ANNEXURE I

ACCEPTANCE OF OFFER OF APPOINTMENT

I, _______________________________________ hereby accept the offer of appointment

to the post of ___________________________________________________in Kendriya
Vidyalaya, _________________________________________________made in your Memo
No_______________________________________ dated __________________ and also the
terms and conditions mentioned therein. I agree to join duty at the place and on the date
indicated therein.

Signature: _______________________
Name in BLOCK letters ___________________________
Dated. ___________________

To
The Principal,
Kendriya Vidyalaya

_________________

==================================================================
ANNEXURE I

ACCEPTANCE OF OFFER OF APPOINTMENT

I, _______________________________________ hereby accept the offer of appointment

to the post of ___________________________________________________in Kendriya
Vidyalaya, _________________________________________________made in your Memo
No_______________________________________ dated __________________ and also the
terms and conditions mentioned therein. I agree to join duty at the place and on the date
indicated therein.

Signature: _______________________
Name in BLOCK letters ___________________________

Dated. ___________________

To
Deputy Commissioner,
Kendriya Vidyalaya Sangathan,
Regional Office,
Picket SECUNDERABAD-500 009

___________________
 ANNEXURE II

MEDICAL CERTIFICATE

Name of the Candidate for appointment

(in BLOCK LETTERS)
Caste or Race

Residence Address

Father’s Name and Address

Date of Birth By Christian Era

Exact Height by measurement
1.
Personal Marks of identification
2.

I do hereby certify that I have examined Shri/Smt/Kumari _________________________

________________________________ a Candidate for employment in Kendriya Vidyalaya
____________________________________________________ and could not discover that
he/she has any disease communicable or otherwise constitutional affliction, or bodily
infirmity, except ____________________________________.

She is now pregnant / not pregnant.

I do not consider this a disqualification for employment in the Kendriya Vidyalaya,

_____________________________. His/her age according to his/her own statement is
_____________ years and he/she appears about ____________ years.

Left hand thumb and finger

impression of the Candidate

Signature of the Candidate

Taken before
Name of the Officer
Signature of the Officer
Designation of the Officer (This
Office should be CIVIL SURGEON
Or MEDICAL OFFICER of equal
rank)

On (Date: ____________________

ANNEXURE III
 DECLARATION

I, Shri/ Shrimati / Kumari ___________________________________________ declare as

under :-

*(a) That I am unmarried/a widower/widow.

*(b) That I am married and have only one wife living.

*(c) That I am married and have more than one wife living. Application for grant of
exemption is enclosed.

*(d) That I am married and that during the life time of my spouse, I have contracted
another marriage. Application for grant of exemption is enclosed.

*(e) That I am married and my husband has no other living wife, to the best of my
knowledge.

*(f) That I have contracted a marriage with a person who has already one wife or more
living. Application for grant of exemption is enclosed.

2** I solemnly affirm that the above declaration is true and I understand that in the (event)
of my declaration being found to be incorrect after my appointment, I shall be liable to be
dismissed from service.

Signature :_________________________
Date: _________________

*Delete clauses not applicable.

**Applicable to the cases of clauses (a), (b) and (c) only.

ANNEXURE IV
KENDRIYA VIDYALAYA SANGATHAN

CANDIDATES STATEMENT AND DECLARATION

 The Candidate must make the statement required below prior to his/her Medical Examination and
must sign the declaration appended thereto. His/her attention is specially directed to the warning
contained in the note below:
1. State your name in full
(in BLOCK LETTERS)
2. State your Age and place of birth
3. (a) Have your ever had small pox, intermittent or any other
fever, enlargement of suppuration of glands, spitting of
blood, asthma, heart disease, lung disease, fainting attacks,
rheumatism, appendicitis?
OR
(b) Any other disease or accident requiring confinement to
bed and Medical or Surgical treatment?
4. When you were last vaccinated?
5. Have you suffered from any form of nervousness due to
over work or any other cause?
6. Have you been examined and declared unfit for Govt.
service by a Medical Board within the last three years?
7. Have any of your near relations been afflicted with
consumption, scrofula; gout, asthma, fits, epilepsy or
insanity?
8. Furnish the following particulars concerning your family:
Father’s age if living Father’s age at Death No. of Brothers living, No. of brothers dead,
and state of health and cause of death their age and state of their age at the death,
health cause of death

