KENDRIYA VIDYALAYA SANGATHAN

18, Institutional Area, Shaheed Jeet Singh Marg

New Delhi - 110602
RECRUITMENT OF POST GRADUATE TEACHERS IN KVS FOR THE YEAR 2011-2012

Registration Number : 14007623

SUBJECT OPTED IN POST CODE QUALIFICATION CATEGORY DATE OF BIRTH GENDER AGE AS ON
PGT CODE (GENERAL/
(DD/MM/YYYY) (Male/Female) YEAR MONTH DAYS
SC/ST/OBC)

CHEMISTRY 14 04 OBC 10/11/1982 FEMALE 28 0 20

(First Name) (Middle Name) (Last Name)
1 . Candidate Name DOLLY SINGH
2 . Father's/Husband's Name BIJENDRA SINGH

3. Choice of Examination City 4. Area Code (For remote area and Abroad)

I Preferrence II Preferrence if Yes,

YES/NO
Name of City City Code Name of City City Code Name of Area Code

DELHI 09 LUCKNOW 18 No NOTAPPLICABLE 00

5. Sub-Category
SUB-CATEGORY- I (Physically Challanged) If Physically Challenged, please SUB-CATEGORY-II
indicate whether Guide/Scribe is
Visually Hearing required at the Examination In Govt. Resident of State Of J&K
Locomotor/Orthopaedically KVS Regular
Challenged Challenged
challenged Centre (write : Yes/No) Regular (Domiciled During 1.1.80
Employee
Service to 31.12.89)
No No No No No No No

Ex-servicemen To be filled only if candidate himsellf/herself is Ex-Servicemen 6. Are you able to teach
through English & Hindi, both
Self Dependent Joining Date Retirement Date Total Service

No No ------ ------ ------ Yes

7. Candidate Address

Name : DOLLY SINGH

Father/Husband : BIJENDRA SINGH

Address : D/O NAND KISHORE SINGH
SHIV SHAKTI BARAT GHAR Please affix one recent
NEAR - DEGREE COLLEGE photograph

City : PILIBHIT

State : UTTAR PRADESH Pin Code : 262001

Contact Details : STD Code Tel. No.

Email ID. prayaas_pbt@yahoo.co.in Mobile No. 9368369523
Signature of Candidate

8. Details of fee paid through Electronic Transfer

UTR No./Journal No. Date Name Of Bank Branch Address Branch Code Amount(Rs.)

0
 Registration Number: 14007623
9. Academic Qualification

Name of Aggregate marks

Examination Duration of
Name of Passed(write Year of
complete name of
Subjects Studied course (in Board / University
Examination passing Max. Marks Marks %age of
course passed as on months)
Obtained marks
30.11.2010)

Senior INTERMEDIATE 2001 500.0 301.0 60.20 PHYSICS,BIO,CHEMIST 24 CBSE,DELHI

Secondary RY,COMP,ENG

(Class-XII)
Graduation/ B.SC. 2004 1350 966 71.56 BOTANY,CHEMISTRY MJPRU,BAREILLY
Diploma 36

Post M.Sc. 2006 1000 637 63.70 Chemistry 24 MJPRU,BAREILLY

Graduation

Other if
any(specify)

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

A Separate Experience sheet is attached in next page (in case of any experience).
11. Permanent address

Name : DOLLY SINGH

Father/Husband : BIJENDRA SINGH Please affix one recent

Address : D/O NAND KISHORE SINGH passport size
SHIV SHAKTI BARAT GHAR Photograph with
NEAR - DEGREE COLLEGE attestation

City : PILIBHIT
State : UTTAR PRADESH Pin Code : 262001
*********************************************************************************************
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.

Place :

Date : Signature of Candidate