8/8/2019 Application%20Form[1]

http://slidepdf.com/reader/full/application20form1 1/2

8/8/2019 Application%20Form[1]

http://slidepdf.com/reader/full/application20form1 2/2

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

200848

5000 2950 UPTU LUCKNOW59.00B.TECH. IT

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

SHRAWAN KUMAR

RAMHIT RAM

GOVT. COLONY ROOM NO-D-81

RAEBARELI

RAEBARELI

229001UTTAR PRADESH

Comp.Sc./IT

48.40 122001 PCM UP BOARD500.012TH 242.0

21002684Registration Number:

Diploma

(Class-XII)