TELANGANA RESEDENTIAL EDUCATIONAL INSTITUTIONS RECRUITMENT BOARD.

HYDERABAD
JUNIOR LECTURERS in TREI-RB NOTIFICATION NO: 03/2018
BASIC INFORMATION DATA
(CHECK LIST)
(To be filled by the candidate)

HALL TICKET NO Paper – I :

Paper – II & III :
PHOTO OF THE
CANDIDATE
DATE OF VERIFICATION:

Signature of Candidate
Name of the
01 Candidate
( as per SSC)

02 Father’s Name

Mother’s
03
Name

04 Gender Male Female Others

Date of Birth D D M M Y Y Y Y
05
( as per SSC)

(Age as on Years Months days

06 01/07/2018)

1 2 3 4 5 6
Name of
Date of the
Subject
Qualifi acquiring Max Marks % of
Method University
cation qualificat Marks Secured Marks
ology
ion

Degree

PG
Notification

Qualifi
As per

07 cation B.Ed
(as on
31/07/
2018) TET

Official use :
 OC SC ST BC

Community A B C D E
(integrated
Community
Certificate
Issued by
1. Caste certificate issued by Telangana Govt Yes/No
Tahsildar
8
for SC/ST/BC 2. Certificate No Dt:
from
Telangana
State Govt) 3. Official use:

BC Candidates Whether non-creamy layer YES NO

should Submit certificate produced
Non Creamy
Layer
certificate as
per 1. Date of issue of Non-Creamy Layer certificate:
G.O.Ms.No:8 2. Certificate No Dt:
of 2014
09
& 3. Official use:

MemoNo.3009
/BCW/
OP/2011,
Dt:18-12-2015.

VH HH OH

1. Percentage of Disability

PH –Category 2. Certificate No Dt:

10

3. Official use:
 If age
relaxation is Whether relevant Certificate
claimed, Years Produced
specify
(No. of years claimed for YES NO
.
1) Retrenche relaxation)
d Census
Employee
2) Telangana
State
11 Govt. Official use:
Employee
3) N.C.C
4) Ex-Service
Men
5) SC/ST and
BC

Erstwhile
Class Year State
Indicate the District
evidence IV
(Original Study
Certificate to
be produced) V
OR
12
Residence VI
certificate for
7 yrs. Prior to VII
SSC if private
Study. VIII

IX

X
Erstwhile
District and
13
erstwhile Zone
you belong to.

Present
Employment
details
Official use:
14 (Government
Employees
should submit
NOC)
 Declaration

I hereby declare that

i) All the columns filled in by me containing my biodata and other particulars, are true
to the best of my Knowledge.

ii) The certificates such as, my educational qualification, community certificate, date of
birth (SSC), study/residence in support of my claim for local candidature are genuine.

iii) I did not resort to any irregular or improper means in connection with my candidature
for selection.

iv) I am liable for permanent debarment from appearing for the recruitment to be
conducted by TREIRB and other PSCs and also criminal prosecution, if I am found
involved in any unfair means / malpractice.

15
v) I further declare that the information furnished by me is correct and my candidature
shall be cancelled at any stage if it is found incorrect.

Address.

………………………………………………….

…………………………………………………

…………………………………………………..

Mobile No…………………………………

Place:
Date: Signature of the candidate.

TO BE USED FOR ADMISSION (OFFICIAL USE)

The Candidate Provisionally Admitted for further process for selection.

Verification CVO Camp

Officer In-charge

TO BE USED FOR REJECTION

The Candidate Rejected for further process of selection with the following reason.

Section OSD EO (Convenor)

Asst

CHAIRMAN
 1

ATTESTATION FORM
Latest colour
(THE CANDIDATES SHOULD PROPERLY FILL THE ATTESTATION passport size
FORM WITH HIS/HER OWN HAND WRITING) Photograph of
the candidate

Name of the
Post
Signature of the Candidate

1.(a) Name in full (capital letters only with aliases, if any. Please indicate if you
have added / dropped at any stage any part of your name/surname.

SURNAME

NAME

GENDER:

(b) Designation of the candidate with category (Appointment by Direct

Recruitment
Enclose supporting certified copies of the documents

(i) Designation
(If presently working)

(ii) Place of Working

(iii) Direct recruitment

2. Details of addresses:
a. Present b. Permanent

House/Apartment/Flat No.

Name of Apartment

Lane Name

Street & Road

Village

Mandal / Taluk

Town / City

Erstwhile District
 2

State

Pin Code

Landline office Landline Residence

Mobile
(with STD Code) (with STD Code)
Contact Phone Numbers

(c) If originally a resident

Of Pakistan, the address
in that Dominion and the
date of migration to Indian
Union

3. Particulars of places where you have resided during the preceding Seven years
from the date of filling up of Attestation From.

