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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 :
SUBJECT OPTED IN PGT
CHEMISTRY

14006079
DATE OF BIRTH
(DD/MM/YYYY) 7/7/1983 (Middle Name)

POST CODE

QUALIFICATION CODE
04 (First Name)

CATEGORY
(GENERAL/ SC/ST/OBC) ST

GENDER
(Male/Female) MALE (Last Name)
YEAR

AGE AS ON
MONTH DAYS

14

27

23

1 . Candidate Name 2 . Father's/Husband's Name 3. Choice of Examination City


I Preferrence Name of City BANGALORE City Code 03

RANGANATHA THIPPESWAMY G

4. Area Code (For remote area and Abroad)


II Preferrence

if Yes, YES/NO
City Code 07

Name of City CHENNAI

Name of Area No NOTAPPLICABLE

Code 00

5. Sub-Category
SUB-CATEGORY- I (Physically Challanged)

Visually Hearing Locomotor/Orthopaedically Challenged Challenged challenged

If Physically Challenged, please indicate whether Guide/Scribe is required at the Examination Centre (write : Yes/No)

SUB-CATEGORY-II

KVS Regular Employee No

In Govt. Regular Service No 6.

Resident of State Of J&K (Domiciled During 1.1.80 to 31.12.89) No

No

No

No

No

Ex-servicemen Self No Dependent No

To be filled only if candidate himsellf/herself is Ex-Servicemen

Joining Date ------

Retirement Date ------

Total Service ------

Are you able to teach through English & Hindi, both Yes

7. Candidate Address Name Father/Husband Address : : : RANGANATHA T

THIPPESWAMY G RANGANATHA T S/O THIPPESWAMY G NANJAYYANA KOTTIGE HIRIYUR TALUK HIRIYUR


KARNATAKA

Please affix one recent photograph

City State

: :

Pin Code : Tel. No. Mobile No.

572143

Contact Details : STD Code Email ID. rnbiochem@gmail.com

9663522156 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.)

9. Academic Qualification
Name of Examination Passed(write complete name of course passed as on 30.11.2010)

Registration Number:
Aggregate marks Year of passing Max. Marks Marks Obtained %age of marks Subjects Studied Duration of course (in months)

14006079

Name of Examination

Board / University

Senior Secondary (Class-XII) Graduation/ Diploma Post Graduation

SENIOR SCHOOL CERTIFICATE EXAM B.SC

2001

500.0

298.0

59.60

PHYSICS, CHEMISTRY, BIOLOGY

12

C.B.S.E

2004

2200

1419

64.50

CHEMISTRY, BOTANY, ZOOLOGY

KUVEMPU UNIVERSITY 36 24 KUVEMPU UNIVERSITY

M.Sc.

2006

2200

1360

61.81

Bio-Chemistry

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 Father/Husband Address : : : RANGANATHA THIPPESWAMY G RANGANATHA T S/O THIPPESWAMY G NANJAYYANA KOTTIGE HIRIYUR TALUK T Please affix one recent passport size Photograph with attestation

City State

: HIRIYUR :
KARNATAKA

Pin Code

572143

********************************************************************************************* 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

Experience Sheet

Registration

14006079

1 . ASSISTANT TEACHER Post Held Name of Institution : ASSISTANT TEACHER : V.C.V.R

Whether Recognized

: YES

Period of Service No. of Completed months Scale of pay and salary per month Subject and Classes taught

: From : 5.0 : 8000

28-May-10

To 23-Nov-10

: CHEMISTRY, PHYSICS

Signature of Candidate