APPLICATION FORM - manipureducation.gov.in

1 APPLICATION for appointment of Lecturer on Contract A P P L I C A T I O N F O R M 1. Name of the Post Applied for: .. (Please select the name of the post from the ANNEXURE-I) 2. Full Name of the Candidate: .. (in Capitals) .. 3. Date of Birth: Day Month Year 4. Gender: (Write 1 for Male, 2 for Female) 5. Marital Status: .. 6. Father s/Husband s Name: .. 7. Mailing Address (in block letters) .. Pin Code: .. Mobil: + ID (if any): .. 8. Permanent Residential Address (in block letters) .. Pin Code.

2 ( bonafide permanent residential certificate of Manipur should be enclosed ) 9. Nationality: .. 10. Whether Physical Handicapped? : (Write 1 for Yes, 2 for No) 11. Community (please tick ) SC ST OBC GENERAL Paste your recent passport size photograph 12. Details of Educational qualifications: Exam passed Division/Grade % of Marks Year of Passing Duration of the Degree/ Diploma Board/ University Subject Subject of Specialization X/HSLC XII or equivalent Graduation or equivalent Post Graduation or equivalent * (* Desirable) 13.

3 Brief experience relevant to teaching profession: School/Institution. Post held Part time/ Contract Basis/ Ad-hoc/ regular/ Exact dates to be given (indicate day, month & year) Total Period (in years) Scale of pay Whether relevant certificate enclosed. (Y/N) From To Years Months Days 14. Choice of Higher Secondary Schools for posting/appointment (Please refers Annexure-II). D E C L A R A T I O N I hereby declare that all the statements made in the APPLICATION form are true and complete to the best of my knowledge and belief. I understand that legal action under section 177, 193, 197, 198, 199 and 200 of Indian Penal Court and other appropriate disciplinary action can be taken against me by the appointing authority, if I am declared by them to be guilty of any type of misconduct or misrepresentation mentioned herein.

4 I have informed my Head , in writing that I am applying for this selection. Date: Signature of candidate Place: Name: Address: (Strike off the last sentence in the declaration in case not relevant) Annexure I to the Notification No. A0/56/ ACB/2010(3)-DE(S)Pt-I Dated 21/6/2018 (Number of Lecturers to be appointed on Contract and its Subject-wise Reservation of Lecturers) Sl. No. Subjects Unreserved OBC(M) OBC(MP) ST SC No. of Lecturers 1 Botany 22 6 2 14 0 44 2 Chemistry 20 5 3 13 2 43 3 English 39 10 3 25 2 79 4 Home Science 22 6 1 13 1 43 5 Manipuri 39 9 4 24 2 78 6 Pol.

5 Sc. 35 10 3 24 2 74 7 Zoology 25 6 2 15 0 48 Total 202 54 17 128 8 409 Annexure II to the Notification No. A0/56/ ACB/2010(3)-DE(S)Pt-I Dated 21/6/2018 (Schools to be indicated for posting in order of preferences starting with for the most preferred School and so on upto No. 57 in the column marked preferences against the name of the schools. This shall be subject to the availability of the post for the concerned subject in the schools as given in the Annexure III Candidate Subject .. Sl School Name Prefe erences Sl School Name Prefe erences 1 Ananda Singh Hr. Sec. Academy 30 Somdal Hr. Sec. School 2 Bishnupur Hr.)

6 Sec. School 31 Sugnu Hr. Sec. School 3 Borobekra Hr. Sec. School 32 Hr. Sec. School 4 Higher Sec. School 33 Tallui Hr. Sec. Academy 5 Chaoyaima Hr. Sec. School 34 Tamenglong Hr. Sec. School 6 Heirok Hr. Sec. School 35 Tengkonjang Hr. Sec. School 7 Ibotonsana Hr. Sec. School 36 Thangtong Hr. Sec. School 8 Jessami Hr. Sec. School 37 Ukhrul Hr. Sec. School 9 Jiribam Hr. Sec. School 38 Vungzagen Hr. Sec. School 10 Johnstone Hr. Sec. School 39 Wangoi Hr. Sec. School 11 Kakching Hr. Sec. School 40 Chakpikarong Hr. Sec. School 12 Khangsillung Hr. Sec. School 41 Sagang Hr. Sec. School 13 Lamlong Hr. Sec. School 42 Thanlon Hr.

