dsaæh; fganh lalfkku] vkxjk l= % (izos'k vkosnu i=)

Transkript

1 dsaæh; fganh lalfkku] vkxjk l= % (izos'k vkosnu i=) (Admission Form must be filled in both Hindi and English) izos'k vkosnu i= la ADMISSION FORM... iathdj.k la[;k ikliksvz lkbt QksVksxzkQ yxk, tks Lo;a izekf.kr gksa Paste Passport size Photograph Self Attested Regd. No.... izos'k la[;k Admis. No ikb~;øe ftlesa izos'k pkgrs gsa Name of the course in which admission is sought 2- uke Jh@dqŒ@Jherh Name of applicant (In Block Letter's) Mr./Mrs./Km. 3- ekrk dk uke Mother s Name 4- firk@ifr dk uke Father/Husband s Name 5- tue frffk (bzloh lu~ esa) tue LFkku ftyk izns'k Date of Birth (i) Place of Birth (ii) District (iii) State 6- (v) ekr`hkk"kk (c) jk"vªh;rk (l) èkez (i) Mother tongue (ii) Nationality (iii) Religion 7- oxz&vuqlwfpr tkfr@vuqlwfpr tutkfr@vu; finm+k oxz@lkeku; oxz Category Scheduled Caste/Scheduled Tribe/OBC/General 8- fodykaxrkµ(;fn vh;fkhz fodykax gs] rks l{ke vfèkdkjh n~okjk tkjh izek.k i= vo'; layxu djsa) If the candidate is physically Handicapped, He/she must attach a certificate issued by a compitent authority. 9- (v) L=h@iq#"k (c) fookfgr@vfookfgr (l) xzkeh.k@'kgjh {ks= (i) Female/Male (ii) Married/Unmarried (iv) Rural/Urban 10- lsokiwoz@lsokjr (;fn vh;fkhz lsokjr gs] rks ftyk ;k Cykd Lrj ds f'k{kkfèkdkjh dk vukifrr izek.k i= vo'; layxu djs a) If the Candidate is in service, he/she must attach No objection Certificate from District or Block Level Education Officer

2 11- LFkk;h irk i= O;ogkj dk irk Permanent Address Correspondence Address... fiu (Pin)......fiu (Pin)... eksckby ua- (Mob.)... ID :... Fkkuk (Police Station)... Fkkuk (Police Station)... ([k) (x) (?k) (p) (N) (t) Matric/S.S.L.C. P.U.C./Intermediate B.A. B.Ed./L.T./Parangat 12- 'ks{kf.kd ;ksx;rk, mrrh.kzrk lalfkk dk uke Js.kh iw.kk±d izkirkad izkirkad ijh{kk&fo"k; dk o"kz fo'ofon~;ky;) izfr'kr Educational Year of Name of Institution Div- Total Secured Marks Qualification Passing (Board/University) ision Marks Marks obtained Subjects Offered Percentage (d) ch-,-,e-,- M.A. vu; izf'k{k.k Other s Training fganh dh led{k ;ksx;rk Hindi Qualification?kks"k.kkµmijksDr lwpuk, esjs Kku vksj fo'okl ds vkèkkj ij lgh gsa ;fn dksbz rf; vlr; ik;k tkrk gs rks esjk p;u jn~n fd;k tk ldrk gsa The above information provided by me is correct to my knowledge and belief. If any information being found false, my selection is liable to be cancelled fnukad % Date : vkosnd ds iwjs glrk{kj Signature of the Candidate

