ¸Á»vÀå ¥ÀjµÀvï    No
      ¤AzÀ ªÀiÁ£ÀåvÉ ¥ÀqÉ¢gÀĪÀ PÀ£ÀßqÀ ¸Ànð¦üPÉÃmï PÉÆøïð£ÀÄß




                                                                                                  R)
      ºÉÆA¢gÀÄ«gÁ? / Possess any Kannada Certificate Course
      by KSEEB / Kannada Sahithya Parished




                                                                                               ST
20     SSLC Details




                                                                                            l(H
a.)   J¸ï.J¸ï.J¯ï.¹. ªÀiÁzsÀåªÀÄ / S.S.L.C Medium                     Kannada

b.)   J¸ï.J¸ï.J¯ï.¹. AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ ¨sÁµÁ «µÀAiÀÄUÀ¼ÀÄ / Languages studied at S.S.L.C.




                                                                                       l
      ¥ÀæxÀªÀÄ ¨sÁµÉ / First Languages                                Kannada




                                                                                    Ce
      ¢éwAiÀÄ ¨sÁµÉ / Second Languages                                English

21     PUC Details
                                                                             on
a.)   ¢éwÃAiÀÄ ¦.AiÀÄÄ.¹. GwÛÃtðgÁzÀ ªÀµÀð / II PUC Year of           2002
      Passing
                                                                       si

b.)   ¦.AiÀÄÄ.¹. ªÀiÁzsÀåªÀÄ / PUC Medium                             English
                                                               is


c.)   ¦.AiÀÄÄ.¹. AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ ¨sÁµÁ «µÀAiÀÄUÀ¼ÀÄ / Languages Studied at PUC
                                                              m



      ¥ÀæxÀªÀÄ ¨sÁµÉ / First Languages                                Kannada
                                                     Ad




       ¢éwAiÀÄ ¨sÁµÉ / Second Languages                               English

22    Bachelor Degree Details - 1
                                         ed




a.) ¥ÀzÀ« «zÁåºÀðvÉ /vÀvÀìªÀiÁ£À / Qualification Degree /             B.A
    Equivalent
                                      iz




b.) ªÁå¸ÀAUÀ ªÀiÁrzÀ «±Àé«zÁ央AiÀÄ / University Studied              Gulbarga
                                                                      2006
                                 al




c.) ¥ÀzÀ«AiÀÄ°è GwÛÃtðgÁzÀ ªÀµÀð / Year of Passing
d.) UÀjµÀ× CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Maximum Marks           1900
                           r




    (Total of all years)
                        nt




e.) UÀ½¹zÀ CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Obtained Marks          1430
                Ce




    (Total of all years)

f.) ±ÉÃPÀqÁªÁgÀÄ / Percentage
g.) ±ÉæÃt / Grade
h.) ¥ÀzÀ«AiÀÄ£ÀÄß ªÁå¸ÀAUÀ ªÀiÁrzÀ ªÀiÁzsÀåªÀÄ / Medium in Degree     Kannada
i.) ¥ÀzÀ«AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ ¨sÁµÉUÀ¼ÀÄ / Languages studied at degree level

      ¥ÀæxÀªÀÄ ¨sÁµÉ / First Languages                                Kannada
      ¢éwAiÀÄ ¨sÁµÉ / Second Languages                                English
j.) ¥ÀzÀ«AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ LaÒPÀ «µÀAiÀÄUÀ¼ÀÄ / Optionals studied at degree level
      ªÉÆzÀ®£Éà LaÒPÀ «µÀAiÀÄ / First Optionals                            English

      JgÀqÀ£Éà LaÒPÀ «µÀAiÀÄ / Second Optional                             Political Science
      ªÀÄÆgÀ£Éà LaÒPÀ «µÀAiÀÄ / Third Optional                             Other-STATASTICS


22    Bachelor Degree Details - 2
a.) ¥ÀzÀ« «zÁåºÀðvÉ /vÀvÀìªÀiÁ£À / Qualification Degree /                  B.A
    Equivalent

b.) ªÁå¸ÀAUÀ ªÀiÁrzÀ «±Àé«zÁ央AiÀÄ / University Studied                   Gulbarga
c.) ¥ÀzÀ«AiÀÄ°è GwÛÃtðgÁzÀ ªÀµÀð / Year of Passing                         2006
d.) UÀjµÀ× CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Maximum Marks                1900




