Vous êtes sur la page 1sur 13

UNIQUE APPLICATION NO.

(FOR OFFICE USE ONLY)

Employee Code No.

(Strike out whichever is not applicable)


KENDRIYA VIDYALAYA SANGATHAN
APPLICATION FOR TRANSFER ON REQUEST 2009-2010
Note 1 : Read instructions carefully before filling up.
2: Submit only ONE application in QUADRUPLICATE for Inter Regional and in TRIPLICATE for Intra Regional.

PRESENT REGION PRESENT STATION PRESENT K.V. CODE/ SHIFT POST HELD & SUBJECT
CODE CODE OFFICE CODE (ALPHABETS)

1. Name

1(a) Title : Shri/Smt./Miss:

2. Whether Male/Female (M/F)

3. Date of birth (DD/MM/YYYY)

4 (i) Date of appointment in the present post

(ii) Date of joining in the Present Post:

a.) In the present vidyalaya

b.) In the present station

c) In Priority areas (applicable for those posted in


North Eastern Region/A&N Islands
Hard Station/Very Hard Station., for cases of combined stay
in conjuction with present posting only)
5. Details of last transfer/posting
From

Reason Code (See Year


instruction at Sl.No.5 at
page No.10) Stn. Code KV Code

6. Grounds for seeking Transfer - PRIORITY CATEGORY FOR GRANT OF REQUEST TRANSFER(PCGR)

a) Medical Grounds (See Instructions) (Y/N)


(Please see page 10)
b) (i) Death of Spouse within a period of 2 years as on
31.03.2009(Y/N)
(ii) If Yes, Date of Demise
(DD/MM/YYYY)

c) Less than three years to retire (LTR) ground (Y/N)


(due to retire on or before 31.03.2012)
(i) Date of retirement
..2..
d) Person who have completed their tenure in
Priority areas (Y/N) (Applicable in case of present stay alone and
combined stay in conjuction with present posting.)

e) Others (See instructions for following Codes):

Category Code Division Code Entitlement Points Applicable


(Y/N)

(i)* V H S 0 4 4 0

(ii)* N E H 0 5 3 0

(iii) P C E 0 6 2 0

(iv) P W S 1 0
(see instructions for division code)

(v) L N S 0 7 1 5

(vi) S P S 1 3
(Please fill-up if applicable)
(vii) L A H 1 4 1 0

Total :

7. For Office Use only(To be filled in by Regional Office)

A) Whether ‘MDG’ grounds accepted by Regional Medical Board (Y/N)

B) Case of DSP verification done( whether accepted/not accepted) (Y/N)

C) Case of LTR verification done( whether accepted/not accepted) (Y/N)

D)* Whether Person completed tenure in Priority areas verification done (Y/N)
(Cases of present stay alone and combined stay in conjuction with present posting.)

Dated Signature of Assistant Commissioner

Note: 1. MDG/DSP/LTR /VHS/HS/NER verification certificate may kindly be filled up at RO level properly. It should be ensured
that only accepted cases are to be indicated as ‘Y’ and not accepted as ‘N’ specifically.
2.* As regard completion of tenure in priority area crucial date as per office memorandum No.F.11-19/2004-KVS
(Admn.-I) dated 26.03.2007, 17.07.2008 and 22/25-08-2008 for inclusion/deletion of Hard/Very Hard Station in the
existing list may be kept in mind for allotment of entitlement points.
3. No entitlements points for PWS in /case of self employment of spouse.
..3..

8. Choice Vidyalaya(s) or Station(s)

Instructions : Employees are eligible to apply either for Intra Station or Inter Station (within the Region) Sl.No. 8.1/8.2 OR
Inter Region Transfers (outside the Region) Sl.No. 8.3 . Applications filled in for more than one type of transfers i.e. Sl.No.
8.1, 8.2 and 8.3 will be summarily rejected.

8.1 For Intra Station transfer – Choice Vidyalayas K.V./ Office Code
[within the same station (within the Region)]
(Please see instructions)

8.2 For Inter Station transfer – Choice Stations STATION Code


[from one station to another ( within the Region)]
(Please see instructions)
(The teacher/employee coming under PCGR Category
except MDG/DSPshall have to indicate five choices of different

stations where post of that category has been sanctioned)

8.3 For Inter Region transfer – Choice Stations STATION Code


[from one station to another (outside the Region)]
(Please see instructions)
(The teacher/employee coming under PCGR Category
except MDG/DSP shall have to indicate five choices of
different stations where post of that category has been
sanctioned)

9. Category of place where spouse is working

10. Have you given the declaration regarding the


Employment and place of posting of spouse (Y/N)

11. Have you obtained a MC on the form (Y/N)

12. Type of disease certified in the MC overleaf Please fill up code

13. Relationship of the patient with the applicant Please fill up code
(Please see instructions at page No.12 for filling
codes in Sl. No.9,11& 13)
..4..

