APPLICATION FORM : SELECTION OF TEACHER /STAFF
THROUGH LOCAL SCREENING BOARD (LSB)
ARMY PUBLIC SCHOOL MISSSAMARI
Regn No: (To be filled in by school)
1. POST APPLIED FOR :(4 POST)- …SCIENCE LAB ATTENDANT ---…COMPUTER LAB
TECHNICIAN--- LDC--- IT
SUPERVISOR………………………………………………………
2. Personal Data :
a) Applicant’s name in block letters: :…ANUP KR
GUPTA………………………………………………………….. b)
Son/Daughter/Wife of :………BABBAN PR
GUPTA………………………….. c) Date of Birth :
………………………………24-05-2000……………………………. d) Age
as on 01 Apr 2022 :………………………
21…………………………………….
e) Present Address : ……………SANTIPUR WARD NO 5 .,BISWANATH
CHARIAI,ASSAM,784176…………
…………………………………….. :
………………………………………
……………………..
………………………………Tele No …8011208241…………...…….
(f) Permanent address : ……………SAME AS PRESENT ADDRESS
……………………………………………….. :
………………………………………
……………………..
: ………………………WhatsApp No …8011208241……….….…….
e-mail:…anujkrgupta9@[Link]……………………………………………………
3. Educational Qualifications(Give particulars of all examinations you have
passed from Graduation onwards):
Examination Board/University Year Subject taken % of marks
obtained
10 SEBA 2016 SOCIAL,SCIENCE,MATH,ENGLIS 78
H,ADV MATHS
12 AHSEC 2018 PHYSICS,CHEMISTRY,BIOLOGY, 70
MATH,ENGLISH
GRADUATION GAUHATI 2021 COMPUTER APPLICATION 76
(BCA) UNIVERSITY
CERTIFICATE-ISO:2015 in HARDWARE
AND NETWORKING
4. Experience : Fill in particulars in chronological order starting with your first appt.
Period School/College Subject taught & level Total
From To PGT/TGT/PRT /Other experience
(In month)
Note: You may attach a separate sheet, if necessary
2
5. Merit Scholarship won? Details ………………NSP
……………………………………………….
6. Classes you prefer to teach with subjects
a) Class(es) : …………………………………………………………….. b)
Subjects : ……………………………………………………………..
7. Family
a) Marital Status : Single / Married / Widowed -SINGLE
b) Occupation of Father/ Husband / Wife :…………………
BUSINESS……..………………………….. 8. Are you AWES Score Card
Holder (If yes): Yes / No
(a) Score Card No:………………….. (b) Year of passed:…………….
(c) Marks scored: Part A………………..Part B………………Over
all…………………… (d) Subject :
…………………………………………………………………………….. 9. Have
you cleared:-
(a) CTET/TET:(Y/N) Year of Passed……… Pass %………… (b) D El
Ed(Y/N) Year of Passed……… Pass %………… (c) Bl Ed(Y/N) Year of
Passed……… Pass %………… 10. Aptitude:
(a) Teaching (Specific subjects) :
…………………………………………………….. (b) Other areas :
……………………………………………………
11. Aspiration (Which you believe will be valuable to this institution)
………………………………………………………………………………
……………………… 12. Are you presently working ? (Yes / No) if yes, give
following:
(a) Apptt and Institution with date:
…………………………………………………………... (b) Salary
(c) Are you ESM : Yes / No
(d) If yes, date of retirement : (Army/Navy/Air Force) ………………………
I solemnly state that all the above particulars/statements are true to the
best of my knowledge and belief. I also understand that in case any particulars
given above are found to be false at any later date, my services are liable to be
terminated without giving any prior notice.
Date : …20/06/2022……Signature of applicant - Anup kr Gupta
Appx
(Ref to this application form ser No 4
Experience : Fill in particulars in chronological order starting with your first appt.
Period School/College Administration experience Total
From To /Subject taught & level experience
PGT/TGT/PRT (In month)
Anup kr Gupta
Date : …20/06/2022……………….. (Signature of applicant)
