Modi Public School, Siliguri – A Brief Profile of the Applicant – 2020-21

1] Post Applied For PRT TGT PGT PET Health Wellness Special Educator Music Warden (Please tick )

2] Name of the Candidate

(in BLOCK letters)

3] Gender M F (Please tick )

Paste your recent

colour passport
4] Marital Status Single Married Divorcee (Please tick )
photograph

5] Social Category Gen S.C. S.T. O.B.C. P.w.D. (Please tick )

6] Mother’s Name
(in BLOCK letters)

7] Father’s/Husband’s Name
(in BLOCK letters)

8] Date of Birth - - (dd-mm-yyyy)

9] PAN - -

10] AADHAAR - -

11] Educational 12 / Graduation with B.A. / B.Sc. / B.Com. with M.A./ M.Sc./ M.Com. B.P.Ed./ (Please tick )
Qualification D.El.Ed. / TTC B.Ed. / B.Fine Arts with B.Ed. / M.C.A. M.P.Ed.

Year of
Name of School / College / % of Subject combinations at 10 / 12 / Graduation (Hons) /
comple- Name of Board / University
University marks TTC / El.Ed. / B.Ed.
tion

10

12

Gradua-
tion

Post
Gradua-
tion

TTC /
D.El.Ed.
/ B.Ed.

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 Modi Public School, Siliguri – A Brief Profile of the Applicant – 2020-21

12] (a) No. of years of teaching experience in an English medium school y m (b) in a CBSE School y m

13] Name of the School

presently teaching &
since when

14] Address for Communication

(in BLOCK letters)

M. No(s). / WhatsApp No.

e-mail ID

15] Willing to stay in Campus Yes No (Please tick )

16] Language proficiency (a) Written Eng Hin Beng Nep (b) Spoken Eng Hin Beng Nep (Please tick )

17] Whether qualified – CTET Yes No WBTET Yes No (Please tick ) if, Yes, then % CTET WBTET

18] Proficiency in co-curricular

activities, if any

Signature of the applicant

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