I, Shri/Smt./Kum .______________________________S/o W/o D/o _________________________do hereby affirm that the


information given in Sl.No. 01 to 13 excepting Sl.No.7 of this application are correct and that the medical certificate (M.C.)/declaration
given is/are bona-fide and I understand that wrong/suppressed information shall render me liable for disciplinary action.

Place: Signature:

Date: Name :

Remarks: Principal of the Vidyalaya in which the applicant is working should state:

a) Whether the teacher/staff member is working in excess to the sanctioned staff strength in the Vidyalaya State Yes/No (Y/N)

b) Whether the teacher/staff member has completed tenure


In Priority Areas i.e. NER (including Sikkim)/A&N Island/Hard Station/Very Hard Station
(Cases of present stay alone and combined stay in conjuction with present posting.) (Y/N)

If Yes, number of completed years

Signature of the Principal with seal


..5..
MEDICAL CERTIFICATE

( To avoid disqualification, please do NOT use abbreviation. Fill in with CAPITAL LETTERS only. Please do not attach any enclosure
except where specifically asked for)
Name of Patient :
Relation of patient with the employee(self/spouse/son/daughter) :
Address :
Date :

I, Dr. ___________________________________ with Medical Council Registration No. _____________hereby certify that
Shri/Smt./Ms ______________________________ aged_____Sex ________ son/ daughter/wife/husband of Shri/Smt
_______________________ (name of KVS teacher/employee) is suffering from the disease/diseases with the details as follows and that
treatment of this disease is not at all available at this station or its vicinity:

A. In Case of Carcinoma :
1. Name of Carcinoma with site effected:
2. Date when it was detected first :
3. Brief Histo-Pathological Report with reference no. & dates :
4. T.N.M. Classification (if applicable) :
5. Evidences in support of uncontrolled growth :
6. Evidences in support of Metastasis :
7. Condition of neighboring or surrounding structures :
8. Treatment being continued in brief :
9. Full name of Surgery/Surgeries in connection with dates :
B. In case of Renal Failure :
1. Name of the disease causing Renal Failure :
2. Evidences in support of Chronic Irreversible changes :
3. Number of Dialysis done with dates :
4. Single or both kidneys are involved :
5. Any surgery including Renal Transplantation done or not :
C. In Case of Loss of Muscle Power:
1. How many extremities are affected :
2. Grading of Muscle Power at present :
3. Grading of Muscle Power at the onset of disease.
4. Duration of Loss of Muscle Power.
5. Any recovery after the onset till date :
6. Most direct cause of Loss of Muscle Power.
D. In Case of Heart Diseases :
1. Name of the disease
2. Date of first detection
3. Coronary Artery By Pass Grafting surgery done or not:
If yes, please mention:

a) Date
b) Name of Doctor – Surgeon
c) Name of Hospital.
E. In case of Thalassaemia:
1. Name of the disease (with specification-major or minor);
2. Date of first detection;
3. Whether blood transfusion required? Y/N
4. If so, periodicity/duration of blood transfusion/replacement required by the patient/
Chelation therapy
5. Blood transfusion done last DD/MM/YYYY
F In case of Parkinson’s disease:
1. Date of detection of the disease:
2. Duration of treatment undergone;
3. Name and designation of treating neurologist;
4 Whether admitted in hospital and if so, details thereof;
5. Progressiveness of the disease- please specify;
(To be certified by a neurologist)
..6..
G In case of Motor-neuron disease
1. Date of detection of the disease:
2. Duration of treatment undergone;
3. Name and designation of treating neurologist;
4. Result of the EMG test report and MRI:
5. Grading of muscle power at present

H Any other disease with more than


50% physical and or mental disability.
1. Name and date of detection of the disease which will be
duly examined by respective Regional Medical Board.

2. Duration of treatment undergone/being continued in brief.

3. Name and designation of the Doctor.

4. Evidences in support of the disease.

(Signature of signing authority)

Name :
Name of the Deptt. :
Name of Hospital :
Name and signature of patient Place :
Date :
Seal :
..7..

