Model Transfers Online Application Form

Government of Andhra Pradesh

Department of School Education

Application for Transfer

Date: 21/06/2012

Time: 12:27:31

Personal Details
1.District :	......................................................................
2.Zone Code :	......................................................................
3.Mandal:	......................................................................
4.Name of the individual seeking transfer :	......................................................................
5.Employee Code Number :	......................................................................
6.Employee Treasury Code :	......................................................................
7.Date of Birth :	......................................................................
8.Gender :	......................................................................
9.Maritial Status :	......................................................................
10.Category of the Post :	......................................................................
11.Subject :	......................................................................
12.Medium of School:	......................................................................
13. Management of the School (Government/Local Bodies):	......................................................................
14.Name of the School:	......................................................................
15.School Code:	......................................................................
16.Category Of the School (Ex:I,II,III,IV) :	......................................................................
17. Whether the individual has completed 8 yrs of service as on 1st July, 2012 in all categories of posts  including the service rendered in the school prior to upgradation or bifurcation : (If Yes, Furnish the Date of Joining)	......................................................................
18.Whether the Individual is male Headmaster Grade-II/Teacher aged below 50 years as on 1st July, 2012 of the year and working in Girls High School :	......................................................................
19.Whether the Individual is working in a school  where the pass percentage in the S.S.C. Public Exam (March) is less than 10%. (Yes /No):	......................................................................
20. Date of First Appointment in service:	......................................................................
21. Date from which the individual is working in the present School in all categories of posts including prior to upgradation/bifurcation:	......................................................................
22 .Whether he/she is President or General Secretary of the District/State of Recognized Association (Yes /No):	......................................................................
23.  Whether spouse is employee of State Govt/Central Govt/Public Sector Undertaking/Local body / Aided Institution in the same district(in the same zone for Gazetted Head Master, Gr.II in Govt Schools)  (Yes /No):	......................................................................
24. Whether the teacher availed the benefit under special category for spouse during the last 8 years as on 01-July-2012 (Yes /No):	......................................................................
25. Whether the individual availed the benefit under Preferential category during the last 8 years as on 01-July-2012 (Yes /No):	......................................................................
26.  Whether the individual Wants to claim under Preferential category(Yes /No):	......................................................................
27.  Performance Parameters(Yes/No):	......................................................................

Note :A Copy of  certificate issued by the competent authority shall be enclosed to the Application form to consider their  cases under special category or Preferential Category  for the items  22,23,25,26.

DECLARATION

I hereby declare that the information furnished by me is correct. If any information found to be incorrect/false, my candidature can be cancelled and action may be initiated against me as per rules Signature of the Applicant

CERTIFICATION
I hereby certify that the above particulars are verified and found correct.
Place:	Signature of the HM/MEO/DyEO
Date:	Stamp