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Hsst priya 2

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            Your Application is received. It is better to keep the barcode Number for future reference
            KERALA PUBLIC SERVICE COMMISSION                    Category No
                                                                456/2010
                                                                Barcode :
                     APPLICATION FORM                           S1001780                   Barcode

Name of post : HSST (SENIOR & JUNIOR), NVT (SENIOR & JUNIOR) IN PHYSICS                  Scale of Pay: as
prescribed for the post
Department / Company/ Corporation/Board/local Authority/Co-operative Institution : KHSE & KVHSE
Gazette Date : 31/12/2010

                                                Preference-1 --: HSST - SENIOR
Your Department in the order of preference      Preference-2 --: Non. Voc. Teacher - SENIOR
                                                Preference-3 --: HSST - JUNIOR
                                                Preference-4 --: Non. Voc. Teacher - JUNIOR
1. Name with Initials (IN BLOCK LETTERS)        PRIYA GOPALAKRISHNAN
                                                TWINS MEENAMKOLLY,PULPALLY
2.(a) Address to which communications are to be WAYANAD, PULPALLY POST,673579
sent (IN BLOCK LETTERS)                         priyajithu3@gmail.com
                                                Mobile: 8891847247
                                                TWINS MEENAMKOLLY,PULPALLY
  (b) Permanent Address
                                                WAYANAD, PULPALLY POST,673579
3.(a) Date of Birth ( In figures and Words)     2/3/1984, SECOND MARCH NINETEEN EIGHTY FOUR
  (b) Sex                                       FEMALE
4. Are you eligible for communal reservation?
                                                NO
(Yes/No)
5.(a) Religion                                  HINDU
  (b) Community/Caste/tribe with sub-caste      OPEN COMPETITION,FORWARD CLASS
                                                MASTERS DEGREE IN PHYSICS, B.ED.SET PASSED,(1,)
6.(a) Educational Qualifications
                                                 WORKED AS GUEST LECTURER IN GOVT. HIGHER
  (b) Experience, if any
                                                 SECONDARY SCHOOL FOR 3 YEARS
7. (a) Name of Mother/Father/Guardian            GOPALAKRISHNAN,FATHER
       (Specify relationship)
   (b) Mother Tongue                             MALAYALAM
8. (a) Nationality
                                                 INDIAN
   (b) State, District and Taluk to which you
                                                 KERALA,WAYANAD,SULTAN BATHERY
belong
9. (a) District/Circle to which you apply
                                                 N.A.
(In the case of District wise selections)
(b) Have you applied for the post in any other
                                                 N.A.
district as per this notification? (Yes/No)
10. Are you eligible for relaxation of upper age
limit?                                             NO
if so give details

11. Are you entitled to weightage / Priority being
Sportsman/Ex-serviceman/Physically                 NO WEIGHTAGE
Handicapped?                                       NO PRIORITY
Give details

12. Are you employed on a regular basis under
State or Central Government?                       NO
Give details

13. Are you presently ineligible to apply for the
post on account of debarment by Public Service
Commission, dismissal from service or conviction NO
by a Court of Law?
Give details
                                                      DECLARATION
I hereby declare that all the particulars furnished above are correct and complete to the best of my knowledge and belief
and that I am in possession of the documents in proof of the claims made in this application.
Place : PULPALLY                                                                            sd
Date : 25/01/2011 8:50:38 PM                                                             Signature

								
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