Format-I
Part “A”
Navodaya Vidyalaya Samiti
Personal Details of JNV Staff
(Mandatory for All Employees&All Field Should Be Filled In the CAPITAL
LETTER)
01.
Name of Employee
:
02.
Designation (with Subject)
:
03.
Contact No.
:
04.
(i) Date of Birth*
(ii) (Age as on 01.01.2016)
:
:
Year(s)
Month(s)
Days(s)
05.
Date of retirement [DD/MM/YYYY]
______________________________
06.
Home District and State as
(i)
State
:
________________________
(ii)
District
:
________________________
(i)
Desig.
:
________________________
(ii)
D-O-J
:
________________________
(iii)
Region
(iv)
(v)
State
:
District :
________________________
________________________
(i)
(ii)
Desig.
D-O-J
________________________
________________________
:
Declared in Service record
07.
JNV where presently working
:
08.
Date of Joining in NVS
09.
Details of service in NVS : (if necessary plz. attach white “A4” size)
Sl.
No.
Post
Place of
posting
:
: ________________________
Duration
From
To
Reasons for change of place of
posting
(Promotion/DirectRectt./Request
transfer/Transfer on Admn.
Grounds etc.)
01.
02.
03.
04.
10.
(i)
Whether served in N.E.R./Hard/:
:
:
[Yes/No]
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1
Very Hard station, if yes, please
mention the periodof working
(ii) If leave for more than 30 days :
at a stretch availed, should be
Indicated.
11.
Reason for last transfer, if any?
From
To
From
To
:
(Whether administrative or any other
ground, please specify).
12.
Details of request transfer, if any
:
2013 :
Availedduring preceding three years
2014 :
2015 :
13.
Whether Joined against Spl. Rectt. Drive: [Yes/No]
Year
for/NER/Hard/V. Hard& difficult areas.
Suffering from diseases, if any (as mentioned in Transfer Policy)
Who is
Disease (As mentioned in the transfer policy)
suffering
[Plz. tick () against the disease]
(Self,
Carcinoma Renal
Paralytic Heart
Thalassemia Parkinson's MotorSpouse (Cancer)
Failure Stroke
(CABG/
Neuron
& Child)
Angiopl
asty)
Designation
JNV
State
16.
Certificate by
the Competent
authority
should be
attached
(Yes/No)
Disabled Category: (if applicable, plz. fill)
Sl. No.
01.
Category of
disability
OH
02.
VH
03.
HI
17.
District
Others
Name
State Govt.
Ifhaving working Spouse [Plz. tick () where working. If not, mention “N.A.”]
Central Govt.
15.
Certificate
attached
(Yes/No)
14.
% of disability
Is declared surplus?
Certificate
attached (Yes/No)
:
[Yes/No]
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2
Remarks
(if any)
18.
Choice JNV for Request Transfer(only3 choice to be given)
[Those who do not want request transfer; they need not fill up this]
(1) RO :
State :
JNV/Distt.
(1) RO :
State :
JNV/Distt.
(1) RO :
State :
JNV/Distt.
*[For date: two digits; For month:first three alphabets; For year:four digits (forexample: 10Apr1959)].
*[For wrong information concerned employee will be penaltied]
Signature of the Employee
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3
Part-B
Calculationof Transfer Count
(For employees desiring request transfer)
19.
Calculation Of Transfer Count: Factors.
Allot Points For Applicable Factors Only And
Write NA For Not Applicable Factors
Points To
Be Allotted
1
for
each
Active Stay at in the present post at present station as +02
st
on 1 January-2016. Periods of continuous absence complete year
from duty of 30 days or more on any account shall
not be counted.
2
for
Annual Performance Appraisal Report Grading for +02
outstanding
the last three years.
grading for each
If the report for any of the last three years is not year
written or is unavailable no point shall be given for
the relevant year(s).
3
Spouse, if working in NVS at the requested station.
Total
Counts
+15
OR
4
5
6
If working in JNV of the adjoining District of
requested station. (In case both are in same +15
cadre/subject/post).