3 (v) (i) (c) (ii) (l) (iii) (n) (iv) vkosnu i= ds lkfk lacafèkr ikb~;øe es a izos'k ds fy, fuèkkzfjr 'ksf{kd ;ksx;rkvks a dh mùkh.kzrk ds izek.k i=] vlfkkbz izek.k i= (Provisional Certificate) vksj vad lwfp;ks a dh Lo&izekf.kr Nk;k&izfr;k gh layxu djs aa Certified copies of certificates and marksheets must be attached to this application which are prescribed for the course. izos'k ds le; vkosnd dks lhkh mrrh.kz ijh{kkvks a ds vksj vu; vko';d ewy izek.k i= izlrqr djus gks axsa The applicant must present all the original certificates at the time of admission (Education and others). lsokjr vh;ffkz;ks a dks lalfkk ds izèkkukpk;z n~okjk fn, x, vuqhko izek.k i= rfkk fuo`frr izek.k i= izos'k ds le; ykuk vko';d gsa In Service candidates Experience Certificate and relieving certificate from the Principal of the Institution, where serving, are to be produced at the time of admission. vuqlwfpr tkfr] tutkfr,oa finm+h tkfr ds vh;fkhz tkfr izek.k i= dh vfhkizekf.kr izfr layxu djs aa Candidates belonging to the SC, ST & OBC Category must attach Certified true copy of the Caste Certificate. fo'ks"k % lalfkku osclkbv ls MkmuyksM fd, x, QkeZ ds lkfk #Œ 200@& (#i;s nks lks) ek= dk csad Mªk V] ^^lfpo] ds aæh; fganh f'k{k.k eamy] vkxjk** ds uke cuokdj layxu djuk vfuok;z gsa Mªk V layxu u djus dh flfkfr esa vkosnu i= ij fopkj ugha fd;k tk,xka Note : Application Forms downloaded from the Sansthan's website must contain a Bank Draft of Rs. 200/- (Rs. Two Hundred) only, in favour of 'Secretary Kendriya Hindi Shikshan Mandal, Agra', Application forms found without the bank draft will not be considered anyway. cs ad Mªk V dk fooj.k % Mªk V la[;k èkujkf'k #ñ fnukad cs ad dk uke Details of Bank Draft : Draft No... Amount (Rs.)... Dated... Name of Bank...

4 dk;kzy; ds iz;ksxkfkz For office Use only lhkh vko';d izek.k i= vkfn ns[k fy, x, gsaa bugsa ikb~;øe es a izos'k fn;k tk ldrk gsa All essential certificates etc. have been examined. He/she can be admitted to... rkjh[k izos'k iz'kklfud vfèkdkjh dqylfpo lgk;d (izos'k ijh{kk&vuqhkkx) Date... Assistant Administrative officer Registrar Admission (Admission and Exam.) izos'k fn;k tkrk gsa Admitted rkjh[k Date funs'kd Director

5 dsaæh; fganh lalfkku] vkxjk ekuo lalkèku fodkl ea=ky;] Hkkjr ljdkj fganh lalfkku ekxz] vkxjk& (mœ izœ) (fganh f'k{k.k izoh.k izos'k ijh{kk) izos'k&i= l= % vh;fkhz viuk izos'k ijh{kk dsaæ QksVks fpidk, 2- vh;fkhz dk uke (fganh esa) LVsfiy u djsa (vaxzsth esa) cm+s v{kjksa esa ekrk dk uke ifr dk uke vh;fkhz dk i=&o;ogkj dk iwjk irk (fiu dksm lfgr) vh;fkhz ds glrk{kj (izos'k&ijh{kk dk;kzy; ds n~okjk Hkjk tk,xk) vh;fkhz dk vuqøekad ijh{kk frffk ijh{kk le; ijh{kk ds aæ dk uke (iwjk irk lfgr) uksvµvh;fkhz izos'k&ijh{kk gsrq bl izos'k&i= dks Hkjdj izos'k vkosnu i= ds lkfk layxu dj 31 ekpz] rd HkstsaA vko';d funsz'k % 1- Øe la[;k 1 ls 5 rd vh;fkhz dks Lo;a Hkjus gsaa 2- bl izos'k&i= dks ijh{kk dsaæ ij vo'; ysdj vk, vu;fkk ijh{kk esa ugha csbus fn;k tk,xka 3- izos'k&i= esa mfyyf[kr ijh{kk dsaæ ij gh ijh{kk gsrq miflfkr gksaa 4- ijh{kk dsanz vkoafvr gksus ij mlesa dksbz ifjorzu ugha fd;k tk,xka 5- iz'uksa dk mùkj dsoy dkyh L;kgh okys ckwyisu ls gh fpg~fur djsaa 6- iz'u dk mùkj lkeus fn, x, ckwdl esa fpg~fur djsaa OgkbVuj dk mi;ksx oftzr gsa 7- ijh{kk Hkou esa eksckby] dsydqysvj] ysivkwi vkfn bysdvªkwfud midj.k ys tkuk oftzr gsa 8- mùkj iqflrdk esa dsoy varjjk"vªh; vad gh fy[ksa] ;Fkk&1] 2] 3 dqylfpo