B.S.E.F.S. -3- 25,000 (2005) Registratio n No.

Board of Secondary Education, Rajasthan, Ajmer

(Examiners Registration Form)
Please fill in English only
photo
1- Name- (Shri/Smt/Kum.) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2- Fathers/Husband Name -----------------------------------------------------------------------------------------------------------------------------------------------------------
3- Edu. Qualification (Graduate, Post Grad., B.Ed./M.Ed.,etc)
Please give details of all
S. Name of Examination Division Year of University Optional Subject
No. Passing
1
2
3
4
5
6
7

4- Teaching Experience (From class ix to xii and Graduate/ Post Graduate)

Subject Class Name of the Institution Service Period Total Period
From To
IX
X / Praveshika
XI
XII / SR. UPDH.
Graduation
Post Graduation

5- Examination for Examinership (Sec./Sr.Sec/Sr. Updh./Praveshika)------------------------------------------------------------------------------

¼× Please choose any one½

6- Subject/Subjects (For Examinership)---------------------------------------------------------------------------------------------------------------------------------------------------

7- Present Institution ----------------------------------------------------------------------------------------------Dist.---------------------------------Tel. No.---------------------------------

¼i½ Board/University, from which recognized--------------------------------------------------------------------------------------------------------------------------------------
¼ii½ Present Designation ------------------------------------------------------------------------------------------------------------------Date of Posting-------------------------------
¼iii½ Present pay scale---------------------------------------------------------------------------------------------- Total Salary --------------------------------------------------------------
¼iv½ Date of first Appointment---------------------------------------------------------------------------------------------Designation-----------------------------------------------
8- Registration No. (If already Regd.) Reg. No.------------------------------- Subject-------------------------------------------- Year-----------------

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fu;fer :i ls in ij fu;qä gS] mijksDr tkudkjh eq>s ekU; gSA
dk;kZy; fjdkMZ vuqlkj lgh gSA gLrk{kj ¼vkosnd½-----------------------------------------------------------------
Address(Residence)-----------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------
¼vxzljdrkZ ds gLrk{kj o in dh lhy½ ---------------------------------------------------------------------------------------------------------------------
'kkyk Øekad ---------------------------------------------- Dist.-----------------------------------------------------Pin Code-------------------------------------
Telephone no. with STD Code---------------------------------------------------------
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Mobile no.------------------------------------------------------------------------------------------------
fo'ks"k %& futh f'k{k.k laLFkkvksa ds vkosnd vkosnu i= lacfa /kr ftyk f'k{kk
vf/kdkjh ds ek/;e ls gh izsf"kr fd;s tkosaA Date of
Birth
Date Month Year
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fdUrq mPp ek/;fed ijh{kk ds okf.kT; oxZ ,oa d`f"k oxZ ds fo"k;ksa ds fy, ijh{kd nks fo"k;ksa esa
iath;u djk ldrs gSAa
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os iqu% iath;u gsrq vkosnu i= vafre dk;Zjr laLFkk ¼tgka ls lsokfuo`r gq, gSa½ ds laLFkk iz/kku ls
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osclkbV www.rajeduboard.nic.in ij Hkh miyC/k gSA
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ls izkIr gksuk vfuok;Z gSA
11- ijh{kd cuus gsrq lEcfU/kr fo"k; dks i<+kus dk U;wure ,d o"kZ dk vuqHko vko';d gSA
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vFkok led{k in ij fu;qDr v/;kid gh ijh{kd cuus ds ik= gSaA mPp ek/;fed ijh{kk ds fy,
O;k[;krk vFkok led{k in /kkjd ijh{kd cuus ds ik= gSAa
13- ijh{kd cuus gsrq Ldwy v/;kidksa dks B. Ed. gksuk vko';d gSA dkWyst f'k{kd] lEcfU/kr fo"k; esa
fdlh rRle vFkok mPp Lrj dh fdlh ekU; lkoZtfud ijh{kk esa mÙkh.kZ ¼;Fkk NET, SLET,
P.HD.½ gksa os ijh{kd cuus ds ik= gSAa
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esa nwjHkk"k la[;k 0145&2421897 ij lEidZ djsa vFkok mifuns'kd ¼xksiuh;½ dks i= fy[ksAa

lEidZ lw= dk;kZy; fuokl

Jh vkjŒ chŒ xqIrk] funs'kd ¼ijh{kk½ 0145&2420071 0145&2429043
Jh lkfyxjke ikjhd] mi funs'kd ¼xksiuh;½ 0145&2421897 0145&2431932
QSDl ua- 0145&2627394