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AP SAMAGRA SHIKSHA - EAST GODAVARI, KAKINADA
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Application for the post of CRT / PGT in KGBVs
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Name of the KGBV:
_______________________________
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Post Category: ____________________
Subject: _________________
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Fill the application in the BLOCK LETTERS by the candidatePHOTO
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1Surname
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2Name
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3Father / Husband Name s per SSC
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4Date of Birth (dd/mm/yyyy) as per SSC4a. Age (as on 01.07.2021)
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5Native District as per Study
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6Native Mandal as per norms
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7Social StatusSC / ST / BC / OC
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8Address for Communication with Mobile No & email address
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9PWD (Disability)Yes / NoPWD Category : (OH / VI / HI) & Percentage(If YES, please enclose the relevant certificate)
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10Qualifications
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A.AcademicCourse TitleMonth & Year of passedName of the InstitutionName of the Board / UniversityMediumMax. MarksMarks obtained% of Marks
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SSC
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Intermediate or Equavalent
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Graduation & Title of the Degree
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Post Graduation & Title of PG
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B.ProfessionalCourse TitleMonth & Year of passedName of the InstitutionName of the Board / UniversityMediumMax. MarksMarks obtained% of Marks
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Deploma (Mention the deploma)
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B.Ed (Mention Methodology)
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(Note : Female Candidates only eligible for these posts)
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Declaration
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 I ______________________________________ declared that, the information furnished above by me is true and correct. If any found false and incorrect I will abide by any action taken by the Authorities.
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Signature of the Applicant
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Enclosures:
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All Qualification Certificates & Mark Lists Xerox copies
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4th Class to 10th Class Study Certificates Xerox copies
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Caste Certificate Xerox copies
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Aadhar Card Xerox copy
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If PWD (Person with Disability), enclose relevant certificates
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6Service Certificate
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