Mother’s age if Mother’s age at Death No. of Sisters living, No. of Sisters dead,
living and state of and cause of death their age and state of their age at the death,
health health cause of death

I declare that all the above answers to the best of my belief are true and correct.
I also solemnly affirm that I have not received a disability certificate/pension on account of
any disease or other condition.

Candidate’ Signature: ________________________

Signed in my presence: _______________________

Signature of the Medical Officer________________

Note: The Candidate will be held responsible for the accuracy of the above statement. By wilfully suppressing
any information, he will incur the risk of losing the appointment and if appointed, of forfeiting all claims to
superannuation allowances or gratuity.

ANNEXURE V

CHARACTER CERTIFICATE
 Certified that I have known Shri/Smt/Kum.____________________________________
Son/Daughter of _____________________________ for the last _______ years , ______
Months and that to the best of my knowledge and belief, he/she bears reputable character and
has no antecedents which render him/her unsuitable for employment in the Kendriya
Vidyalaya Sangathan.

2. Shri/Smt/Kum.______________________________________________ is not related

to me.

Signature ________________________

Designation: _____________________
Place: ________________
Date: ________________
==================================================================
ANNEXURE V

CHARACTER CERTIFICATE

Certified that I have known Shri/Smt/Kum.____________________________________

Son/Daughter of _____________________________ for the last _______ years , ______
Months and that to the best of my knowledge and belief, he/she bears reputable character and
has no antecedents which render him/her unsuitable for employment in the Kendriya
Vidyalaya Sangathan.

2. Shri/Smt/Kum.______________________________________________ is not related

to me.

Signature ________________________

Designation: _____________________

Place: ________________
Date: ________________

ANNEXURE VI

KENDRIYA VIDYALAYA SANGATHAN

HYDERABAD REGION
 PICKET SECUNDERABAD-500 009

OATH TO BE TAKEN

I, ______________________________________________________ do swear /
solemnly affirm that I will be faithful and bear true allegiance to India and to the Constitution
of India as by law established and that I will carry the duties of my Office loyally, honestly
and with impartially.

So help me God.

Signature: ________________________________

Designation: ______________________________

Date: ________________

KENDRIYA VIDYALAYA SANGATHAN

HYDERABAD REGION
PICKET SECUNDERABAD-500 009
 ATTESTATION FORM

WARNING:

1. The furnishing of false information or suppression of any factual information in the

Attestation Form would be a disqualification and is likely to render the candidate unfit for
employment under the Government.

2. If detailed, convicted, debarred etc., subsequent to the completion

and submission of this form, the details be communicated
immediately to the Union Public Service Commission or the
Authority to whom the Attestation Form has been sent earlier as the
Affix a Passport size case may be, failing which it will be deemed to be suppression of
Photograph factual information.

3. If the fact that false information has been furnished or that

there has been suppression of any factual information in the
Attestation Form comes to notice at any time during the
Service of a person, his services would be liable to be terminated.

1. Name in full (in BLOCK Letters with SURNAME NAME

aliases, if any) (please indicate if you
have added or dropped in any stage, any
part of your name or surname
3. Present address in full (i.e., Village,
Thana & District or House No.,
Lane/Street/Road and Town)
4. a) Home Address in full (i.e., Village,
Thana & District or House No.,
Lane/Street/Road and Town and name of
the District Headquarters)
b) If originally a resident of Pakistan, the
address in that country and the date of
immigration to Indian Union.
5. Particulars of places (with periods or residences) where you have resided for more than
one year at a time during the preceding 5 (five) years. In case of stay abroad (including
Pakistan), particulars of places where you have resided for more than one year after
attaining the age of 21 years should be given.
Present address in full (i..e, Village, Name of the District Hqrs.,
From To Thana & District or House No., of the place mentioned in
Lane/Street/Road and Town) the preceding column
 Contd....2...

