Receipt No………….								School No. 04164                                                              Date:-………..								Contact no. 9254230570
           D.A.V. CENTENARY PUBLIC SCHOOL
BHIWANI (Haryana)
  (Directly Managed by DAV College Managing Committee, New Delhi)
(An English Medium Co-Educational Senior Secondary School)
(Affiliated to CBSE, New Delhi Vide its No. 530143)

  Post applied for			 : ……………………………………………………………………..
1)	a) Full Name (In Block letters)  : ……………………………………………………………………..

b) Father’s/Husband Name	 : ……………………………………………………………………..

c) Aadhar No. of Candidate	: ……………………………………………………………………...

d) Mobile No	: ……………………………………………………………………..
2) Date of Birth 			: ……………….. In Words ……………………………………….
3) Marital Status 			: …………………………………………………………………….
4) Academic Qualification :-	
1	2	3	4	5	6	7	8	
Examination	Year of Passing	School / College	Board/
University	Subjects	Marks Obtained	Percentage of Marks	Division	

Matriculation								

Sr. Sec.								

B.A/B.Sc./B.Com								

M.A/M.Sc./
M.Com								

B.Ed/M.Ed								

M.Phil/Ph.D.								

Any Other								

6)  Detail of experience in DAV institution  if any:
S. No.
	Name of Institution	Designation	From	To	Emoluments	

						

						

						

						

						

						
7)
Present Address	Permanent Address	

		
Email :	Email :	

8) Whether qualified NET, HTET, CTET ………………………………………..
9) If Yes, mention the category…… PRT/TGT/PGT
 	Signature of Candidate
Place………………… 	Name…………………….
Date ………………….	Mobile No .………………