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19/09/ 2015 Haryana Staff Sel ect i on Commissi on : Regi st ration Pri nt ht tp: //recrui tment-portal.i n/pgt advt 5/RegPrint.aspx 1/ 2 APPLICATION FORM | Haryana Staff Selection Commission (Advt. No. 5 / 2015 ) Registration Number 20008929 Post Applied For PGT Computer Science (Cat.No .1) Applicant's Name meenu Father's Name veer bhan Mother's Name rajpati Date of Birth 16/10/1989 Age as on 2 1.0 9.2 01 5 25 Year 11 months 5 days Gender Female Marital Status Un Married Nationality indian Category General District Mewat Cadre NO Matric with Hindi/Sanskrit or 10+2/B.A./M.A. with Hindi as one of the subject ? YES Certificate of having qualified Haryana Teacher Eligibility Test (HTET)/School Teacher Eligibility Test (STET) of respective subject for the post applied, Conducted by Board of School Education Haryana, Bhiwani NO QUALIFICATION Class Name/Qualification Passing Year University/ Boar d Subjec t Marks Obtained / Total Marks Matric 2005 HBSE hindi,eng,maths,social science,science,physical education 511 / 600 10+2 (Senior Secondary) 2007 CBSE physics,chemistry,maths 412 / 500 B.Tech. Computer Science(Regular Course) 2012 maharshi dayanand university computer science 6132 / 8750 OTHER Haryana Domicile YES Birth Place and Country narwana jind/ india Whether Working as a teacher in privately managed Govt. aided, recognized and Govt. Schools. Age relaxation to the extent of service rendered as a teacher subject to a maximum of 5 years. NO Worked for minimum 4 years commulatively as on 11/04/2012 in privately managed Government aided schools, Recognized Schools and Governmnet Schools. Should be in service as on date. NO Whether Servi ng In State/central Govt. NO Password F6724273CB ADDRESS
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19/09/2015 Haryana Staff Selection Commission : Registration Print
http://recruitment-portal.in/pgt_advt5/RegPrint.aspx
APPLICATION FORM | Haryana Staff Selection Commission (Advt. No. 5 / 2015 )
Registration Number 20008929
Post Applied For PGT Computer Science (Cat.No.1)
Applicant's Name meenu
Father's Name veer bhan
Mother's Name rajpati
Date of Birth 16/10/1989
Age as on 2 1.0 9.2 01 5 2 5 Year 1 1 months 5 days
Gender Female
Marital Status Un Married
Nationality indian
Category General
District Mewat Cadre NO
Matric with Hindi/Sanskrit or
10+2/B.A./M.A. with Hindi as one of
the subject ?
YES
Certificate of having qualified
Haryana Teacher Eligibility Test
(HTET)/School Teacher Eligibility
Test (STET) of respective subject for
the post applied, Conducted by
Board of School Education
Haryana, Bhiwani
NO
QUALIFICATION
Class Name/Qualification Passing
Year University/Board Subject
Marks Obtained / Total
Marks
Matric 2005 HBSE
hindi,eng,maths,social
science,science,physical
education
511 / 600
10+2 (Senior Secondary) 2007 CBSE physics,chemistry,maths 412 / 500
B.Tech. Computer Science(Regular
Course) 2012
maharshi
dayanand
university
computer science 6132 / 8750
OTHER
Haryana Domicile YES Birth Place and Country narwana jind/ indiaWhether Working as a teacher in privately managed Govt. aided,
recognized and Govt. Schools. Age relaxation to the extent of
service rendered as a teacher subject to a maximum of 5
years.
NO
Worked for minimum 4 years
commulatively as on 11/04/2012 in
privately managed Government
aided schools, Recognized Schools
and Governmnet Schools. Should be
in service as on date.
NO Whether Serving In
State/central Govt. NO
Password F6724273CB
ADDRESS
7/17/2019 491
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19/09/2015 Haryana Staff Selection Commission : Registration Print
http://recruitment-portal.in/pgt_advt5/RegPrint.aspx
Permanent Address
house no 310 ward no 13 pujabhi chowk, narwana, Jind, Pin-126116, Telephone No -9818780874, Email ID-
Corresspondence Address
house no 21 police colony nangloi , nangloi, OTHER, Pin-110041, Telephone No -9818780874
DECLARATION: I hereby declare that:-
1.All statements made in this application form regarding age limit,educational qualifications & experience etc. are true, correct
and complete to the best of my knowledge, belief, record and nothing has been concealed therein.
In the event of any information being found/detected false, incorrect, incomplete and ineligible before or after the
interview/selection/appointment then my candidature may be cancelled and any legal action as per law can be intiated/takenagainst me.
2. I have read the terms and conditions prescribed in advertisement carefully and accordingly, I hereby undertake to abide by
them. I, also, fulfill all the conditions of eligibilty as per relevant rules and instructions prescribed by Government of Haryana
from time to time.
3. I have never been convicted by any competent court of law.
SIGNATURE
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