PERFORMA FOR TEACHING FACULTY
1. Name of the School/College ……………………….. Paste Passport Size Photograph of teacher duly attested by the Principal. |
2. Name of Teacher ; ………………………
3 .Father/Husband’s name : ………………………
4.Designation of the Teacher. ……………………..
5. Permanent Address : ………………………..
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6. Present Address : ………………………..
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7. Phone No. : Land Line ……………………
Mobile ……………………
Fax …………………..
E mail …………………….
8. Income Tax PAN Number : …………………….
9.Qualification.of the teacher
Qualification | Name of School/College | From ---To -- | Date of Qualification | Board/University | Registration No. PNRC & Date |
ANM | | | | | |
GNM | | | | | |
B.Sc.Ng | | | | | |
B.Sc Ng(Post Basic) | | | | | |
M.Sc Ng with Specialty | | | | | |
10. Clinical Experience
Designation | Institution where worked | From …. To …. | Letter of Posting No & date | Salary drawn | Attach copy of work & conduct certificate |
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11. Teaching Experience
Designation | Institution where worked | From …. To … | Letter of Posting No & date | Salary drawn | Attach copy of work & conduct certificate |
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Signature of the Teacher