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					                                                            To be Written by Verification Team :
                                                            Board No.______             Application Sr.No.________


                                 NAVODAYA VIDYALAYA SAMITI
                      (REGIONAL OFFICE), Bay No.26-27, Sector-31-A, CHANDIGARH

                                                   PART-I                        BIO-DATA

1A. Application for the post of            :           ___________________________(on contract basis)
 B. Date of Interview                      :           _____/07/2011

2. Tel.No. (with STD Code)/Mobile no.:                 ____________________________

3. Name                                        :       ____________________________               Paste Latest
                                                                                                  photograph
4. Father’s/Husband Name                       :       ____________________________               here

5. Date of Birth (DD/MM/YYYY)                  :       ____________________________

6. Full Address for                            :       ____________________________
  Communication
                                                       ____________________________

7. Home District                               :       ______________________________________

8. Preference of state for Positing            :       ______________________________________
   (J&K, Punjab, HP State)

9. Category to which belong :-   :                     ______________________________________
   Gen/SC/ST/PH/OBC/Departmental
   Candidate/Navodaya Spouse

10.In case of Navodaya Vidyalaya Spouse, give full details:
    A. Name of spouse               :       ______________________________________

     B. Post Held                              :       ______________________________________

     C. Place of Posting                       :       ______________________________________

11. Educational Qualification:
S.     Course of Study                                 Max. Marks          Marks         % age of marks
No.                                                                        Obtained
1.       10th
2.       12th
3.       Graduation (BA/B.Sc.)
         (Others Please specify)
4.       Post Graduation in the subject
5.       B.Ed. (Theory & Practical)
(Kindly enclose proof in respect of conversion of grades into marks.                       P.T.O….2
                                                                  :: 2 ::
A. Only for TGT(Mathematics)
                        Ist year                 IInd year                   IIIrd year             Total         Maximum
   Course       Subject         %age       Subject         %age of       Subject         %age       Marks         Marks
   of           offered         of         offered         marks         offered         of         obtained      allowed
   study                        marks                      obtaine                       marks      (all years    (all years
                                obtaine                    d                             obtain     together)     together)
                                d                                                        ed
                Maths                      Maths                         Maths
   B.Sc.    1
                Physics                    Physics                       Physics
            2
                Chemistry                  Chemistry                     Chemistry
            3

B. Only for TGT (Science)
                        Ist year                 IInd year                    IIIrd year             Total        Maximum
   Course       Subject        %age of     Subject         %age of       Subject         %age of     Marks        Marks
   of           offered        marks       offered         marks         offered         marks       obtained     allowed
   study                       obtained                    obtaine                       obtaine     (all years   (all years
                                                           d                             d           together)    together)
                Chemistr                   Chemistry                     Chemistry
   B.Sc.    1   y
                Botany                     Botany                        Botany
            2
                Zoology                    Zoology                       Zoology
            3

C. Only for TGT (Social Studies)
                          Ist year                   IInd year                   IIIrd year          Total        Maximum
   Course       Subject         %age of     Subject         %age of       Subject         %age       Marks        Marks
   of           offered         marks       offered         marks         offered         of         obtained     allowed
   study                        obtaine                     obtaine                       marks      (all years   (all years
                                d                           d                             obtain     together)    together)
                                                                                          ed
                History                     History                       History
   B.A.     1
                Geography                   Geography                     Geography
            2
                Economics                   Economics                     Economics
            3
                Pol. science                Pol. science                  Pol. science
            4

D. Only for TGT(English)
   Course        Subject        Ist year        IInd             IIIrd           Total            Maximum
   of                                           year             year            Marks            Marks (all
   study                        %age of      %age of         %age     of         obtained         years
                                marks        marks           marks               (all years       together)
                                obtained     obtained        obtained            together)
                Eng.
   B.A.     1   Elective


E. Only for TGT(Hindi)
   Course        Subject        Ist year        IInd             IIIrd           Total             Maximum
   of                                           year             year            Marks             Marks (all
   study                        %age of      %age of         %age     of         obtained          years
                                marks        marks           marks               (all years        together)
                                obtained     obtained        obtained            together)
                Hindi
   B.A.     1   Elective


F. Only for TGT(Punjabi)
   Course        Subject        Ist year        IInd             IIIrd           Total             Maximum
   of                                           year             year            Marks             Marks (all
   study                        %age of      %age of         %age     of         obtained          years
                                marks        marks           marks               (all years        together)
                                obtained     obtained        obtained            together)
                Punjabi
   B.A.     1   Elective


                                                                                                                               P.T.O….3
                                                         ::- 3 -::

G. Only for TGT(Urdu)
      Course        Subject    Ist year    IInd         IIIrd        Total        Maximum
      of                                   year         year         Marks        Marks (all
      study                    %age of    %age of     %age     of    obtained     years
                               marks      marks       marks          (all years   together)
                               obtained   obtained    obtained       together)
                   Urdu
      B.A.     1   Elective




14.      Experience in Govt. recognized/                             Duration                     Period
         CBSE/ICSE Affiliated Schools                           From        To                  From     To
         i)     Day School                                      ______     _______             ______ _____

          ii)     Residential School                            ______            _______      ______   _____
15.       Participation in sports :
          National /                                 Yes/No.         _________
          State / University                         Yes/No.         _________

        I solemnly undertake that in the event of my appointment on contractual basis in
the samiti, my services are liable to be terminated without notice if any of the foregoing
information furnished by me in my application form is found to be wrong or suppressed. I
further understand that this appointment is purely on contract and does not confer the
right for regularization.

Dated:                                                                   SIGNATURE OF CANDIDATE

                              PART – II        CERTIFICATE (For office use)

        Certified that I have scrutinized personally the information in Part – I above with
originals and found it to be in order. Candidate is eligible for the post.

                                                                             SIGNATURE OF THE DEALING ASSISTANT

				
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