DECLARATION
(Kindly fill the Information in bold letters. Strike out whichever is not applicable)

I, __________________________________ solemnly declare that my spouse ________________ is presently Employed at/ under orders of
transfer to ____________________________________________________ (Place)as __________________________(Designation) in -----
_______________________________________ (Deptt./unit/branch) since ________________________

(Date). His/her full office address with Name and Designation of immediate superior/detail of self-employment is/are as follows:

Name and Office/Registered Business Name and Address of Immediate Superior Officer
Or Professional Address of Spouse or Registration No. of Business/Profession

…………………………………………….. ……………………………………………………

…………………………………………….. ……………………………………………………

…………………………………………….. ……………………………………………………

Signature of the Employee ______________________________________


Name ______________________________________
Designation _______________________________________

For Office use only in Kendriya Vidyalaya


*(Strike out whichever is not applicable)

1. *Disciplinary case is pending/contemplated/ not pending/not contemplated against


Shri/Smt./Kum. _____________________________________________________

2. *The Medical Certificate/declaration given in the application itself is from the competent authority.

3. *Certified that the details including entitlement points furnished by the applicant have been verified from the service records and
found correct.

4. *She/he was on leave/absent/absent without pay during ________________________ and is still away/not away from duties.
(Period)

Signature ____________________________
Name of the Principal _____________________________
Office Seal

Note: 1 Sl.No. 1 to 6 and 8 to 13 have to be checked and verified by the Principal from the service records. They should take
personal interest/care and ensure that the entries made by the applicant are correct before countersigning. Any wrong
information filled in by the applicant and duly countersigned by the Principal will attract disciplinary action against the
individual as well as countersigning authority.

2. Assistant Commissioners have to ensure that the correct required points are given in Sl. No.5, 6(e), 7 and implement note 1
above in letter and spirit with respect to entries to be checked by the respective Principals within their Region

3. Employee Code Number also to be checked.


..8..

INSTRUCTIONS FOR FILLING UP APPLICATION FOR TRANSFER

GENERAL

(i) Transfers are regulated in a limited time frame. A single cancellation of transfer is enough to upset the schedule/chain
and hamper the prospect of a group of needy persons getting transfer. Transfer, once effected, will not be cancelled.
The employees are disuaded in their own interest from taking chance with the intent of obtaining cancellation later.

(ii) All columns must be legibly filled in Block letters using alphabetical/numerical code, wherever prescribed. No
enclosures are allowed except where specifically asked for. Medical Certificate/Declaration should be obtained/made
on the appropriate page of the application form itself.

Name of the Vidyalaya where the employee is working presently must be expressed in Code. Present region code,
present station code, present K.V. code and shift/present office code must be filled in, from the codes given in the list
of codes. In case of Non-teaching staff, the office code/KV code should be filled in accordance with the list of codes
for office/KV code annexed.

Note: Write 1 for I shift and 2 for II shift in the appropriate box. In case there is only one shift in the Vidyalaya,
the teachers/staff working in these Vidyalayas will write 1 in the box provided for shift.

(iii) POST HELD: These boxes given in the Top row on the front page of the application may be filled in from
the abbreviations given below.

POST SUBJECT

e.g.
Trained Graduate Teacher Maths T G T M A T H

Trained Graduate Teacher Biology TGT BIOL

Trained Graduate Teacher English TGT ENGL

Trained Graduate Teacher Hindi TGT HIND

Trained Graduate Teacher Sanskrit TGT SANS

Trained Graduate Teacher Social Studies TGT SOST

Post Graduate Teacher Biology PGT BIOL

Post Graduate Teacher Chemistry PGT CHEM

Post Graduate Teacher Physics PGT PHYS

Post Graduate Teacher Maths PGT MATH

Post Graduate Teacher English PGT ENGL

Post Graduate Teacher Hindi PGT HIND


..9..

