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Offline Application Form PGT 2024

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70 views

Offline Application Form PGT 2024

All Done

Uploaded by

dipanshubazzad07
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

Offline Application Form for the post of Post Graduate Techers (PGTs) in the

subject of ______________________________.

In compliance of the orders of Hon’ble High Court dated ______________ in

CWP No. __________________________

Advertisement Number : _____________________ Latest Passport size


photo of candidate
Name of Post Applied for: _____________________

1. Court Case details :

a) CWP No.

b) Name of Petitioner

c) Sr. No. of Petitioner

2. Fee details

Note: Demand Draft (DD) should be in favour of Secretary, Haryana Public


Service Commission, Panchkula

Name of the Bank ____________________

Demand Draft No. & Dated ____________________

Amount ____________________

3. Personal Details

Name of the Applicant (in Capital Letters)

Date of Birth

Age as on 14.08.2024

Father’s Name

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Mother’s Name

Gender (Male / Female)

Marital Status (Married / Unmarried)

Mobile Number

Email ID

Nationality

4. Are your domicile of Haryana? (Yes / No) ___________________

5. (i) Category ___________________


(General / SC/ BCA / BCB/ EWS) ___________________
(ii) Sub Category (if any) ___________________

Sub Category in case of ESM (Tick the correct option):

Disabled ESM who has not availed reservation for re-employment in


civil services yet.
Child (upto One only) of a Disabled ESM of Haryana who is eligible to
avail the benefit of reservation but has not availed it yet.
1. Family member of disabled ex-servicemen
Other ESM (other than disabled ESM) who has not availed reservation
for re-employment in civil services yet.
Child (upto One only) of an ESM (other than disabled ESM) of Haryana
who is eligible to avail the benefit of reservation but has not availed it
yet.
Ex-servicemen of Haryana who has secured employment in civil
services on regular basis in a Department / Board/ Corporation /
University etc. under Govt. of Haryana after already availing the benefit
of reservation.
Family members up to two (02) of Martyr Military Personnel who have
not taken benefit of compassionate appointment under ex-gratia policy.

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6. Fee Claim Category ____________________

7. Category for getting benefit of age relaxation __________________

Note: PwBD category candidates must write his/ her sub-category of i.e.
PwBD Low Vision, Hearing Impairment / Cerebral Palsy etc.

8. Are you child or grandchild of Freedom Fighter of Haryana? ____________


If yes, attach proof

9. Have your ever been debarred by UPSC/ HPSC/ other State


PSCs or any other Government Department? (Yes / No.) _____________

10. Have you ever been convicted by Criminal Court? (Yes/No) ____________

11. Are you an employee of Govt. of Haryana? (Yes/ No) _______________

12. Have you worked or are you presently working on _______________


adhoc/ contract/ work-charged/daily wages basis
in any Department / Board / Corporation of Haryana
Government?

If yes please give detail of experience and attached _______________


experience certificate.

13. Correspondence Address

Address _________________________

City/ Town / Village ________________________

Tehsil ________________________

District ________________________

State ________________________

Pin Code ________________________

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14. Is Permanent Address same as Correspondence address?

If No (Write Permanent Address) ________________________

__________________________________________________________

__________________________________________________________

15. Qualification Details as per Advertisement

Qualification Name of Subjects Marks Maximum Percentage Year of Division


the Board/ Obtained Marks of marks/ Passing
University Grade
Matric

Senior
Secondary

Graduation

Post
Graduation

B.Ed

HTET

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16. Bank Details of the candidates:- (for refund of fees, if required in future)

a) Name of the Account Holder ____________________________

b) Bank Account No. ____________________________

c) Name of the Bank ____________________________

d) IFSC Code ____________________________

Declaration by the Candidate

I, hereby declare that the above information is true to the best of my knowledge, I
am aware that Haryana Public Service Commission will be sending important on
my registered details. I agree that I have read the advertisement and ensured my
eligibility before applying. Also, I agree that I have read and understood all the
instructions specified in the advertisement and agree to abide by the same.

2. I have been allowed to apply provisionally in view of the interim orders dated
________________ passed by the Hon’ble Punjab & Haryana High Court in CWP
No. _____________ in which I am a petitioner at Sr. No. ______. My candidature
is subject to the final outcome of the above said writ petition.

Signature of the candidate

Enclosures:-

1. Copy of Court orders

2. List of all supporting documents attached with application forms.

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