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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-----------------

izekf.kr fd;k tkrk gS fd eSa izkFkhZ }kjk fn;s x;s eSa izekf.kr djrk gwa fd mijksDr nh xbZ lwpuk lgh gSA
mi;qZDr rF;ksa ls lUrq"V gw¡] izkFkhZ bl laLFkk esa xyr ik;s tkus ij cksMZ esjs fo:) tks Hkh dk;Zokgh djsxk]
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---------------------------------------------------------
¼f’k{k.k laLFkk iz/kku gksus dh n’kk eas mPp vf/kdkjh }kjk vxzsf"kr gksuk pkfg;s½
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
fu;e@'krsZa

1- fu;fer :i ls in ij fu;qDr v/;kid ijh{kd cu ldrs gSAa


2- vfrfFk f'k{kd] iqLrdky;k/;{k] iz;ksx'kkyk lgk;d] 'kkjhfjd f'k{kd o okMZu ijh{kd cuus ds ik=
ugha gSAa
3- dEI;wVj foKku fo"k; ds v/;kid viuh ;ksX;rk dh QksVks&izfr;kWa djokdj vkosnu i= ds lkFk
layXu djsaA M. Tech/ C-Level/ B.E./ M.C.A./ B-Level/ M.Sc./ B. Tech./ B.Sc./ A-
Level/ PGDCA ;ksX;rk okys v/;kid ijh{kd cu ldrs gSa
4- T;ksagh] in vFkok irs esa ifjorZu gks rks d`i;k bldh lwpuk viuh iath;u la[;k dk gokyk nsrs
gq, 'kh?kz lwfpr djsAa
5- mPp ek/;fed esa dsoy ,d fo"k; esa rFkk ek/;fed esa nks fo"k;ksa esa iathdj.k djk;k tk ldrk gS
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
6- ,sls lsokfuo`r f'k{kd ftudk iath;u iSuy ls gV x;k gS rFkk os ewY;kadu dk;Z djus ds bPNqd gSa]
os iqu% iath;u gsrq vkosnu i= vafre dk;Zjr laLFkk ¼tgka ls lsokfuo`r gq, gSa½ ds laLFkk iz/kku ls
vxzsf"kr djokdj izsf"kr djsAa ijh{kd cuus dh vf/kdre vk;q 70 o"kZ gSA
7- vkosnu i= cksMZ }kjk fu/kkZfjr izk:i o bldh QksVks izfr ij gh Lohdk;Z gksxkA vkosnu i= cksMZ
osclkbV www.rajeduboard.nic.in ij Hkh miyC/k gSA
8- viw.kZ vkosnu i= ij fdlh Hkh fLFkfr esa fopkj ugha fd;k tkosxk vkSj u gh bl lEcU/k esa i=
O;ogkj fd;k tkosxkA
9- ,d ls vf/kd ckj iath;u djkus okys ijh{kdksa dk iath;u fujLr dj mUgsa ijh{kd dk;Z ls oafpr
dj fn;k tk,xkA
10- futh f'k{k.k laLFkk ds v/;kidksa ds vkosnu i= lacaf/kr ftyk f'k{kk vf/kdkjh ¼ek/;fed½ ds ek/;e
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
12- ek/;fed ijh{kk ds fy, iz/kkuk/;kid] O;k[;krk ¼Ldwy f'k{kk½] ofj"B v/;kid] lgk;d v/;kid
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
14- vkosnu i= ij viuk uohu vko{k fp= fpidkosaA
15- izfro"kZ Qjojh ekg rd ijh{kd fu;qfDr gsrq lgefr i= izkIr ugha gksus dh fLFkfr esa rqjUr dk;kZy;
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

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