                                                                                                     R)
    (Total of all years)

e.) UÀ½¹zÀ CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Obtained Marks               1430




                                                                                                  ST
    (Total of all years)

f.) ±ÉÃPÀqÁªÁgÀÄ / Percentage




                                                                                               l(H
g.) ±ÉæÃt / Grade
h.) ¥ÀzÀ«AiÀÄ£ÀÄß ªÁå¸ÀAUÀ ªÀiÁrzÀ ªÀiÁzsÀåªÀÄ / Medium in Degree          Kannada




                                                                                            l
                                                                                         Ce
i.) ¥ÀzÀ«AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ ¨sÁµÉUÀ¼ÀÄ / Languages studied at degree level

      ¥ÀæxÀªÀÄ ¨sÁµÉ / First Languages                                     Kannadaon
      ¢éwAiÀÄ ¨sÁµÉ / Second Languages                                     English
j.) ¥ÀzÀ«AiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ LaÒPÀ «µÀAiÀÄUÀ¼ÀÄ / Optionals studied at degree level
                                                                            si
      ªÉÆzÀ®£Éà LaÒPÀ «µÀAiÀÄ / First Optionals                            English
                                                                 is


      JgÀqÀ£Éà LaÒPÀ «µÀAiÀÄ / Second Optional                             Political Science
                                                                m



      ªÀÄÆgÀ£Éà LaÒPÀ «µÀAiÀÄ / Third Optional                             Other
                                                       Ad




23    B.Ed / B.P.Ed Details -             1
a.) ªÀÈwÛ¥ÀgÀ «zÁåºÀðvÉ / Professional Qualification                       B.Ed
b.) GwÛÃtðgÁzÀ ªÀµÀð / Year of Passing                                     2007
                                           ed




c.) UÀjµÀ× CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Maximum Marks                1400
    (Total of all years)
                                        iz




d.) UÀ½¹zÀ CAPÀUÀ¼ÀÄ (J¯Áè ªÀµÀðUÀ¼ÀÄ ¸ÉÃj) / Obtained Marks               1132
                                  al




    (Total of all years)
e.) ±ÉÃPÀqÁªÁgÀÄ / Percentage
                            r
                         nt




f.) ±ÉæÃt / Grade
                Ce




g.) ©.ErAiÀÄ°è ªÁå¸ÀAUÀ ªÀiÁrzÀ ¨ÉÆÃzsÀ£Á «¢ü / Methods Studied in B.Ed
      ¥ÀæxÀªÀÄ ¨ÉÆÃzsÀ£Á «¢ü / First Method                                English
      ¢éwÃAiÀÄ ¨ÉÆÃzsÀ£Á «¢ / Second Method                                History


24      PG Degree Details
a.)    ¤ÃªÀÅ ¸ÁßvÀPÉÆÃvÀÛgÀ ¥ÀzÀ«AiÀÄ£ÀÄß ªÁå¸ÀAUÀ ªÀiÁrgÀĪÀgÉÃ? / Have   Yes
       you studied Post Graduation
b.)    jÃf£À¯ï E¤ì÷ÖlÆåmï D¥sï JdÄPÉõÀ£ï zÀQët ¨sÁgÀvÀ ¢AzÀ               False
       ªÀiÁ£ÀåvÉ ¥ÀqÉ¢gÀĪÀ ¸ÁßvÀPÉÆÃvÀÛgÀ r¥ÉÆèªÀÄ ªÀiÁrgÀÄ«gÁ? /
       Possess P.G Diploma from R.I.E South India
c.)   ¸ÁßvÀPÉÆÃvÀÛgÀ ¥ÀzÀ«AiÀÄ£ÀÄß AiÀiÁªÀ ¨sÁµÁ «µÀAiÀÄzÀ°è         English
      ªÀiÁrgÀÄ«j? / Mention Post Graduate degree in applied
      language
d.)   ªÀiÁ£ÀåvÉ ¥ÀqÉzÀ «±Àé«zÁ央AiÀÄ¢AzÀ r¥ÉÆèêÀiÁªÀ£ÀÄß AiÀiÁªÀ   None
      ¨ÁµÁ «µÀAiÀÄzÀ°è ªÀiÁrgÀÄ«j? / Possess any diploma in
      applied post medium (language) from recognized
      university.

