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PART-I.

APPLICATION FOR THE POST OF POST GRADUATE TEACHER IN

PROVI NCIALISED H IGHER SECON DARY SCHOOLS.

Colored Photo

THE PRINCIPAL

POST APPLIED FOR

1, NAME OF THE APPLICANT

2 FATHER'S/MOTHER'S/H USBAN D'S NAM E

3 MALE/FIMALE
4 PRESENT ADDRESS OF COMMUNICATION WITH
CONTACT NUMBER

5 PERMANENT ADDRESS

6 ARE YOU A CITIZEN OF INDIA? IF SO, HOW

7 CATEGORY OF CASTE 1. General, 2. OBC/MOBC, 4.

ST (P), 5. ST(H), 6. SC,7 PWD (person with
disability) attach a copy of certificate from the
competent authority (where necessary).

8 Are you presently employed? lf yes, attach a copy

of NOC from your employer or Head of office.

9 Date of Birth as per HSLC pass Certificate.

10 Age on 01-01-2019..

1,1 Educational Qualification- M.A/M.Com/wt. Sc (ln

Subject. Professional Qualification B. Ed/B.T
(furnish the name of lnstitution. Also give full
details of qualification in appropriate boxes in
Pa rt-l I )

12 Do you have NCC Certificate? lf yes, mentioned

the grade. (Attach a self attested copy of the
certificate ).
13 Did you have Assamese/Hindi/Aengali as MIL at 1. Assamese at HSLC.
the HSLC level or equivalent Certificate/Diploma ? 2. Bengali at HSLC.
lf yes, tick the appropriate Sl. 3. Hindi at HSLC.
4. Other
 Part- ll

Educational Qualification: Please insert information correctly:-

SI Examination Year of University/Boa rd Grade/Division Pass percentage

pass of marks.
1. HSLC Exam

? HSSLC Exam

3 B.A/B.Sc/B.Com Exam

4 M.A/M.Sc/M.Com Exam

5 B.EdlB.T Exam (Name of

University, if NCTE
Recognized the lnstitution,
mentioned the year of
Recognition )

6 TET Name of TET Marks secured Paper-1=

in Paper-ll=

Other Qualification :

1,. NCC.

2. Representation of State in Cultural and Sports events :

Full Sienature of the Applicant.

Declaration :

l, do hereby declare that the information provided in my application form is true and nothing has

been concealed. lf it is proved otherwise my candidature for the post is liable to be cancelled.