-2-

5) a) Father’s Name in full with alias if any

b) Present Postal address (if dead, give last

Address

c) Permanent Home Address

d) Profession

e) If in service, give designation &

Official address

6) Nationality

a) Father
b) Mother
c) Husband / Wife
d) Candidate

7) a) Exact Date of Birth

b) Present Age
c) Age at Matriculation

8) a) Place of Birth, District and State in

which situated

b) District and State to which you belong

9) a) Your Religion
b) Are you a member of SC/ST write
“YES” or “NO”. If the answer is
YES, state the name thereof
10) Education Qualification Showing places
of Education with years in Schools and
Colleges since:

Contd....3...
 -3-

11. If you have at any time been employed, give details:

Designation or Full Name and Full reasons for

post held or Period address of the leaving the
Description of From To Office/firm/ previous service
work institution

12. Have you ever been prosecuted, kept

under detention or bound down, fined,
convicted, by a Court of Law for any
offence?

If any case pending against you in any

Court of Law at the time of filling up
this Attestation form?

If the answer is YES full particulars of

the Case, detention, fine, conviction,
sentence etc., should be given.

13. Name of two responsible persons of

your locality or two references to
whom you are known.

1.

2.

I certify that the foregoing information is correct and complete to the best of my
knowledge and belief. I am not aware of any circumstances which might impair my fitness
for employment under Government.

Signature of the Candidate: _________________________________________

Name (in BLOCK LETTERS): ______________________________________

Date: ________________
Place: ________________

Contd....4...
 -4-

IDENTITY CERTIFICATE

(Certificate to be signed by any one of the following)

i) Gazetted Officer of Central Government or State Govt.

ii) Members of Parliament or State Legislative belonging to the constituency where the
candidate or his parent / guardians ordinarily resident.
iii) Sub-Divisional Magistrate /Officers.
iv) Tehsildars or Naib Deputy Tehsildars authorized to exercise magisterial power .
v) Principal / Headmaster of the recognized School/College/Institution where the
candidate studied last.
vi) Post Masters
vii) Block Development Officer
viii) Panchayat Inspectors.

Certified that I have known Shri/Smt/Kum. ___________________________________

Son/Daughter of Shri __________________________________________ for the last
_______________ years and ____________ months and that to the best of my knowledge
and belief, the particulars furnished by him/her are correct.

Signature: _______________________
Name: __________________________

Designation / Status and Address (Seal)

Place: __________________
Date: __________________
SERVICE AGREEMENT CUM SURETY BOND (To be executed on non-judicial stamp paper worth of
Rs. _____/- (Rs. ________ (of the value as per rules of the State) only and Rs 1.00 (Rs. One only)
Revenue Stamp to be affixed on top left side of first page.

This contract made on this ___ day of __________ Two thousand and Nineteen BETWEEN the KVS
through the _____________________ (designation of the person in KVS) having its office at
______________________ hereafter called the “Employer” (which term shall unless repugnant to
the context mean and include its successors-in-interest and permitted assignees) of the ONE PART;
AND, Shri/Smt./Kum.........................……………………………………………., Son/
daughter of Shri.............…………………..………………….. Resident of ................................................
……………………………………………..in the tehsil of the .................................................. District…............
……………….., hereinafter called the “Probationer/employee” (which term shall unless repugnant to
the context mean and include its successors-in-interest and permitted assignees) of the SECOND
PART; AND, Shri/Smt./Ku…...…………………………………………........................,
son/daughter of Shri..…………………..………………............… Resident of .................................................
…………………………………in the tehsil of the .................................................. District……………………………..,
hereinafter called the “Surety” (which term shall unless repugnant to the context mean and include
its successors-in-interest and permitted assignees) of the “THIRD PART”.