      Choice
25    ²PÀëPÀgÀ £ÉêÀÄPÁwUÉ DAiÉÄÌAiÀiÁzÀ°è DzÀåvÁ£ÀĸÁgÀ f¯ÉèAiÀÄ     1.Bangalore North, 2.Chitradurga, 3.Davanagree, 4.Kolar, 5.Shimoga,
      ºÉ¸ÀgÀÄUÀ¼ÀÄ / If selected for teachers post, choice of        6.Tumkur, 7.Ramanagara
      Districts in order of preference for




                                                                                                R)
      Contact Information
26    vÁ¬ÄAiÀÄ ºÉ¸ÀgÀÄ / Mother's Name                               MEENAKSHI




                                                                                             ST
27    vÀAzÉAiÀÄ ºÉ¸ÀgÀÄ / Father's Name                              SIDDARAM




                                                                                          l(H
28    ¥Àw / ¥ÀwßAiÀÄ ºÉ¸ÀgÀÄ / Name of the Spouse                    BASAVARAJ

29    ºÉ¸ÀgÀÄ ªÀÄvÀÄÛ CAZÉ «¼Á¸À / Name and Postal Address           KAVITA W/O BASAVARAJ SHEELVANT H NO 2-909/42/1
                                                                     GREENHILLS COLONY GANESH NAGAR GULBARGA




                                                                                     l
                                                                                  Ce
30    ¦£ï PÉÆÃqï / Pin code                                          585105

31    J¸ï.n.r. PÉÆÃqï / STD Code                                     08472

                                                                     249363
32    zÀÆgÀªÁt ¸ÀASÉå / Telephone Number
                                                                           on
33    ªÉƨÉÊ¯ï ¸ÀASÉå / Mobile Phone Number                          8971756364
                                                                     si

34    E-ªÉÄïï / E-mail                                              ananya.net@gmail.com
                                                                     is


35    SÁAiÀÄA «¼Á¸À / Permanent Address                              KAVITA W/O BASAVARAJ SHEELVANT H NO 2-909/42/1
                                                                     GREENHILLS COLONY GANESH NAGAR GULBARGA
                                                                    m



36    ¦£ï PÉÆÃqï / Pin code                                          585105
                                                         Ad




37    J¸ï.n.r. PÉÆÃqï / STD Code                                     08472

38    zÀÆgÀªÁt ¸ÀASÉå / Telephone Number                            249363
                                           ed




      Payment Details
39    ZÀ®£ï ¸ÀASÉå £ÀªÀÄÆ¢¹ / Challan /Journal No.                   508693
                                        iz




40    ªÉÆvÀÛ / Amount Paid                                           420
                                  al




41    ¨ÁåAQ£À ºÉ¸ÀgÀÄ / Bank Name                                    STATE BANK OF MYSORE
                           r




42    AiÀiÁªÀ f¯ÉèAiÀÄ ¨ÁåAPï / Bank City                            GULBARGA
                        nt




43    ¨ÁæAZï PÉÆÃqï / Branch Code.                                   40702
                Ce




          Candidate's Thumb Impression                                                                      Candidate's Signature
If any of the information provided in the application form is found to be false/incorrect, the application is liable to be rejected at any point of time
and the post for which he/she is selected if any, is also liable to be cancelled at any stage and action to be taken as per law.

                                                                 DECLARATION:

         I here by declare that all the contents entered in this application are true, complete and correct to the best of my knowledge and belief. I
have read the rules and understand that in the event of any information being found false or ineligibility being detected before or after the
selection, my application is liable to be rejected. The Department (SRC) /Government can take action against me under rule 20 of the KCSR. I
have read the rules and instruction carefully and hereby undertake to abide by them. I further declare that I fulfill all the eligibility condition
regarding are, educational qualification, reservation etc. wherever applicable, prescribed for the post/examination.




                                                                                                    R)
                                                                                                                  Candidate's Signature




                                                                                                 ST
                           CAUTION : CANDIDATE SHOULD TAKE A PRINT OUT FOR HIS/HER RECORD




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