Application Probation
Application Probation
PROFORMA
1. 2. 3. 4. Name of the incumbent Designation Subject Name of School with School code District and pincode 5. Date of Birth 6. Date of superannuation 7. Phone No. of School with STD code & Mobile No. 8. Pay and Scale of Pay 9. Date of joining Higher Secondary Education service with designation and school with school code of first posting 10. If appointed by transfer as HSST from the post of HSST (Jr) (i) Specify order No. and date (ii) Date of joining in the post of HSST 11. Whether enrolled in a) PF : Yes/No b) SLI : Yes/No c) GIS : Yes/No (Specify the account No. correctly) 12. Whether availed any leave other than C/L during the period of probation If yes, furnish details If No, Nil should be written in the column shown below
Nature of Leave From To
: : : : : : :
: : :
Suffix/Prefix if any Total period of Leave
13. Whether participated in strike during the probation period If yes, furnish details : 14. Whether any disciplinary action was initiated against the teacher during the probation period. If yes furnish details. : 15. Details of joining date as HAS/UPSA/LPSA (a) No. and date of PSC advice with Sl.No. and district : (b) Date of joining service as HAS/UPSA/LPSA : (c) Details of Inter District Transfer if any, (Date of joining in new district to be Furnished) : (d) No. and date of PSC advice with Sl.No., if appointed in another district : (e) Order No. and date of order if appointed as HSA by promotion : (f) Date of declaration of probation in the post Of HAS/UPSA/LPSA : (Specify order No. and date) 16. Educational Qualifications : (Original Certificate and Mark Lists are to be produced at the time of verification).
Name of University from which EC Obtained & Details of course certificate
Qualificati ons
Univeristy/ Board
Service History Name of School with School code & District Date of joining Date of Leaving Appointment/Placement Order No. and Date
Designation
18.
I............................................(Name).......................................(Designation) ...........................................................................(School) hereby certify that all the details given above are correct to the best of my knowledge and belief. Place : Date : Signature Name :
19.
CERTIFICATE
Certified that the details furnished above have been verified with the service records of the incumbent and are found correct. Further it is certified that during the probation period the work and conduct of Sri/Smt............................................................................HSST/HSST (Jr) in ....................... is good/satisfactory/not satisfactory (strike off whichever is not applicable) ...........................................we.......................further certified that the incumbent is fully qualified for the post of HSST/HSST (Jr) ......................................as per Special Rules. Recommended that he/she may be declared to have completed the period of probation the post of HSST/HSST (Jr)........................................satisfactorily with effect from ...................................
Office Seal
Place Date
: :