S.6(A) HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION DHARAMSALA-176213 ACCEPTANCE FORM Reference No...................... N.B .-1. The eligibility will be determined according to the facts communicated herein and no correspondence will be made in this connection. This form will not be accepted if any of the column is left blank. Cross 'X' mark must be shown against those columns which are not required to be filled in. 2. No one can be appointed in two major subjects, papers of examination in the same year. 3. Head examiners cannot be appointed for more than three years(including sub-examiner ship)consecutively. Head Examiner ship / for Middle/Matric/+1/+2 Examinations, 200 To Shri................................ Section Officer(Secrecy) H.P. Board of School Education Dharamsala-176213 Dear Sir, With reference to your letter No....................................dated................... I am to inform you that I am WILLING/NOT WILLING to act as Head-Examiner/ in .........................................paper.............................. for Middle/Matric/+1/+2 Examination 200................................ under the conditions mentioned in your letter quoted above. I will observe all the rules. 1. Name (in block letter)................................................................................... 2. Father's Name................................................................................................... 3. Academic qualifications with subjects passed and Division. B.A../BSc ........................................................................... M.A./M.Sc. .............................................................................. B.T.or B.Ed. ............................................................................... Any other examination. .................................................................... 4. Address (for answer books)........................................................................... Tehsil..................................Distt.............................Pin code.......................... 5. A Telegraph office with distance..................................................................... 6. Permanent home address with Telephone No................................................. ......................................................................................................................... Railway Out Agency....................................................................................... 7. Date of birth...............................Regd. No. for Head Examiner ship (also quote Regd. No. for other examination, if any). 8. Name and place of the recognised Middle/ High/Senior ............................... High/Senior Secondary School/College in which working as Headmaster/Principal Lecturer at present. Secondary School/College.........................................District.......................... Downloaded from: http://hpeducationboard.nic.in Page 1 of 3 9.Persons not in service should indicate date of retirement or reasons for not being in service................................................................................................. 10. Scripts (Hindi ,Punjabi and Urdu) in which competent to examine the answer books.......................................................... 11.Teaching Experience (subject-wise)to:-Subject Years Months (a) VIII class ........... ........... ................. (b) High Classes ........... ........... ................ (c) Sr .Secondary ........... .............. ............... Total teaching experience (excluding teaching experience of Middle Classes)............................................................................................................. 12. (a) Have you written any book to be used at any stage............................ (b) If so mention the books written by you.1..............2......................... 3.........................4.............................5................................6........................... 13(a) Have the books written by you been approved by the D.U.I or Director of Education, Himachal Pradesh...................................................................... (b) If so, mention letter No. and date under which the books were approved (1) Letter No................................................... (2) Date........................................................... (A book which has not been approved either by the D.U.I or by Director of Education, Himachal Pradesh shall be considered as a guide or help-book). I certify that..........................Railway Station/Railway Out Agency.............. is at a distance of ........................miles from my headquarters, where I shall receive the scripts. I shall make necessary arrangements for receipt and dispatch of answer books at my own cost and no. T.A. etc. will be claimed on this account. I hereby declare that I have already acted or am still acting as Examiner/Head-Examiner or Paper Setter in the following examination of the Board/H.P. University (This means examination in any faculty of this Board) Omission to mention any year or any assignment in another examination along with this appointment would render a person liable for disqualification and forfeiture of his remuneration). 14.Seniority Number If you have already been appointed or continuing as examiner in any exam., please note "I prefer............................Examination." Year Exam. Sub/Head Examiner ship Subject Paper Id. No. Regd. No. 1995.................................................................................................................. 1996.................................................................................................................. 1997................................................................................................................. 1998................................................................................................................ 1999............................................................................................................... 2000............................................................................................................. 2001............................................................................................................. Examiner's Signature Downloaded from: http://hpeducationboard.nic.in Page 2 of 3 PRESENT OFFER IS ALSO TO BE MENTIONED AGAINST THE YEAR CONCERNED. I ....................................................the Examiner certify................................... (a) That I have neither been disqualified nor warned for any negligence from any Board/University work assigned to me. I shall inform the Asstt. Secretary (Evaluation). If disqualification intimation is received by me after the submission of the acceptance form. (b) That I have received no other appointment letter either for Head/Sub-Examiner ship except this one for the same subject or in any other examination of this Board. (c) THAT I AM NOT A MEMBER OF THE SCHOOL BOARD. (d) That I am not working consecutively for the fourth year as Sub/Head Examiner in any examination of this Board. (e) That I am not acting as Centre Superintendent for the Matric/Sr.Sec.Exams.,200 . (f) That my son/daughter is not appearing in this examination this year. (SIGNATURE IN FULL) Designation with stamp of the Institution. Downloaded from: http://hpeducationboard.nic.in Page 3 of 3
