ATOMIC ENERGY EDUCATION SOCIETY (REGD.) (An Autonomous Body under Department of Atomic Energy, Govt.

of India), Anushaktinagar, Mumbai 400 094.

RECRUITMENT OF PRINCIPAL & TEACHERS

Advertisement No. AEES/01/2012 Important Note: Before filling this form, please read the instructions carefully. ALL ENTRIES SHOULD BE MADE IN CAPITAL LETTERS. (Fill two copies of application form A4 size) For Office Use Screened IN OUT
Please affix recent passport size photograph duly attested

Application Number (will be allotted by Central Office, AEES) _______________________

POST CODE POST APPLIED PRIN/ PGT/TGT/PRT SUBJECT OPTED CENTRE CODE CENTRE

1. Candidates Name & Address (IN CAPITAL LETTERS) (SHRI / SMT / MS / DR )

2. Fathers / Husbands Name (IN CAPITAL LETTERS) (Please mark ( ) in the appropriate box)

Father

Husband

3.
CATEGORY
(SC/ST/ OBC/UR/ PH)

DATE OF BIRTH DAY MONTH YEAR

GENDER
(Male / Female)

AGE AS ON 31/01/2012 DAY MONTH YEAR

4. Sub category (please mark ( ) tick in the appropriate box)

Physically Challenged (If yes, mark the appropriate column) Visually Challenged Hearing Challenged Locomotor / Orthopadecally Challenged If Physically Challenged, please indicate whether Guide / Scribe is required at the Examination Centre (Write YES / NO) AEES Regular Employee In Govt. regular service

Women

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:- 2 -: 5. Contact Tel. No. / Mobile No./e-mail ID / Fax No. (if any) with STD code:

6. Whether you have English subject in class XII (Write YES / NO) 7. Academic/Teaching Qualification (starting from class 10th) (attach zerox copies) (Attach separate sheet if columns are insufficient)
Name of examination (Write complete name of course passed as on 01/01/2012)

Name of Examination Passed

Aggregate Marks Year of Passing Subject Offered

Max. Marks

Marks Obtd.

%age of marks

Duration of Course

Board / University

Class X Class XII Graduation / Diploma Post Graduation JBT/B.E.Ed B.Ed. / B.P.Ed. M.Ed. / M.Phil. / Ph.D.

Other, if any

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:- 3 -: 8. Teaching/Administrative Experience (attach separate sheet, if columns are insufficient)

Name of the Institution/ Department Whether Central Govt. /State Govt./ Autonomous Body/ Public Sector/ Recognised/Unrecognised (if applicable) Period of Service No. of completed years & months Scale of pay and salary drawn per month

Post Held

Nature of Duties

From

To

9. Indicate the language(s) through which you are able to teach:

10. Do you have working knowledge of computer: 11. Details of Fee paid:
D.D. No. Date Name of Bank

YES
Branch

NO
Amount

12. Enclosures:

Date of Birth proof Teaching Qualification SC/ST/OBC/PH Cert. Demand Draft

Mark sheets Cl X onwards Passing Certificates Cl.X onwards Passing Certificate Tchg. Qual. Experience

I hereby certify and declare that: i) I have read the provisions given in the advertisement.
ii) All statements made and information given by me in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information or part of it being found false or incorrect before or after the examination/interview or appointment, action can be taken against me by the AEES and my candidature / appointment shall automatically stand cancelled / terminated. I further declare that I fulfill all the conditions of eligibility regarding age, educational / professional/teaching qualifications, etc. prescribed for the post applied for as on 31/01/2012. The essential qualifications prescribed are possessed by me, the proof of which has been enclosed.

iii)

PLACE : ____________________________ DATE : ____________________________ Signature of candidate