7 Sec. School 14 Langmeidong Hr. Sec. School 43 Parbung Hr. Sec. School 15 Lilong Hr. Sec. Madrasa 44 Sagolmang Hr. Sec. School 16 Lilong Hr. Sec. School 45 Gelnel Hr. Sec. School 17 Maha Union Hr. Sec. School 46 Langmei Hr. Sec. School 18 Mekola Gulap Hr. Sec. School 47 Nungba Hr. Sec. School 19 Model Hr. Sec. School 48 Kangvai Hr. Sec. School 20 Moirang Multipurpose Hr. 49 Churachandpur Hr. Sec. Sch 21 Moreh Hr. Sec. School 50 Azad Hr. Sec. School 22 Hr. Sec. School 51 Bengoon Hr. Sec. School 23 Nambol Hr. Sec. School 52 Sangai Yumpham Hr. 24 Nilapadma Hr. Sec. School 53 Khangabok Hr. Sec. School 25 Phungyar Hr.

8 Sec. School 54 Ningthoukhong Hr Sec. Sch 26 Purul Hr. Sec. School 55 Wangoo Hr Sec. School 27 Ramlal Paul Hr. Sec. School 56 Lamding Hr. Sec. School 28 Recent Hr. Sec. School 57 Lamlai Hr. Sec. School 29 Rengkai Hr. Sec. School Signature of Candidate Annexure III to the Notification No. A0/56/ ACB/2010(3)-DE(S)Pt-I Dated 21/6/2018 (Subject-wise number of Lecturer to be appointed) Sl.

9 No. Name of School Botany Chemistry English Home Sc. Manipuri Pol. Sc. Zoology School Total 1 Ananda Singh Hr. Sec. Academy 0 1 0 1 1 1 0 4 2 Azad Hr. Sec. School 1 0 2 2 2 2 0 9 3 Bengoon Hr. Sec. School 1 0 0 0 2 1 1 5 4 Bishnupur Hr. Sec. School 0 1 1 0 2 1 1 6 5 Borobekra Hr. Sec. School 1 0 1 2 2 0 0 6 6 Higher Sec. School 0 0 1 1 4 3 0 9 7 Chakpikarong Hr. Sec. School 2 2 4 2 2 2 2 16 8 Chaoyaima Hr. Sec. School 1 0 1 0 1 0 0 3 9 Churachandpur Hr. Sec. School 2 2 4 0 2 2 2 14 10 Gelnel Hr. Sec. School 2 2 4 2 2 2 2 16 11 Heirok Hr. Sec. School 1 1 1 0 2 0 2 7 12 Ibotonsana Hr. Sec. School 1 0 1 0 2 3 0 7 13 Jessami Hr. Sec. School 0 0 2 1 0 1 1 5 14 Jiribam Hr.

10 Sec. School 2 0 0 2 2 2 1 9 15 Johnstone Hr. Sec. School 0 1 0 2 2 1 1 7 16 Kakching Hr. Sec. School 0 0 0 1 1 1 1 4 17 Kangvai Hr. Sec. School 2 2 4 1 2 1 1 13 18 Khangabok Hr. Sec. School 1 0 1 0 2 1 1 6 19 Khangsillung Hr. Sec. School 2 0 3 0 0 1 0 6 20 Lamding Hr. Sec. School 0 0 1 0 2 2 1 6 21 Lamlai Hr. Sec. School 2 2 2 0 2 2 2 12 22 Lamlong Hr. Sec. School 0 0 0 0 1 0 0 1 23 Langmei Hr. Sec. School 2 2 4 2 2 1 2 15 24 Langmeidong Hr. Sec. School 0 0 0 0 1 0 0 1 25 Lilong Hr. Sec. Madrasa 0 1 0 0 0 0 0 1 26 Lilong Hr. Sec. School 0 0 1 0 0 0 1 2 27 Maha Union Hr. Sec. School 0 0 0 0 0 0 1 1 28 Mekola Gulap Hr. Sec. School 0 0 0 1 0 0 0 1 29 Model Hr.