Spouse, other than NVS if working at the requested
station or in its adjoining District :
+10
(i)
In Central Govt./Organization.
+05
(ii)
In State Govt./Organization.
DFP/DFR* Cases (+10 for each case; maximum 20 +20
points)
Woman employee
+05
Clarification: Women employees eligible for points
under serial no.3, 4 & 5 herein above shall not be
eligible for the points.
Total Score of
All The Points
Total No. of Transfer Count >>
* DFR = Death of Spouse/Child if occurred in last 12 months prior to the 01st January-2016.
* DFR = Due For Retirement within next 03 years from 01st –January-2016.
Signature of the Employee
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4
Part-C
20.
Calculation of Displacement Count
(Mandatory for All Employees)
Calculation Of Displacement Count: Factors.
Allot Points For Applicable Factors Only And Write NA For
Not Applicable Factors
Points To
Be
Allotted
1 Stay at a station in the same post as on 1st January in complete
years
Clarification:
 Period of absence from duty on any account shall also be
counted for this purpose
 If an employee returns to a station X on request after being
transferred from X within three years (two years for very
hard station), the stay of such an employee at X shall be
no. of years spent after coming at X. However, if an
employee returns to station after mandatory period of
three years (two years for very hard station) the stay shall
be counted afresh.
2 Annual Performance Appraisal Report Grading for the last five
years.
If the report for any of the last three years is not written or is
unavailable no point shall be given for the relevant year(s).
3 Employees below 50 years (as on 1st Jan.-2016 of the year) who
have not completed one tenure at hard/very hard/NE stations.
4 DFR/DFP/MG cases (-10 for each case maximum-20)
5 Spouse, of Central/State Government/PSU employee other than
NVS and posted at the same station
6 Physically challenged employee (as defined in Annexure-II)
7 Employee who is spouse of a NVS employee and
a) Posted in the same State
b) Posted at the same station
+02 points
for
each
completed
year
Total No. of Displacement Count>>
Total score of
all the points
Total
Counts
+02
for
each below
benchmark
grading
+08
-20
-05
-20
-10
-20
Part- D : Declarations And Certificates
21
Declaration For Working Spouse
I, __________________________(name of the Employee) solemnly declare that my spouse
___________________________(Name)
is
presently
employed
at
_________________________(Name of JNV/District) which is my present station/choice
station(s) (Strike out whichever is not applicable). The spouse is employed in Navodaya
Vidyalaya Samiti/government sector (strike out whichever is not applicable) as
__________________________ (Designation of the spouse).
Date:
Signature of the Employee
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5
22
Medical Certificate
(To avoid disqualification, please do NOT use abbreviation. Fill it with CAPITAL LETTERS only.
Please do not attach any enclosure except where specifically asked for)
Name of Patient :
Relation of patient with the employee(self/spouse/son/daughter) :
Address :
Date :
I, Dr. ______________________with Medical Council Registration No. ___________________hereby
certify that Shri/Smt./Ms_________________________________ aged______________ Sex______
son/daughter/wife/husband of Shri/Smt. ____________________________ (name of JNV
teacher/employee) is suffering from the disease/diseases with the details as follows and that treatment
of this disease is not at all available at this station or its vicinity:
A.
In case of Carcinoma (Cancer) :
1.
2.
3.
4.
5.
6.
7.
8.
9.
B.
In case of Renal Failure :
1.
2.
3.
4.
5.
C.
Name of the disease causing Renal Failure :
Evidences in support of Chronic Irreversible changes :
Number of Dialysis done with dates :
Single or both kidneys are involved :
Any Surgery including Renal Transplantation done or not :
In case of Loss of Muscle Power (Paralytic Stroke) :
1.
2.
3.
4.
5.
6.
D.
Name of Carcinoma with site affected.
