ANNEXURE-V

JAWAHAR NAVODAYA VIDYALAYA

___________________ Distt.___________________
FORMAT FOR PGTs/ TGTs/ Music/Art/ Librarian/ PET(M/F) & FCSA
ETC. FOR EMPANELMENT OF TEACHERS PURELY ON
CONTRACT BASIS FOR THE SESSION 2017-2018

PART-I

1 Application for the post of : ___________________________(on contract basis)

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

3. E-Mail Address : ____________________________

Paste Latest
4. Name : ____________________________ passport size
photograph
5. Fathers Name : ____________________________ of applicant

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

As on 15.06.2017 ___________Yrs._________Months___

7. Full Address for : ____________________________

Communication
____________________________

8. Home District : ______________________________________

9. Category to which belong :- : ______________________________________

Gen/SC/ST/PH/OBC/Navodaya Spouse

10.In case of Navodaya Vidyalaya Spouse, give full details:

A. Name of spouse : ______________________________________

B. Post Held : ______________________________________

C. Place of Posting : ______________________________________

11. Education Qualification :

S. Course of Study Max. Marks Marks % age of
No Obtained marks
.
A) FOR PGTs/TGTs
1
10th SSC (For all the candidates)
2
12th HSC (For all the candidates)
3 Graduation
(Please Specify)
4 Post Graduation in the subject
(Mention Subject)
5 B.Ed. (Theory & Practical)
B.PED/D.PED.
6 CTET conducted by CBSE (Mention
if qualified only ) (Only for TGTs)

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 7 M.Phil/Ph.d. (For all)
(Kindly enclose proof in respect of conversion of grades into marks) Specify Graduation/Post Graduation etc. with
subjects, if requiring in the additional rows.

(B) Co-Scholastic achievement:

1. Representing National/SGFI in Sports and Games Attach copy of certificate

2. Representing State/University/Region in Sports and Attach copy of certificate
Games
3. Representing Distt. in Sports and Games Attach copy of certificate
4. NCC C / B / A Certificate Attach copy of certificate
5. NSS Attach copy of certificate
6. Scout & Guide President award/Governors Attach copy of certificate
Award.
7. Certificate of performance awarded by Govt. Attach copy of certificate
Institution in Art/Music/Literature at National
level
8. Certificate of performance awarded by Govt. Attach copy of certificate
institution in Art/Music/Literature at State Level
9. Teaching experience in day school/Residential Attach copy of certificate
(In a Govt. Semi.Govt., Aided Schools only)
A. Only for TGT(Mathematics)
Ist year IInd year IIIrd year Total Maxi
Course Subject %age Subject %age of Subject %age Marks mum Total % Remarks
of offered of offered marks offered of obtained Marks of marks
study marks obtaine marks (all years allowe
obtaine d obtain together) d (all in degree
d ed years
togeth
er)
B.Sc. 1 Maths Maths Maths Attach copy of
2 Physics Physics Physics mark sheet of
3 Chemistry Chemistry Chemistry B.Sc-I,II & III

Total

B. Only for TGT (Science)

Ist year IInd year IIIrd year Total Maxim
Course Subject %age of Subject %age of Subject %age of Marks um Total % Remarks
of offered marks offered marks offered marks obtained Marks of marks
study obtained obtaine obtaine (all years allowe
d d together) d (all
in degree
years
togethe
r)
B.Sc. 1 Chemistry Chemistry Chemistry
Attach copy of
2 Botany Botany Botany
mark sheet of
B.Sc-I,II & III
3 Zoology Zoology Zoology

Total

C. Only for TGT (Social Studies)

Ist year IInd year IIIrd year Total Maximu
Course Subject %age of Subject %age of Subject %age Marks m Marks Total % Remarks
of offered marks offered marks offered of obtained allowed of marks
study obtaine obtaine marks (all years (all years
d d obtain together) together) in
ed degree
Attach copy of
mark sheet of
B.A. 1 History History History B.A. I,II & III
2 Geography Geography Geography

3 Economics Economics Economics

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 4 Pol. science Pol. science Pol. science
Total

D. Only for TGT(English)

Course Subject Ist year IInd IIIrd Total Maximum Total % Remarks
of year year Marks Marks (all of marks
study %age of %age of %age of obtained years together) in degree
marks marks marks (all years
obtained obtained obtained together)
B.A. 1 Eng. Attach copy of mark
Elective sheet of
B.A.-I, II and III

E. Only for TGT(Hindi)

Course Subject Ist year IInd IIIrd Total Maximum Total % of Remarks
of year year Marks Marks (all marks in
study %age of %age of %age of obtained years degree
marks marks marks (all years together)
obtained obtained obtained together)
B.A. 1 Hindi Attach copy of
Elective mark
sheet of
B.A.-I, II and III

F. Only for TGT(Gujarati)

Course Subject Ist year IInd IIIrd Total Maximum Total % Remarks
of year year Marks Marks (all of marks
study %age of %age of %age of obtained years in degree
marks marks marks (all years together)
obtained obtained obtained together)
Gujarati Attach copy of
Elective mark
B.A. 1
sheet of
B.A.-I, II and III

H. Only for TGT(Marathi)

Course Subject Ist year IInd IIIrd Total Maximum Marks Total % Remarks
of year year Marks (all years of marks
study %age of %age of %age of obtained together) in degree
marks marks marks (all years
obtained obtained obtained together)
B.A. 1 Marathi Attach copy of
Elective mark
sheet of
B.A.-I, II and III

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S. Course of Study Max. Marks % age
No Marks Obtaine of
. d marks
I) FOR PGT (IT)
1 BE or B.Tech.(Computer Science/IT)
2 BE or B.Tech. (any stream) and Post
Graduate Diploma in Computers from
any recognized University.
3 M.Sc. Computer Science/MCA
4 B.Sc. Computer Science/BCA and
Post Graduate Degree in any subject
from a recognized university
5
Post Graduate Diploma in Computer
and Post Graduate Degree in any
subject from a recognized University.
6 A level from DOEACC & Post Graduate
Degree in any subject.
J) FOR PET (MALE/FEMALE)
1 Bachelor degree in Physical Education
(B.PEd.)
2 Post Graduation in Physical Education
(M.PEd.)
3 BA/B.Sc./B.Com.
4 D.P.Ed. (one year)
K) FOR ART TEACHER
1 5 years recognized Diploma in Fine Art
2 Graduate with Fine
Arts/Drawing/Painting/Sculpture
3 B.Ed. (Theory & Practical)
4 MA (Drawing and Painting, Fine Arts
from a recognized University
L) FOR MUSIC TEACHER
1 BA with Music
2 Post Graduation in Music
3 B.Ed. (Theory & Practical)
4 Sangeet Visharad/Sangeet Bhushan.Nritya
Visharad or the recognized equivalent in
Southern states
5 Sangeet Bhaskar/Nritya Bhushan Nritya
Visharad or the recognized equivalent in
Southern States
6 Graduation.
M) FOR LIBRARIAN
1 BA/B.Sc./B.Com
2 Degree/Diploma in Library Science

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12. Experience in Govt. Residential/Day Schools, Semi Govt. Aided School/Unaided.
In case of private recognized/unaided schools, experience certificate should be counter
signed by DEO.

S.No. Name of the Duration Total Period

Institution
From To Years Months

Total Experience : ___________ Years.

(to be rounded off in completed years and months should be ignored)

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.

Date:
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 OS/DEALING ASSISTANT/VERIFYING COMMITTEE

Name & Designation
Date: