Thursday, May 28, 2009

GVVK

Annexure – II

G.O.Ms.No.53, SW (TW.Ser.III) Dept., Dt. 28-6-2005

Application seeking transfer through counseling

(to be filled in by the applicant teacher/ Hostel Welfare Officer)

    1. Name of the teacher / Hostel Welfare Officer:

    1. Gender :

M

F



    1. Qualification



    1. Date of Birth





D D M M Y Y

    1. Present post held



    1. Posts and tenure starting with present post.



Sl.No

Post & place held

From (dd/mm/yyyy)

To

(dd/mm/yyyy)

I



Ii



iii



iv



V



Special Considerations:

    1. Whether seeking retention beyond (8) years at the place/or/transfer without completing (3) years tenure.

Y

N

2.2 If so under which category? (Please fill in the code number and for code

numbers see below)



2.3 Whether principal office (Dist. / State Level) bearer of any recognized service

association (if so furnish a certificate/ documentary proof from State body)

Y

N

    1. Whether taking up NCC/ Scouting program in the school?

Y

N

    1. Whether yourself along with your spouse willing to work in a category – IV

institution, if so mention the preferential location.

Y

N

Name of the institution and place

2.6 In case your spouse is working in a non-transferable post, please furnish the

details along with a certificate from employer /head of the institution.

Y

N

Entitlement points

3.1 places worked for the last (8) years (please see para 11.A (i) of the

G.O.Ms.No.53, SW (TW.Ser.III) Dept., Dt. 28-6-2005)

From

To

Name of the institution

Location falls under which category

No.of points earned as per location of the institution



3.2 Results secured in ClassVII in case of UP School / Class X in case of High School

(Please see para 11.C (i) of the G.O)

Year

No. appeared

No passed

% Pass

Points earned

2009

    1. Status of enrolment /retention as on 23/4/2005 (Academic performance) (for Primary Schools only) (Please see para 11.B(i) of the G.O.)



No. of school age children as per school census register

Admitted as on

31-07-2008

Total children on the rolls of the school as on 23-4-2009

% enrolment

% retention

Points earned for enrolment

Points earned for enrolment and retention put together



Total

    1. Non-academic participation (for all Schools) (Please see para 11.A(ii) of the G.O)

Sl.

No.

Level of various competitions

No. of Children sponsored 2008-09

Event

Date

Points earned

1

District Level

2

State Level

3

National Level

(Please attach proof from Head of the Institution)

3.5 Non-academic achievement (for all Schools): (Please see para 11.A. (iii) of

the G.O.Ms.No.53, SW (TW.Ser.III) Dept., Dt. 28-6-2005)

Sl.

No.

Level

No. fo Prizes Merit certificates received by the Children during 2008-09

Event

Date

Points earned

1

District Level

2

State Level

3

National Level

(Please attach copies of certificates)

    1. Professional achievements of staff: (Please see para 11.A(iv) of the G.O)



Sl.

No.

Nature of award

received

Date

Awarding authority

Points earned

1.

2.

3.

3.7 In case of Primary Schools (for improving retention of girl children) (Please

see Para 11.B (ii) of the G.O.Ms.No.53, SW (TW.Ser.III) Dept.,

Dt. 28-6-2005)


Total girl children enrolled in the school during 2007-08 (as on 31-7-2008)

Total girl children on the roll of the school as on 23-4-09

% retention

Points earned for retention of girl children

3.8 Retention in Upper primary /High Schools (please see para 11.C (ii) of the

G.O.Ms.No.53, SW (TW.Ser.III) Dept., Dt. 28-6-2005)

Enrolled as on 31-7-2008

In the roll as on 23-4-2009

% retention

Points earned

    1. Total entitlement points earned



120

for Upper Primary Schools and High Schools

(3.1+3.2+3.4+3.5+3.6+3.8)

  1. for Primary Schools

(3.1+3.3+3.4+3.5+3.6+3.7)



3.10(i) I certify that the above information furnished is true to best of my

knowledge. I will be liable for disciplinary/ prosecution in the event any

information is found to be wrong .

Name and Signature of the applicant

3.10 (ii) I have verified the data with the Service Register of the individual

and also with available schools record and I attest the correctness of

the data furnished above.

Signature of the Headmaster/ Headmaster of Paycenter

(for Teachers of Ashram Schools/ Primary Schools)

I have verified the date with the Service Register of the individual

and also with available school/hostel record and I attest to the

correctness of the data furnished above.

Signature of the DTWO

(for Headmasters of Ashram Schools and Hostel Welfare Officers)













Code Numbers:

Sl.

No.

For filling up column 1.3

Code

Nos.

For filling up column 2.2

Code

01

P.G. Headmasters

01

Physically challenged

(70% and above)

01

02

School Assistant (Science)

02

Single Women

02

03

School Assistant (English)

03

Major Surgical Operation

03

04

School Assistant (Maths)

04

Having Mentally challenged children

04

05

School Assistant (Social Studies)

05

06

Telugu Pandit Gr. - I

06

07

Telugu Pandit Gr. - II

07

08

Hindi Pandit

08

09

Physical Education Teacher

09

10

Secondary Grade Teacher

10

11

Musical Training Instructor

MUSIC/Dance/Craft

11

12

Hostel Welfare Officer Gr. II

12

13

Hostel Welfare officer Gr.I

13

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