Date when it was detected first
Brief History-Pathological Report with reference no. & dates :
T.N.M. Classification (if applicable) :
Evidences in support of uncontrolled growth :
Evidences in support of Metastasis “
Condition of neighboring or surrounding structures :
Treatment being continued in brief :
Full name of Surgery/Surgeries in connection with dates :
How many extremities are affected :
Grading of Muscle Power at present :
Grading of Muscle Power at the onset of disease.
Duration of Loss of Muscle Power.
Any recovery after the onset till date :
Most direct cause of Loss of Muscle Power.
In case of Heart Diseases :
1.
2.
3.
4.
Name of the surgical procedure undergone. CABG/Angioplasty.
Date of Surgical procedure.
Name of Doctor – Surgeon
Name of Hospital.
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6
E.
In case of Thalassaemia :
1.
2.
3.
4.
Name of the disease (with specification-major or minor) :
Date of first detection:
Whether blood transfusion required? Y/N
If so, periodicity/duration of blood transfusion/replacement required by the
patient/Chelation therapy
5. Blood transfusion done last DD/MM/YYYY
F
In case of Parkinson’s disease :
1.
2.
3.
4.
5.
G
Date of detection of the disease :
Duration of treatment undergone :
Name and designation of treating neurologist :
Whether admitted in hospital and if so, details thereof :
Progressiveness of the disease – please specify :
(To be certified by a neurologist)
In case of Motor-neuron disease :
1.
2.
3.
4.
5.
Date of detection of the disease :
Duration of treatment undergone :
Name and designation of treating neurologist :
Result of the EMG test report and MRI :
Grading of muscle power at present :
(Signature of Signing Authority)
Name
Name of the Deptt.
Name and signature of patient
Name of Hospital
Place
Date
Seal
Name of the Patient :____________________________________________
Relation with the Employee (Self/Spouse/Son/Daughter) :_______________________
23
If the certifying doctor is below the rank of civil surgeon or equivalent it should be countersigned
by a Doctor of the rank of civil surgeon or equivalent.
Signature of the Employee **
24
Signature of the Principal
25
Signature of the AC (Admn.)
26
Signature of the Deputy Commissioner.
** The employee should sign as a token of having satisfied himself/herself on the allotted points and other
entries at school level. Signature shall not be, mandatory if Part B is left blank. The school shall fill
up Part A and C if employee is not present or not available otherwise and forward the same to the NVS
(However,
this
is
not
applicable
for
current
year).
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7
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8
Format-II
Navodaya Vidyalaya Samiti, Regional Office………..
Request Transfer & Also the details of the Employee who are not seeking the Request Transfer of Vidyalaya Cadre – 2016
District
NAME
DESIGNATION
Status (Applied/Not Applied)
Remarks (if any)
31
State
30
Department
29
Spouse working
in Samiti
38
39
40
41
42
43
44
Third
28
District
27
State
26
Second
25
First
24
District
23
State
22
District
21
Choice Place for
request transfer
(in three choices.
Those will be
available it will be
given)
State
20
Year
19
If
appoint
ment on
Spl.
Rectt.
Drive
for NER
/ Hard /
Very
Hard
Station
then
year of
Recruit
ment
may be
stated
Particular
18
Year
17
To
16
From
15
Yes/No
14
Certificate attached (Yes/No)
13
Served
in Hard
Station
earlier
(Yes/No)
Disease (As per the transfer policy)
Total Displacement count
12
Sufferin
g from
serious
disease /
depende
nt (Only
Spouse
&
Children
)
Who is suffering
Total Transfer count
11
% (in figure)
District
10
Yes/No
State
9
Sex (Male/Female)
Age as on 01/01/2016
8
Length of service NVS as on 01/01/2016
Date of Birth [DD/MM/YY]
7
Length of service in present station (JNVs) as on 01/01/2016
Designation
6
JNV (District)
Name of the employee
5
State
JNV [District]
4
Region
State
3
Physical
Handica
pped
Date Of Joining [DD/MM/YY]
Regional Office
2
Hom
e
Tow
n
Date of Retirement [DD/MM/YY]
Sl. No
1
DOJ in Present post in Present JNV* [ District]
Joining in
NVS*
(At present)
Present
place of
posting
of the
employe
e
32
33
34
35
36
37
*For date: two digits :For month :first three alphabets : For year :four digits (for example : 10Apr1959).
