पीएम श्री कें द्रीय विद्यालय क्रमाांक.
1 िायु सेना स्थल चकेरी कानपुर
PM SHRI KENDRIYA VIDYALAYA NO.1 AFS CHAKERI KANPUR
APPLICATION FORM FOR PART TIME / CONTRACTUAL TEACHERS/INSTRUCTORS/COACHES/EXPERTS/ DOCTOR/ NURSE
SPECIAL EDUCATOR AND COUNSELOR, ETC.- 2025-26
Important notes: 1. All entries should be in capital letters
2. Use separate form for each post.
3. Enclose attested copies of testimonials with each form. (If applied for more than one)
1. POST APPLIED SUBJECT APPLIED
Apply for any one of posts mentioned below :- (Write subject in case you have applied for the
(PGT/TGT/PRT/Computer Instructor/Coach/Experts Yoga Post of PGT / TGT)
Teacher /Doctor / Nurse/Counselor/Special Educator)
POST : SUBJECT :
2. Candidate’s Name (in capital letters) (Please keep one box blank between First name, Middle name & Last name)
3. Father’s /Husband’s Name (in capital letters) : Father Husband
4. Gender : Male / Female 5. Date of Birth:
6. Cast Category : Gen. / OBC / SC / ST
7. Age as on 31.03.2025 Year Month Days
8. Candidate’s Correspondence Address
Please affix one recent
Name : Photograph
Father/Husband’s Name :
Address :
City/Town :
State & PIN
Phone/Mobile No.
Signature of Candidate
9. Academic Qualification (Starting from High School level)
(Please give information as applicable. (Attach attested copies of Mark sheets and Certificates)
Name of Write name Board/ Year of Duration Subjects / AGGREGATE MARKS
Examination of Examination Univers passing of course Specialization Max. Marks % age
(with complete name passed ity (in months) Remarks
Marks obtained of
of course passed) marks
High School (Class X)
Intermediate (Class
XII)
Graduation
(Name of Course)
Post-Graduation
(Name of Course)
Others if any
(Specify)
10. Professional Qualification (Attach attested copies of mark sheets & certificates)
Write name Duration AGGREGRATE MARKS
Name of Examination Year
of Board/ Subjects of course %age
(with complete name of of Max. Marks Remarks
Examination University /Specialization (in of
course passed) passing Marks obtained
passed months) marks
CTET
JBT/ B.E.ED / D.E.C.Ed
(specify)
B.ED /B.ED Theory
(Nursery) /
B.Ed (Special Practical
Education)
BE/B.Tech(CS)/MBBS
Degree/Diploma in
Nursing
Other if any
(specify)
11. Experience (Attach separate sheet, if columns are insufficient)
Period of service No. of
Name of Class Scale of pay and
Post completed Subjects taught Remarks
Institution From To taught salary per month
months
12. For teaching posts:-
a. Are you able to teach in English and Hindi medium? YES NO
(Please mark √ tick in the appropriate box)
b. Do you have knowledge of computer applications? YES NO
(Please mark √ tick in the appropriate box)
UNDERTAKING
I hereby certify that all the information given above is true and correct to the best of my knowledge. I
have attached attested copies of my testimonials in support of the entries made above. I also agree that
mere eligibility does not confer right to be called for interview/selection. My candidature may be
cancelled in case any information is found to be incorrect on verification.
Date: Signature:
Place: Name:
Contact No.
For office use
Eligible / Not Eligible
Merit point (if any) Signature of the verification committee member
Experience points (if any) Name of the verification committee member