WHEREAS the employer has offered to engage Shri/Smt./Ku. ………………………….

….. ...............................as .................................................. (post) for on a probation/ training for a
period of _________ years, which may be extended and the probationer/employee has agreed to
accept the offer of the employer.

AND WHEREAS Shri/Smt./Ku. ………………………….…..….. has been selected by the Employer as

_____________________________________ vide its offer of appointment No. ………………………..…..….
….. dated ………………………for undergoing training/probation with a view to utilize his/her service with
the Employer after successful completion of the training, which offer has been unequivocally
accepted by the probationer;

AND WHEREAS in terms of clause _______ of the Main Terms and Conditions of the said offer of
appointment, the Probationer is required to undergo initial training as determined by the Employer
for a period of twenty-four months, which may be extended to twelve more months in case of
unsatisfactory performance by the Probationer, and to serve the Employer for a minimum period of 2
years from the date of joining on initial appointment in KVS.

AND WHEREAS in terms of clause _______ of the Main terms and Conditions of the said offer of
appointment, the Probationer and his Surety are required to execute a Service Agreement cum
Surety Bond on non-judicial stamp paper in favour of the Employer, undertaking to complete the
training and to serve the Employer for a minimum period of two years failing which the Probationer
and the Surety shall be jointly and severally bound to pay the Employer a sum of Rs.2,00,000/-
(Rupees Two Lakhs only);

AND WHEREAS the Probationer recognizes and accepts that at the time of appointment as
Probationer, except exposure to academic knowledge, he/she has received no formal, effective,
technical or practical training enabling him/her to become professionally viable to the Employer;

AND WHEREAS the Probationer is aware that the Employer would be incurring substantial sums of
money and incurring substantial costs, expenses, man hours in the process of selecting and
appointing him/her as Probationer & training him/her thereafter.

AND WHEREAS this service agreement cum surety bond executed with the Employer by the
Probationer along with a Surety to the extent Rs. 2,00,000 (Rs. Two lakhs only) will be used for
indemnifying the Employer against all such costs as mentioned above by reason of breach and/or
non-compliance of any of the terms of this agreement with by the Probationer;
AND WHEREAS the Probationer also agrees that if he/she commits any breach of any of the
conditions of this agreement, the Probationer and the Surety shall be jointly and severally liable to
pay to the Employer on demand immediately the above said sum of Rs. 2,00,000 (Rupees Two lakhs
only) from the date of breach of the terms of the contract.

AND WHEREAS in order to secure the Employer against the expenses incurred by it on the training of
the Probationer and to ensure due compliance of all terms and conditions stipulated by the Employer
and accepted by the Probationer, it is agreed that the Probationer shall be liable to compensate the
Employer in the manner and under the circumstances enumerated in this agreement;

IN WITNESS WHEREOF THE parties hereto have signed these presents on this date and year in the
presence of the following witnesses:

WITNESSES: (For the Probationer& Surety) Clear Signature :

1. Name:………………………….. Signature of the Probationer Address ………………………..

…………………………………….. ……………………………………..
2. Name Signature of the Surety Address……………………….. Name………………………………..
……………………………………. Occupation………………………. ………………………………… …. PAN No.
………………………….. Address………….………………… ………………………………………… …………………
…………………….. _______________________________________________________________
(Attestation of signatures of Probationer and Surety by Gazetted Officer)

…………………………………….. …….…………………………….. Signature of the Probationer Signature of the

Surety Attested Signature & seal of Gazetted Officer Signature & seal of Gazetted Officer
_______________________________________________________________

For office use only)

WITNESSES: (For the Employer) 1. Accepted. Name:………………………….. Address ……………………….

Signature of the ____________- ………………………………… …. For and on behalf of
KVS………………………………….… Name…………………………..

2. Address……………………….. Name………………………….. …………………………………….