**[For wrong information concerned employee will be penaltied]
Particulars verified and found correct.
Deputy Commissioner:
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9
Format-III
Application for Request Transfer of Regional Language Teachers
(Other than English & Hindi) for the year 2016
01.
Name
:
02.
Designation
:
03.
(i) Date of Birth*
:
(ii) (Age as on 01.01.2016)
:
04.
Contact No.
:
05.
Date of retirement [dd/mm/yy] :
06.
Sex (Male/Female):
:
07.
JNV where presently working
:
08.
Originally recruited by which RO:
09.
Completed tenure of stay at
:
Year(s)
Month(s)
Days(s)
(i)
D-O-J
:
________________________
(ii)
Region
:
________________________
(iii)
State
:
________________________
(iv)
District :
________________________
Year(s)
Month(s)
Days(s)
present station as on 01St Jan-2016
10.
Sl.
No.
Details of posting during last five(05) years.
RO
State
JNV(Distt.)
Period
From
Remarks
(if any)
To
01.
02.
03.
04.
05.
11.
Home Town
:
(i)
State
(ii)
District
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10
:
________________________
:
________________________
Name
13.
Sl.
No.
01.
Posting in JNV
State
Distt.
Posting in other
department
(Desig.,Departme
nt, District)
Disabled Category: (if applicable, plz. fill)
Category of
% of disability
Certificate attached
disability
issued by the
Competent
authorities (CMO)
(Yes/No)
OH
02.
VH
03.
HI
14.
Designation
Certificate of
Employer to be
attached (Yes/No)
Detailed Particulars of Spouse working in Samiti:
Working Since
(Year only)
12.
Remarks
(if any)
Choice JNV for Request Transfer (Only3 choice to be given)
(1) RO :
State :
JNV/Distt.
(1) RO :
State :
JNV/Distt.
(1) RO :
State :
JNV/Distt.
*[For date: two digits; For month:first three alphabets; For year:four digits (for example: 10Apr1959)].
*[For wrong information concerned employee will be penaltied]
(Signature of Applicant)
Verification by Principal/Regional Office
Above particulars are verified and found correct.
(Signature of Principal of the JNV)
(Counter signed by Deputy Commissioner of the RO)
Error! Reference source not found.
11
Format IV
13
14
15
16
17
18
*For date: two digits :For month :first three alphabets : For year :four digits (for example : 10Apr1959).
**[For wrong information concerned employee will be penaltied]
Particulars verified and found correct.
Error! Reference source not found.
12
24
25
26
27
28
29
30
31
32
33
34
Remarks (if any)
Posted in the region of Original
Recruitment (Y/N)
Posted outside native state (Y/N)
Mandatory period completed (Y/N)
JNV [Distt]
State
JNV [Distt]
23
State
22
JNV [Distt]
21
Choice place for request
Transfer
First
Second
Third
State
20
Certificate of employer
to be attached [Yes/No]
19
Working since
Designation
12
Name
11
District
10
State
9
Detailed particulars of Spouse
working in Samiti
Department
8
District
Date of joining in present JNV*
7
State
Age as on 01/01/2016
6
Home
Town
as per
the
Service
record
Sex ( M/F)
Date of Birth
5
JNV (District)
Designation
4
State
Name of the Employee
3
Region
District
2
Date Of Joining [DD/MM/YY]
State
1
Length of service in present station
(JNVs) as on 01/01/2016
Region
Joining in NVS*
Sl. No
Present
place of
posting
Length of service NVS as on 01/01/2016
Navodaya Vidyalaya Samiti, Regional Office:……………………..
Consolidated List of Transfer of Regional Language Teachers forthe Year 2016
35
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13
Format-V
Navodaya Vidyalaya Samiti, Regional Office………..
