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Government of Karnataka

Application form for the Post of Assistant Teachers in Government Primary Schools a

District Level - 2012 - 13

Bangalore

General Teacher in Urdu Medium Schools -Priority 1

3. Post(s) Applied

1.

In Which District do you wish to apply for the Teacher

Post

3066403Application No

6.

Applicants Name (in Capital letters - as in SSLC or

equivalent exam marks card)

Gender

otification No & Date

5.

Medium opted for the CompetitiveExamination

MOHAMMED ABDUL AZEEZ

GULBARGA

Urdu

2.

Male

4.

8. Fathers Name MOHAMMED ABDUL JALEEL

7. Mothers Name BI BI SARA

9. Marital Status UnMarried

01 Aug 1980

0.

1. Date of Birth (as in SSLC Marks card)

Name of the Spouse

Category 2B2.

5

MUSLIM

NullDo you require the Assitance of Scribe in the

examination. (The Examining Authority will provide

the scribe)

Sub Caste

Are You Physically challenged ?4

3.

No

6.b.

MOHAMMED ABDUL AZEEZ S/O MOHAMMED ABDUL JALEEL,H.NO.5-992/35F/4A

Name and Postal Address

585104Pin code6.a.

6.c.

9886085488

Telephone Number

Mobile Phone Number6.d.

imrans777.net@gmail.comEmail6.e.

MOHAMMED ABDUL AZEEZ S/O MOHAMMED ABDUL JALEEL,H.NO.5-992/35F/4A

Permanent Address7.

STD Code7.b.

7.c. Telephone Number

585104Pin code7.a.

NoDo you come under Rural candidate reservation ?8.

ESERVATION DETAILS

6

STD Code

AS:3[1]C:P:15:2011-12, AUg,AP: 02 sj, 2013

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0.a.

NoHave you studied in Kannada Medium from 1st to 10th

Std?

---

---Specify No.of Year of Service

9.

NoDo you come under Ex-Service Men reservation?0.

.

If served as Honorary/Part time teachers in Govt.

Schools (No.of Completed years in two digits)

Property Aquired Year ---

0

2.a.

3.

2.

Do you come under Dependents of Ex-Service Man?

Specify Relationship.a.

No

NoAre you a project displaced person ?

---6.a.

6.

No

4.

If yes, you have to furnish orginal permission letter at

the time of verification.

No

NoAre you Government Employeed ?

Posses any Kannada Eligible Exams ?

Posses any Hindi Eligible Exams5.

8. Year of Admission to Tch/D.Ed ( Specify year in Four

digits)

2007

Tch / D.Ed

UALIFICATION DETAILS

7. Type of Teachers Training

SLC DETAILS

UrduMedium Studied in SSLC9.a.

Urdu, KannadaLanguages studied in SSLC9.b.

Total Marks Obtained9.c.

Total Maximum Marks in SSLC9.d.

Marks Details of II PUC/ Equv

II PUCQualifying Exam Passed0.a.

0.e.

2005Year of Passing ( Specify year in Four digits)

English

ScienceCombination Studied in II PUC/Equv

0.c.

KarnatakaII PUC/ Equv Exam Board affiliated to0.b.

489212Registration Number0.d.

0.f.

Total Marks Obtained

Elective subjects studied in II PUC/Equv Physics, Chemistry, Mathematics, Biology

314

0.i.

0.j.

0.h.

If Studied Science in II PUC have you studied

Mathematics ? ( Yes/No)

Medium Studied in IIPUC/Equv0.g.

Yes

Languages studied in II PUC/Equv

0.k.

100

600Total Maximum Marks

Maximum Marks for the English Subject

Marks Obtained in English Subject0.l.

0.m.

38

Reg.Num.1.a.

CH/DEd Details

2007405515

1.c. Urdu, NoneLanguages studied in TCH/D.Ed

Medium Studied in TCH/D.Ed1.b. Urdu

333

625

English, Urdu

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arks Details of I Year TCH/D.Ed

.d. Internal Marks

300Total Internal Marks Obtained in I Year TCH/DEd

370Total Maximum Internal Marks in I Year TCH/DEd

304

.e. External Marks

Total External Marks Obtained in I Year TCH/DEd

Total Maximum External Marks in I Year TCH/DEd 500

Total Internal Marks Obtained in II Year TCH/DEd

350

311

arks Details in KSEEB-OTHER Examination (Tch / D.Ed)

.f. Internal Marks

Total Maximum Internal Marks in II Year TCH/DEd

Total Maximum External Marks in II Year TCH/DEd 500

Total External Marks Obtained in II Year TCH/DEd 364

.g. External Marks

Urdu

Urdu, Kannada

Medium Studied in SSLC

Languages studied in SSLC

. SSLC Details

or Candidates with PUC Ed with Internship Educational Qualifications]

a.

.b.

c. 333Total Marks Obtained

Total Maximum Marks in SSLC 625.d.

---

.d.

UCEd Details

Year of Passing ( Specify year in Four digits)a.

.b. ---Registration Number

---Languages studied in PUCEd

c. ---Medium Studied in PUCEd

Total Marks Obtained ---e.

Total Maximum Marks ---.f.

Journal Number

Date of Payment.

40383.

Bank Name

.

Payment Amount.

.

yment Details

Branch Code

olemnly declare that the information provided are true. In case any information is found to be false or incorrect, I shall forfeit the claim to b

nsidered for selection.

Declaration

719768

400

19-Feb-201304:14:55 PM

State Bank of Mysore19 Feb 2013

ate :

Signature of the Applicant103.5.16.2

Taluk Details. ALAND - Priority 1, JEVERGI - Priority 2, SEDAM - Priority 3,CHITTAPUR - Priority 4, CHINCHOLI - Priority 5

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