Executive Office : 101, Chattashory Road, Chawkbazar, Chittagong.

Phone: 031-2868800; 01715-900004

Application for the post of ........................................................................ in the Department of ........................................................................

1. Name (in Bengali) : ..................................................................................................................................... Surname : .............................................................
Name (in English) : ...................................................................................................................................... Surname : .............................................................
2. Mothers Name : .............................................................................................................................................. Occupation : ......................................................
3. Fathers Name : ................................................................................................................................................ Occupation : .......................................................
4. Permanent address : .....................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................................................

5. Mailing address : ..............................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................................................................................

6. Date of birth : ............................... Age (As on 11 Nov 2012) : ..................... Years, ............................ Months, ............................. Days
7. Nationality : .................................................................. Religion : .................................................................... Blood Group : ....................................................
8. Marital Status : ................................................................ Name of spouse (if married) : ..................................................................................................
9. National I D Card no / Passport no : ................................................................................................................................................................................................
10. Telephone no : .................................................................................................... E-mail(if any) : ......................................................................................................
11. Educational Qualifications:
Name of Exam

Group/
Subject

Institutions and
Board/University

Passing
Year

Remarks

Result
(Division/ Class/
GPA)

SSC
HSC
Bachelor Degree
Masters Degree

12. Non Govt. Teachers Registration and Certification (NTRC): No. .............................................................
Subject

Total Marks

Year

Remarks

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13. Extra Academic Qualification (s):

.........................................................................................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................................................................................

14. Training:
15. Previous experience in any field:
16. Language skill: (Excellent/Good/Moderate/ None)
Language
Bengali
English
Arabic

Listening

Speaking

Reading

Writing

17. Computer Skill:

Typing Skill (MS Word)

: a) Bengali............................... b) English ...............................

Spread Sheet (MS Excel)

Presentation (Power Point)

Any other (Acct/Database etc.):

18. Publication(s) :
.........................................................................................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................................................................................

19. If parent is a Freedom Fighter: Yes / No

20. Bank Draft /Pay-order No. ..................................................Amount:.............................................. Date: .........................................
Bank Name: ....................................................................................................................................................................................................................................

21. Declaration
a. All information and data given above are true.
b. I was convicted / not convicted of any criminal charges previously. (tick as applicable)
c. I am involved / not involved in any criminal charges which is/are under investigation. (tick as applicable)
d. I was / was never an active member of any extremist/terrorist group. (tick as applicable)
e. I am not suffering from any contagious disease.
I am aware that, if any information provided above and documents & certificates attached are found to be
untrue, false or fake, the school authority may reject this application or terminate my employment at any
time. For any falsehood I may face legal actions as well.
________________________________________________
Signature with date
Note :
A.

Please enclose attested copies of all qualification certificates, mark sheets, two recent passport size photographs, Experience
Certificate, permission letter from present employer, Nationality & Character Certificate, Freedom Fighter Certificate etc. (as
applicable) and use extra paper if necessary.
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