Detailed particulars of Regional Language Teachers who have completed 5 years of stay or more as on 01.01.2016
(To be furnished by Regional Office POST WISE)
*For date: two digits :For month :first three alphabets : For year :four digits (for example : 10Apr1959).
**[For wrong information concerned employee will be penaltied]
Particulars verified and found correct.
Error! Reference source not found.
14
17
18
19
20
21
22
Remarks (if any)
16
Exemption if any & ground thereof
15
Certificate of employer to
be attached [Yes/No]
14
Working since
13
Designation
12
Name
11
District
10
State
9
Department
8
Recruited Originally by which RO
Date of Retirement [DD/MM/YY]
7
Sex ( M/F)
Length of service in present station
(JNVs) as on 01/01/2016
6
Detailed particulars of Spouse working in Samiti
District
Date of joining in present JNV*
5
Home Town as
per the Service
record
State
Age as on 01/01/2016
District
4
Date of Birth
3
Designation
2
Name of the Employee
1
State
Sl. No
Region
Present place of
posting
23
24
Format-VI
10
11
12
13
14
15
16
17
18
19
20
21
22
1
2
3
4
5
*For date: two digits :For month :first three alphabets : For year :four digits (for example : 10Apr1959).
**[For wrong information concerned employee will be penaltied]
Particulars verified and found correct.
Error! Reference source not found.
15
23
24
25
26
27
28
29
30
31
32
33
34
Remarks (if any)
Working since
Certificate of employer to
be attached [Yes/No]
Designation
Name
District
State
If intends to seek transfer with
spouse working in NVS & other
than NVS
Department
JNV [District]
State / UT
JNV [District]
State / UT
JNV [District]
State / UT
JNV [District]
State / UT
JNV [District]
State / UT
9
Choice Place for request transfer
(in five choices. Those will be available it will
be given)
First
Second
Third
Fourth
Fifth
Sex Male/Female
8
District
Region
7
Home
Town
as per
the
Service
record
State
Date Of Joining [DD/MM/YY]
6
No. of Years, Month & Days Completed in
NVS As on 01/01/2016
Date Of Birth [DD/MM/YY]
5
No. of Years, Month & Days Completed in
present JNV as on 01/01/2016
District
4
JNV (District)
State / UT
3
State
Region
2
Joining in NVS*
Designation
1
Name of Teacher
Sl. No.
Name of JNV
presently
posted
(District
only)
Date of Joining in present JNV [DD/MM/YY]
Navodaya Vidyalaya Samiti, Regional Office………..
Performa for willingness for posting to N.E.R/Hard/Very Hard Station-2016
35
Format -VII
Navodaya Vidyalaya Samiti, Regional Office………..
9
10
11
12
13
14
15
16
17
19
20
*For date: two digits :For month :first three alphabets : For year :four digits (for example : 10Apr1959).
**[For wrong information concerned employee will be penaltied]
Particulars verified and found correct.
Error! Reference source not found.
16
21
22
23
24
25
26
27
28
29
30
31
Remarks (if any)
Exemption if any & ground thereof
(Y/N)
Working since
Designation
Name
District
State
Spouse working in Samiti
Department
%
Yes/No
District
State
18
Who is suffering
Disease As per the
transfer policy)
Certificate attached
(Yes/No)
Physical
Suffering
Handicapped from serious
disease /
dependent
(Only Spouse
& Children)
M/F
Home
District
(as per
the
Service
Record)
Sex
Length of service in present station
(JNVs) as on 01/01/2016
8
State
JNV
(District)
7
Region
6
[DD/MM/YY]
5
Joining in NVS*
Date of Retirement [DD/MM/YY]
Date Of Joining
Age as on 01/01/2016
DOJ in Present post in Present JNV*
[ District]
4
Date of Birth [DD/MM/YY]
3
Designation t present)
State
2
Name of the employee
Regional Office
1
JNV District]
Sl. No
Present place
of posting of
the employee
Length of service NVS as on 01/01/2016
Detailed particulars of Employees working in their Home Districts
(To be furnished by Regional Office POST WISE)
32