Residential Address in full

( i.e., House / Apartment /
Flat Number)
From To Police station and
( Apartment/Complex/Lane/
(Month / Year) (Month / Year) District
Street/Colony and Road,
Village,Mandal and District/City)

1
2
3
4
5
6
7

4. Father’s details:
(a) Name in full with aliases, if any

(b) Profession

(c) If in service, give designation and

official address

(d) Present postal address (if dead, House No.

give last address
Lane Name
Street & Road
Village/Mandal
Dist
State
Pin Code
 3

(e) Permanent House Address House No.

Lane Name
Street & Road
Village/Mandal
Dist
State

Pin Code

5. (i) Nationality of:

(a) Father

(b) Mother

(c) Wife / Husband

(ii) Place of Birth of Wife / Husband

6. (a) Date of birth of the applicant

(b) Present Age

(c) Age at SSC / Matriculation

7. (a) Place of birth, Erstwhile District and State

(b) Erstwhile District and State to which you belong

8. (a) Religion

(b)Are you member of Scheduled Caste / Scheduled Tribe / Backward Class?

Non Creamy
Scheduled Tribe Layer
Backward Class
Scheduled Caste
Creamy
S.T Agency
Layer
Area

Please specify the Class / Tribe Grade A,B,C,D & E

9. Physically Handicapped: VH HH OH
 4

10. Educational Qualifications showing places of education with years in schools and colleges since 15th
year of age (Please enclose certified copies of Study Certificates and indicate whether study is
regular or distance / correspondence).
Name of the
School / Examination
Date of Date of
College with passed with
entering leaving Police
Sl.No full address Reg.No.etc.
Course (mention (mention Station and
(Village / (Name of the group
month month District
Mandal i.e.,Inter/Degree/
& year) & year)
/ District / Diploma/ PG,etd
City
SSC/
1
Matriculation

Intermediate/
2
Diploma
Graduation/
3 Professional
Course
Post
4 Graduation

B.Ed /
5
Equivalent

Any other
6
qualification

Degree Maximum Marks:

Degree Marks Secured:
Degree Percentage of Marks:

PG Maximum Marks:
PG Marks secured:
PG Percentage of Marks:

B.Ed. Maximum Marks:

B.Ed Marks Secured:
B.Ed Percentage of Marks:
B.Ed Methodology 1. Methodology 2.

School Education Details

Class IV
School Name:
Erstwhile Dist:
Zone:

Class V
School Name:
Erstwhile Dist:
Zone:
 5

Class VI
School Name:
Erstwhile Dist:
Zone:

Class VII
School Name:
Erstwhile Dist:
Zone:

Class VIII
School Name:
Erstwhile Dist:
Zone:
Class IX
School Name:
Erstwhile Dist:
Zone:
Class X
School Name:
Erstwhile Dist:
Zone:

11. If you have at any time been employed, give details, (Please enclose certified copies of
the documents).
Have you been at any
Designation of Post Period Full Address of the time dismissed /
held or description of Office, Firm or removed from service /
work From To Institution resigned to the post? If
so, please give details.

12. Have you ever been arrested by the police, convicted by a Court of law or detained under any
state /central preventive detention laws for any offence? Whether such conviction sustained in
the Court of Appeal or set aside by the Appellate Court if appealed against.
(Note: If detailed, convicted, debarred etc. subsequent to the completion and submission of this
form, the details should be communicated immediately to the concerned Department or the
authority to whom the Attestation Form has been sent earlier, as the case may be, failing which it
will be deemed to be suppression of factual information). If the answer is ‘Yes’, the full
particulars of the conviction, sentences and detention should be given.
 6

13. Name and complete address of two responsible persons of your locality to whom you are known or
two referees to whom you are known. (Persons shall not be blood relatives).

House/Apartm
ent/Flat No.

Name of Apts./
Complex

Lane Name

Street & Road

Village

Mandal/Taluk

Town/City

Erstwhile District

State

Pin Code

14. Have you ever been member/worker of any Political Party or Communal
organization/Youth/Student/Service/Labour? If so furnish details
 7

DECLARATION SHOULD BE SIGNED BY THE CANDIDATE

1. I here declare that the statements made in this form are true to the best of my knowledge and
belief.

2. I am married/unmarried and have only one wife living (delete which is not applicable).

3. I am fully aware that furnishing of false information or suppression of any factual information
in the Attestation Form would be a disqualification and is likely to render me unfit for
employment under the Government.

4. I am also fully aware that if it comes to notice at any time during my service that false
information has been furnished or that there has been suppression of factual information in the
Attestation Form, my services would be liable to be terminated solely on this ground.

Date: Signature of Candidate

Place:

CERTIFICATE TO BE SIGNED BY A GAZETTED OFFICER OR MEMBER OF

LEGISLATURE OR OTHER AUTHORITY AS PRESCRIBED BY THE
APPOINTING AUTHORITY

Certified that I have known Sri / Smt / Kum.

Son / Daughter / Wife of

For the last years months and to the best of my knowledge and belief,

the particulars furnished by him / her are correct.

Date: (Signature)
Name & Designation with Seal
Place:

Photograph of the
candidate attested
by Gazetted Officer
/ MLA / other with
seal of Competent
Authority