Form No. RKMSG 001 For Office Use Only Sarisha Ramakrishna Mission Sarada Mandir Form : ……………… Girls’ Madhyamik School Admit : ……………. PO- Sarisha, PS & SD- Diamond Harbour, District: - South 24 Parganas, Pin- 743368, Phone – 03174 244-812 (A unit of Ramakrishna Mission Ashrama, Sarisha which is a branch Centre of Ramakrishna Mission Belur Math, Howrah, West Bengal, Pin – 711202) ====================================================================== Note : Use BLACK PEN only. Before filling, please read the prospectus for proper post/vacancy codes. Over-writing and use of white ink are strictly prohibited. ----------------------------------------------------------------------------------------------------------------- Application Form for the Selection Test for the Post Of HEADMISTRESS/ASSISTANT TEACHER ( Female only) Post Applied for ………………………………………………………………. Vacancy Code : ………………………. Affix Recent To Colour Photo here The Secretary, Sarisha Ramakrishna Mission Sarada Mandir Girls’ Madhyamik School (35mm x 25mm size) Sarisha, South 24 Parganas Pin Code - 743368 Full Signature in above 1. Name (in Block Letters) : [as per School Leaving Certificate] ………………………………………………………………………………………………………. 2. Father’s Name (in Block Letters) : [as per School Leaving Certificate] ………………………………………………………………………………………………………. 3. Husband’s Name (in Block Letters) : ………………………………………………………………………………………………………. 4. (a) Date of Birth DD MM YY [as per School Leaving Certificate] : (b) Age as on 01.01.2017 : …………….. years …………….. months …………….. days 5. (a) Caste ……………………….. (b) Sub caste ……………………….. (c) Religion ……………………….. (d) PH : Yes / No. 6. Complete Postal Address House Street ………………………….……………………………………….………………….……… ………………………….…………… Village Post ………………………….…………… PS ………………………….…………… ………………………….…………… Dist. State ………………………….…………… Pin ………………………….…………… ………………………….…………… Phone/ Mobile ………………………………, …………………………… Email : ……………………………………………………………………………. 7. (a) Particulars of School Education : Examination Year of Board/Council Full Marks Division/ % of Subjects passing Marks Obtained Class Marks Madhyamik/ Equivalent Higher secondary/ Equivalent Page 1 of 3 7. (b) Particulars of Higher Studies (For Pass Category) : Please tick the Year of Examining Subjects Full Part Part Part Total % of Academic course where passing University Marks I II III Marks Marks Score applicable (A) (B) (C) (A + B +C) 7. (c) Particulars of higher studies (For Hons./ PG category) : Name of the Year of Examining Subjects Full Part Part Part Total % of Academic examination/ passing University Marks I II III Marks Marks Score PG Degree in (A) (B) (C) (A + B +C) concerned subject 7. (d) Particulars of Work Education (Only for the post of work education group) : Name of the Year of Examining Subjects Full Total Marks % of Academic Examination passing University Marks Obtained & Marks Score Division BA BSc B.Com B.Ed with work ducation 7. (e) Particulars of B.Ed. / B.T. / B.P.Ed./ PGBT. : Name of the Year of Examining University Subjects Full Total Marks % of Academic Examination passing Marks Obtained & Marks Score division 8. If in service please mention the service information:-( Please attach N.O.C.) : Name of the post last joined and Name of the Institution Date of joining in last post Total length of service in the last post ( Years & Months) 9. Particulars of TET Examination Roll No. ………………………………………………………… [(If applicable, attach a copy of the TET Certificate ) Year of Passing…………………………………….. Page 2 of 3 10. Additional information of the applicant ( If YES please attach separate sheets): i) Has the applicant, at any point while in service, has dismissed from service? If so, full particulars thereof including the charges leveled against the applicant and full name and address of the school. ii) Has the applicant, at any point of time been detained in Police Custody on any charge / charges? If so, the name of the Police Station and District where such Police station is located. iii) Is any criminal case pending against the applicant in any Court of Law? If so, name of the Police Station which initiated the criminal case, the District where such police station is located, the case no and the name of the court concerned where such criminal case is pending. iv) Has the applicant at any point of time been convicted in any criminal case? If so, full particulars thereof, name of the Police Station which initiated the criminal case, the District where such police station is located, the case no and the name of the court concerned which convicted the applicant and the nature of the punishment given by the Court to the applicant. 11. DECLARATION : a) I do hereby declare that I have not applied in any post other than this post under Teachers’ Selection Test of the Sarisha Ramakrishna Mission Sarada Mandir Girls’ Madhyamik School, PO- Sarisha, Pin- 743368. b) I do hereby declare that all the statements made in this application and all of the self-attested documents submitted herewith are true and correct. In the event any of the information being found to be false or incorrect or any ineligibility being detected before or after the selection/ recommendation is made, my candidature / selection is liable to be cancelled and any recommendation made in my favour is liable to be revoked/rescinded and/or cancelled and appropriate legal action be initiated against me by the authority for making such selection / recommendation. Place………………………………….. ……………………………………………………… Date………………………………………… Full signature of the applicant Page 3 of 3 .