Post Graduate Teacher History PGT HIST

Post Graduate Teacher Geography PGT GEOG

Post Graduate Teacher Commerce PGT COMM

Post Graduate Teacher Economics PGT ECON

Post Graduate Teacher Comp.Sc. PGT COMP

Post Graduate Teacher Sanskrit PGT SANS

Primary Teacher PRT PRT ----

Head Master HDM HDM -----

Miscellaneous Drawing teacher MSC DRGT

Miscellaneous Physical Edn.teacher MSC PETR

Miscellaneous Yoga teacher MSC YOGA

Miscellaneous Work Exp.teacher MSC WETR

Miscellaneous Music teacher MSC MUST

Miscellaneous Librarian MSC LIBR

Non-Teaching Staff Assistant NTS ASST

Non-Teaching Staff UDC NTS UDCL

Non-Teaching Staff LDC NTS LDCL

Non-Teaching Staff Lab. Asstt. NTS LAST

Non-Teaching Staff Lab Attdt. NTS LATN

Non-Teaching Staff Senior Steno NTS SRST

Non-Teaching Staff Junior Steno NTS JRST

Non-Teaching Staff Hindi Translator NTS HITR

Non-Teaching Staff Staff Car Driver NTS DRIV

Non Teaching Staff Group ‘D’ NTS GRPD

Except Primary Teachers and Head Masters/Head Mistress all others would use both the block of the boxes.
Primary Teachers and Head Masters/Head Mistress may leave the second block of boxes blank.

Sl. NO.1: NAME


..10..
Write full name without any prefix like SHRI/SMT/KUM. One box is meant for one alphabet. Add
additional box, if necessary. Leave one box blank between initials and name.
e.g. Shri Ajay Kumar Ram will be written as
A K R A M Or A J A Y K U M A R R A M
Sl.No.1 (a): Please mention the title appropriately i.e. Shri/Smt./Miss

Sl. NO.2: WHETHER MALE/FEMALE


Write M for Male and F for Female.

Sl. NO. 3 / 4 (i) & (ii) (a),(b) & (c): Date of Birth/Date of Appointment in the present post/ DATE OF JOINING THE
PRESENT K.V./STATION (IN THE PRESENT POST/DATE OF JOINING IN PRIORITY AREAS)

These columns are to be filled in Christian era, the date followed by month and year in “DD MM
YYYY” format. For example, Third September, Nineteen Eighty Four will be written as

0 3 0 9 1 9 8 4
(Date of appointment in the present post should exclude any service on ad-hoc contractual basis.)

Sl. NO. 5 DETAILS OF LAST TRANSFER:

The reason col. has to be filled in by the Code No. as detailed below:
Code No. Explanation

1. Transfer on Surplus grounds (Excess to requirement) in Public interest due to withdrawal of post/closure of
stream/K.V.
2. Transfer in Public interest on displacement (for accommodating the request of other teacher/staff)
3. Transfer in Public interest on Administrative Grounds.
4. On direct appointment
5. On promotion including selection through departmental examination.
6. On request transfer (other than those transferred on MDG/DSP/LTR ground)
7. Request transfer on MDG, DSP and LTR ground
8. Transfer under para 9.1(A) of KVS transfer guidelines.
9. Other grounds including return from long leave.
Sl. NO. 6 : GROUNDS FOR SEEKING TRANSFER
The grounds envisaged in the transfer guidelines have been assigned Category Codes (alphabetical).
Division Codes (numerical) having entitlement points as follows:

GROUNDS CATG DIVISION ENTITLE-MENT


CODE CODE POINTS
(e) OTHERS
i) Very Hard stations VHS 04 Staff posted in declared Very hard 40
stations completed/going to complete
their tenure of 2 years as on 30.06.2009
(Please see note (iii) page-9)
ii) North East and NEH 05 Staff posted in 07 NE States, Sikkim, 30
Hard Stations A&N Islands and declared Hard Stations
completed/going to complete their tenure
of 3 years as on 30.06.2009
iii) Physically PCE 06 Visually and orthopedically 20
challenged employee handicapped persons
iv) Ladies not LNS 07 Unmarried/Divorced/Widowed Lady 15
having spouse
..11..

v) *Posting with PWS Category of Employee Priority


spouse spouse(as per para 12.4 of
Transfer Guidelines)
08 Spous I
e in
09 KVS II

Spouse in Central
10 Govt.
III 10
Spouse in Central
Autonomous Bodies
/PSUs
11
Spouse in State IV
Govt./State
Autonomous Bodies/
PSUs
12 V
Spouse working in
an Org. other than I-
IV above
vi) On completion SPS 13 Other grounds on completion of 3 years 01 for each year of
of more than 3 Stay, as on 31.03.2009/30.06.2009 as stay exceeding 3
years stay at the applicable. years subject to
present station maximum of 20
except those points
covered under
VHS and NEH
vii) Lady teachers LAH 14 10
who are posted
to places more
than 500 Kms
away from their
home town.

