S-2(a) HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION DHARAMSALA-176213 ACCEPTANCE FORM Note:1. This form will not be accepted if any column is left blank. The word "NIL" must be shown against those columns which are not to be filled. 2. No correspondence will be made regarding discrepancy found, if any. The particulars stated by the examiner will be considered as correct and his eligibility will be determined accordingly . 3.No one can act as Sub-Examiner for more than three years consecutively may it be in any paper, subject or examination. 4. No one can be appointed in two major subjects paper or examination in the same year. 5. All the columns should be filled in legible and neatly. MIDDLE/MATRIC/PLUS ONE/PLUS TWO EXAMINATION,200 To Shri........................................ Reference No.......................... Section Officer(Secrecy-I) Himachal Pradesh Board of School Education Dharamsala-176213 Dear Sir/Madam, With reference to your letter No..............................dated.............................. I am to inform you that I am WILLING/NOT WILLING to act as an examiner in the subject of ...........................paper.....................for the Middle/Matriculation/Sr.Sec.(+1/+2)examination to be held in March/September,200 , under the conditions mentioned in your letter quoted above, I will strictly observe all the rules and I give my full particulars in this connection as required by the Board of School Education. 1.Name in full(in block letters)........................................................................... 2. Father,s Name................................................................................................ 3. Academic qualifications with subject passed: (a)F.A./F.Sc............................... (b)B.A./B.Sc............................... (c)M.A./M.Sc.............................. (d)B.T.or B.Ed............................. (e) Any other examination.......... 4. Address for dispatch of answer books to me.................................................. 5(a) Name of Post office with distance ...............................Km........................ period required in transit for Regd. Parcels to reach you.............................. (b) Telegraph Office with distance..................................................................... (c) PERMANENT HOME ADDRESS with Telephone No............................. ..................................................................................................................... 6. I am competent to examine the answer books in the following scripts out of Hindi, Punjabi and Urdu, having passed the examination noted against each. Preference will be given to those who are competent to marks in Hindi, Punjabi and Urdu. SCRIPT: EXAMINATION PASSED IN THE RELEVANT SCRIPT (i)............................... (ii) ............................. (iii).............................. (iv).............................. Note:-If you have not passed any examination in a script but you consider yourself competent this fact may be clearly stated. Downloaded from: http://hpeducationlboard.nic.in Page 1 of 3 7. Date of birth(in Christian era)................................................................................ 8. Correct Registration No. with subjects for which Regd.(i) Middle/Matriculation ............................................................................................................................. (ii) Sr. Secondary (+1/+2)................................................................................. 9. Also quote Regd. No., if Regd .for examinations others than Middle/Matriculation/ Sr. Secondary examination. 10. NAME AND ADDRESS OF THE AFFILIATED ................................... MIDDLE/HIGH/SR.SEC.SCHOOL IN WHICH Middle/High/Sr. Sec. School WORKING AS TEACHER AT PRESENT. .....................Distt................ (Persons not in service due to retirement or some other reasons must give clear indication of their position). 11. If a retired teacher, please state the Date of retirement.................................. and name of the School from which retired..................................................... 12. TOTAL TEACHING EXPERIENCE TO (a)Middle classes in affiliated schools..................... (b)High classes in affiliated schools............................ (c)Sr. Secondary classes 13.Seniority Number Total teaching experience............................................ 14.(a) Subject being taught to Middle/High/+1/+2 classes at present..................... (b) Subject taught during the last three years...................................................... (c) Subject taught to classes at present............................................................... (d) Subject taught during the last three years...................................................... IMPORTANT:-Have you ever been disqualified for any Board/University? if so clearly mention the same, with the period of disqualification. From............................To................................................ 15. (a) Are you working in Middle/High/Sr. Sec. School or as B. E. O. at present: .............................................................................................................. (b) If so mention the date and the year of your transfer to Middle/High /Sr. Sec. School or appointment as B. E. O. or having stopped teaching to Middle /High Sr. Sec. classes. Since month.......................year 16. (a) Are your appearing in any University Examination?(a).................. (b) If so, mention the name of examination. (b).......................... (c) State whether appearing privately or regular (c)........................... Important Note:-16. Have you received any other appointment or availability letter for this or any other examination? If so, give detail for the same with reference number and also give your preference for one as no one can act in 2 different major examinations and subjects in the same year. Omission to mention any year of assignment in another examination would render a person liable for disqualification. I hereby declare that I have already acted or I am still acting as a Examiner/Head Examiner or Paper setter in the following examination of the H.P. University/Board of School Education, Himachal Pradesh(This means any examination of this Board/University). Details for Theory Papers only Year Head or Sub- Subject and Idenity No. Mention year when appoint- Examiner ship Paper -ment offered and was in Middle/Matric/ refused indicating reasons or Sr.Sec.Exams. for refusal. 1995 ................................................................................................................................... 1996 .................................................................................................................................... 1997 .................................................................................................................................... 1998 Downloaded from: http://hpeducationlboard.nic.in Page 2 of 3 ..................................................................................................................................... 1999 .................................................................................................................................. 2000 ..................................................................................................................................... 2001 ................................................................................................................................. (Present officer is also mentioned against the year concerned) I will inform immediately the Secretary, if disqualification intimation is received by me after the submission of the acceptance form without fail under registered cover and I am not working consecutively for the fourth year in any examination of the Board. Yours faithfully Dated........ Signature of Examiner(in full) Declaration for the examiners who have not qualified in English atleast of the Matric Standard I do hereby solemnly declare that I posses working knowledge of English. Note:-Examiners in the subject of Hindi, Punjabi, Urdu and Sanskrit should sign at both the places. Signature of Examiner(in full) CERTIFICATE BY THE HEAD OF THE INSTITUTION Certified that Shri / Shrimati.......................................is working as a teacher to Middle /High /Senior Secondary+1/+2 classes at present and facts stated by him/her are correct to the best of my knowledge. He/She is not working as an examiner consecutively for the fourth year or in any other subject or paper for the Matriculation or any other examination of the H.P. University. The school has been recognised permanently. Further certified that Shri / Shrimati.....................................is/has been teaching to Middle/High /Sr. Secondary classes for ...............................year the subject of......................for which he/she has been appointed. He/She is registered for the subject of..............................under Registered No................His/her total teaching experience to High/Sr.Secondary classes is...................year. He/She is the real appointee. Signature of Head of the Institution.................. (in full) Note: Attesting Authority is requested........................Middle/High/Senior Secondary schools to check that the facts by the examiner are correct and.............. District ...........................nothing have been concealed. (Stamp of the School must be affixed) The retired teachers must get their acceptance form duly attested and certified by the Headmaster of a recognised High/Senior Secondary School or by the Principal of an affiliated college. The B.E.Os. should send their form through D.E.O. FOR USE IN THE OFFICE Discrepancy ,if any...................................... Action taken Signature in full Checked by Rechecked by. Test check applied by Assistant/Superintendent. Downloaded from: http://hpeducationlboard.nic.in Page 3 of 3
