DEPARTMENT OF SCHOOL EDUCATION   Affix Recent
                                        KRISHNA DISTRICT          Passport Size
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                                 PROFILE OF -                         Here

Treasury I.D Number
Teacher Name
Employee ID(eg 111-05047598-111)
School Name
Mandal Name

Division Name
Name of the Father
Date of Birth(as in SR)
Present Designation
Post Subject
Post Medium
Handling Classes
Handling Subject(s)
Mobile Number


Detailed Sub Caste Name
Local/Non Local
Appointment Mode(direct/ promotee /compassinate)
If Promotee..Proceding Number
If Direct Year of DSC
Hall Ticket Number

DSC Rank
First Appointed Management

Present Working Management
Date of Join in Present Cadre

If Special VV Date of Join as SPLVV
If Special Teacher Date of Join as SPL Teacher

Date of Absorption in the Present Cadre

Date of Regularization in the Present Cadre
Antecedents Verified (Y/N)
Any advderse report (Y/N)
Whether came to the district on IDT
If IDT Yes. District which came on IDT

If IDT Yes. date on which came on IDT
                                                   Page 1 of 4
Whether 610 G.O Affects?
If 610 G.O Yes Date of Join in the District

if 610GO- Yes District from which came on 610 GO
Whether continue on court case in the dist. under 610 GO

Whether continue on spouse case in the dist. under 610 GO

Whether continue on permission from C&DSE under 610 GO

Local District as per Study

Local District as per Service Register

Whether Physically Challenged                                   Yes/No
If PHC Yes.. Type of PHC                                        Visual/Hearing/Ortho

Whether Selected Under PHC Category in DSC                      Yes/No

Percentage of PHC

                                              LOWER CADRE DETAILS(FOR S.A & H.M)
Post Name(SGT or Equivalent)
Hall Ticket Number(SGT or Equivalent)
DSC Rank(SGT or Equivalent)

First Appointment Management(SGT or Equivalent)

Date of Appointment(SGT or Equivalent)

Date of Absorption(SGT or Equivalent)

Date of Regularisation(SGT or Equivalent)

Name of the Post(SA or Equivalent
Subject(SA or Equivalent)

Hall Ticket Number(SA or Equivalent)

DSC Rank(SA or Equivalent)

Appointed Management(SA or Equivalent)

Date of Appointment(SA or Equivalent)

Date of Absorption(SA or Equivalent)

Date of Regularisation(SA or Equivalent)

                                                 PROMOTION REJECTED DETAILS
Promotion Rejected Previously(Y/N)
Promotion Rejected Post Name
Promotion Rejected Subject

Promotion Rejected Year

Reasion for Rejection
                                                            Page 2 of 4
                                             ACADEMIC QUALIFICATIONS
                  Period    Passed        Board/                          Subject
Qualifications                                             Subject 1                  Sub 3      Sub 4    Max       Secured     % Per     Medium
                 of Study    year        University                         2

Note: Please write Degree/PG Name like B.A./B.Sc./B.Com/M.A./M.Sc etc.,

                                         PROFESSIONAL QUALIFICATIONS
                  Period     Passed     Board/
Qualifications                                        Subject 1    Subject 2        Sub 3     Sub 4      Max        Secured     % Per     Medium
                 of Study     year     University

                                       DEPARTMENTAL QUALIFICATIONS
   DEPARTMENTAL TEST NAME                    YEAR OF PASSING                        HALL TICKET NO.                  GAZETTE MON & YEAR

                                  DISCIPLINARY CASES / LOSS OF PAY DETAILS
  Suspended         Suspension from     Suspension to         Loss of Pay           Date form LOP     Date to LOP      Cause for suspension / LOP

                                                                  Page 3 of 4
                              PREVIOUSLY WORKED SCHOOLS HISTORY
                                                                                               Worked from      Worked to
Sl.No.         Name of the School with DISE Code           Name of the Mandal and District
                                                                                             (DD/MM/YYYY)    (DD/MM/YYYY)

                                            SSC HANDLING DETAILS
                                                   Name of the Mandal and                      Worked from      Worked to
Sl.No.      Name of the School with DISE Code                                    Subject
                                                          District                           (DD/MM/YYYY)    (DD/MM/YYYY)

                                                   ADDRESS DETAILS
                        PERMANENT                                                            PRESENT

                                    DECLARATION BY THE TEACHER

       The particulars shown above are genuine. If found wrong I am liable any action taken by the
concerned authorities.

                                                                                      Signature of the Teacher

         Verified with regard to the Service Register of the concerned teacher

                                                                 Signature of the MEO/Headmaster/Headmistress

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