*The self employed spouse does not fall under the ground PWS (posting with spouse), therefore will not get any
entitlement points for the same.
Note:-
i) The above Codes are just indicative of the grounds and not to be construed as the order of priority. Applicants having
more than one ground amongst the above may indicate their choices in Category Code, Division Code and Entitlement
Points accordingly.

ii) While calculating the period of stay, the period or periods of absence from duties exceeding 30 days (45 days in case of
NE Region, Sikkim and A&N Islands) at a stretch other than on maternity leave, training or vacation is to be excluded.

iii) Listed Stations as Hard/Very Hard as per Annexure 2 of transfer guidelines.

Sl. NO. 7 : To be filled up at Regional Office level as per rules.

SI.NO. 8.1 For Intra Station Transfers (within the Region)


Code Numbers of five choice KVs/Office according to your order of preference Sl.No. 8.2 and 8.3 should be left
blank.
..12..

Sl. NO. 8.2: For Inter Station Transfers (within the Region)
Code Numbers of five choice stations according to your order of preference. Sl. No. 8.1 and 8.3 should be left
blank. (The teacher/employee coming under PCGR Category except MDG/DSP shall have to indicate five choices of
stations where post of that category has been sanctioned)

Sl. No. 8.3: For Inter Region transfers (outside the Region)
Code numbers of five choice stations can be filled in, according to your order of preference subject to the
grounds chosen, choice station is permissible. Sl. No. 8.1 & 8.2 should be left blank.

Note:
(i) Employees are eligible to prefer only one application in triplicate FOR INTRA STATION OR INTER
STATION TRANSFER (WITHIN THE REGION) OR IN QUADRUPLICATE FOR INTER REGION
TRANSFER (OUTSIDE THE REGION). Any application form found filled in for more than one type of
transfer i.e. Sl.No. 8.1, 8.2 and 8.3 would summarily be rejected.

Sl. NO.9: CATEGORY OF PLACE WHERE SPOUSE IS WORKING.

The Codes prescribed are:


Code PARTICULARS
1. Spouse working at or under orders of transfer to the station of choice, or nearby.
2. Spouse working at the same station where applicant is currently working.
3. Choice stations bear no relation to the place where spouse is working.

Sl. NO.10

In case the answers is in the affirmative write Y: Otherwise Write N.

Sl.No.11

In case the answers is in the affirmative write Y: Otherwise Write N.

The Medical Certificate or declaration is to be obtained on the body of the application itself. Only Cancer, Paralytic
Stroke, Renal failure, coronary artery disease where by-pass surgery has been actually done, Thalassaemia, Parkinsons’ disease
or Motor-Neuron disease for self, Spouse and dependent children are considered as valid for transfer on medical grounds when
facilities for treatment are not available at the station of posting (duly certified by a Govt. Medical Officer not lower than the
rank of a Civil Surgeon).

Sl. NO.12 : TYPE OF DISEASES: AS PER ANNEXURE- I of transfer guidelines w e f 14.3.2006

CODE TYPE OF DISEASE

CN CANCER
PS PARALYTIC STROKE
RF RENAL FAILURE
CA CORONARY ARTERY DISEASE WHERE BYPASS
SURGERY HAS BEEN ACTUALLY DONE
TS THALASSAEMIA
PK PARKINSONS’ DISEASE
MN MOTOR-NEURON DISEASE
OD ANY OTHER DISEASE
Sl. NO.13 : RELATIONSHIP

..13..

This column is applicable where transfer is sought on Medical Grounds and Sl.No. 11 and 12 are also filled in. The
relationship of the patient with the applicant should be indicated in the following Codes:

SF - Self
SP - Spouse
CH - Dependent Children

PHYSICALLY CHALLANGED EMPLOYEE- Explanation

Transfer of employees with visual and Orthopedic disabilities, provided they fulfill the following conditions:

(a) Blind Employees having vision less than 3/60 or field vision less than 10 both the eyes as certified by the Head
of the Ophthalmologic Department of Government Civil Hospital.

(b) Orthopedically handicapped employee who has a minimum of 40% permanent partial disability of either upper
or lower limbs or 50% permanent partial disability of both upper and lower limbs together, as certified by the
Head of Orthopedics Department of a Government Civil Hospital according to the standards contained in the
manual for Orthopedic Surgeon in Evaluating Permanent Physical Impairment brought out by the American
Academy of Orthopedic Surgeons, USA and published by Artificial Limbs Manufacturing Corporation of
India, Kanpur.