Application form for the post

BIO DATA

*. Post applied for : PGT__Subject __Physics

2. Name of applicant: __ Haribansh Prasad Shukla

(First Name) (Middle Name) (Surname)

3. Father’s Name : Shri Janardan Prasad Shukla

(First Name) (Middle Name) (Surname)

4. Marital Status : Marriied

5. Date of Birth :_ 01/11/1972 (DD/MM/YYYY)

6. Sex : Male

7. Languages ( Read, Write and Speak ) : English,_Hindi,

8. Whether SC / ST /OBC /General : General

9. Address for communication : __Qr No B/.183,Ujjwal nagar,NTPC Sipat,

Bilaspur__(C.G) 495555

10. Contact Nos. : 758-***-****,989-***-****

11. Email ID : acuzn1@r.postjobfree.com

12. Academic and Professional Qualifications:

Sl.

Examination

Year

Board/ University

Percentage

Medium

Subjects

1 B.Ed 2007 APS University, Rewa MP 64% Hindi Maths Phy

2 M.Sc. 1996 APS University, Rewa MP 63.5% English Physics

3 B.Sc 1994 APS University, Rewa MP 56.5% Hindi PCM

4 H Sc 1990 M.P Board, Bhopal 48.5% Hindi Maths

5 S Sc 1988 M.P Board, Bhopal 68.5% Hindi

13. Spouse’s Occupation: House wife Place of working

14. Teaching Experience ( in reputed CBSE English Medium school only):

Sl. Name&Addr.of SchoolPost held ClassestaughtSubjectstaughtDates

From to Salary drawnBasic+GP+DA only

1 Bal Bharati Public School, NTPC, SIPAT,BilaspurCG PGTIX.X,XI,XII Physics April,2011 to till now

13350+4800+125%

2 Gyanodaya vidya Mandir,Mycem cementfactory,Narsingarh,Damuh MP PGTIX.X,XI,XIIPhysicsSept,2010 to March2011 9300+4600+DA

3 Chanakya Public SchoolPGTIX.X,XI,XIIPhysicsJuly,2007 to Aug,2010 Rs 14000/- Consolidated

4

15. Gross Salary expected: Rs__55,000_ In Indian rupees.

16. Details of curricular activities /Games / Sports during service period :

a)Organized N.A

b)Given coaching / training for N.A

17. Any Other information you would like to give us :

Capable of giving coaching of IIT,AIEEE,JEE

18. Children (If any)

Sl .Name Age Sex Studying in Class

1 Monarch Shukla 19 M BE

2 Shree Shukla 16 F XII

3 Shrey Shukla 12 M VIII

19. Reference:

Sl. Name Address Contact no.

1 Shri T Chourasiya Mukhtiyar ganj, Satna 882-***-****

Certified that the information furnished are correct and true to the best of knowledge and the school management can take any action,at any time,against me,if found incorrect.

Date : 20/04/12 Name : Haribansh Prasad Shukla

Place : NTPC, Sipat signature :

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