DIRECTOR GENERAL SCHOOL EDUCATION

Punjab ICT Education Society

Teacher's Personal Information
Date:
1. Name (in block letters)
First Name
Middle Name
Last Name

2. Father/Husband's Name (in block letters)

First Name
Middle Name
Last Name

3. Permanent Address (in block letters)

House Number Sector /Phase
Locality/Mohalla (if any)
Post Office
Village City
tick Vill. or City whichever is applicable

Block
Tehsil
District
Pincode

4. Correspondence Address (in block letters)

House Number Sector /Phase
Locality/Mohalla (if any)
Post Office
Village City
tick Vill. or City whichever is applicable

Block Name
Tehsil Name
District Name
Pincode
STD Code
Phone Number
Mobile Number

5. Other Information
PP Number

Date of Birth (DD-MM-YYYY) - -

For Example 25 May, 1970
Regular Joining Date(DD-MM-YYYY) - - should be filled in as
2 5 - 0 5 - 1 9 7 0

Date of Retirement(DD-MM-YYYY) - -

Current Designation

Educational Qualification

Category General SC ST BC OBC

Cadre State District

Subject Code Note: SUBJECT CODE to be filled in by Secondary Teachers only

Sex Male Female

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 Marital Status Married Unmarried

Handicapped Yes No (if yes, Nature of Disability - Blind Leg Other )

This section is for teachers suffering from chronic diseases

Suffering from Chronic Disease Yes No

i.e. Cancer/Heart Trouble

If yes, please specify following details of Doctor treating the case

Doctor's Name

Qualification

Address of Clinic

Phone No.

Is child mentally ill

or suffering from any disease Yes No Specify disease

This section is for female teachers only

If Married Widow Divorcee Deserted Newly Married None

if Married (Marriage Date DD-MM-YYYY) - -

Husband in defence service Yes No Not Applicable

6. Present Posting
D D M M Y Y Y Y
Date of Joining at present school - -
School Type Primary Middle High Sr. Secondary
Category Group-A Group-B Group-C Group-D
School Name

Locality / Mohalla(if any)

Post Office
Village City
tick Vill. or City whichever is applicable

Block
Tehsil
District
Pincode
School Situated in Border Bet Kandi Area Not Applicable

7. Distance Between Present School and Residence Where Staying

Kilometer Meter

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8. Results for Three Previous Years

Total Board Students

Specify Subjects Total Students Total Students Total Students
Year Classes Taken Passed at State Level(%age)
Taught Appeared Passed Passed (%age) (for board classes only)

2007-08

2006-07

2005-06

For Example:

Total Board Students Passed at

Total Students Total Students Passed
Classes Taken Specify Subjects Taught Total Students Passed State Level (%age)
Appeared (%age) (for board classes only)

8th English 40 30 72.9 85

1. Fill details of one class in one row.

2 For different subjects taught to same class, use seperate rows.
3. Primary teachers should fill one row for each class taught

9. Posting Details (order wise)

Specify, if the Area

From Date To Date comes under
S.No District Block School Name
(DD/MM/YYYY) (DD/MM/YYYY) (Urban/Rural/Border
/Bet/Kandi)

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 10. Suspension/Chargesheet During Service

From Date To Date Total Duration

Description of Chargesheet issued or Show Issue Date
S.No (DD/MM/YYYY) (DD/MM/YYYY) Year Month Cause Notice
charges (DD/MM/YYYY)

11. Absent During Service, if any

From Date To Date Total Duration

S.No (DD/MM/YYYY) (DD/MM/YYYY) Year Month

12. Any Departmental Enquiry Going On

Yes No

13. Details of Transfer on Administrative Grounds

Date of Transfer Transfer From(School)

S.No Transfer To (School)
(DD/MM/YYYY)

13. Training Programs Attended (if any, in last three Years)

S.No Year/Session Number of days attended

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14. Spouse Details
Spouse working Yes No

If Spouse is Working

Is Spouse Govt Teacher Yes No

If Spouse is Govt Teacher

Spouse PP Number

If Spouse not a Govt. Teacher

Type of Job Private Govt.

Is Job Transferable Yes No

Spouse Present Posting Address

Office Name

Department
Designation
Locality / Mohalla (if any)
Post Office
Village City Name
Block
Tehsil
District
Pincode
STD Code
Phone Number
Mobile Number

I certify that the information given above is correct. In case any information given
above is found to be incorrect, the department may take the action against me, as
deemed fit.

Date:

SIGNATURE OF THE CANDIDATE

SCHOOL HEAD

Name:

Signature:

Stamp:

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