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UNIQUE APPLICATION NO. (FOR OFFICE USE ONLY) Employee Code No. (Strike out whichever is not applicable) KENDRIYA VIDYALAYA SANGATHAN APPLICATION FOR TRANSFER ON REQUEST 2009-2010 1 : Read instructions carefully before filling up. 2: Submit only ONE application in QUADRUPLICATE for Inter Regional and in TRIPLICATE for Intra Regional.

Note

PRESENT REGION CODE

PRESENT STATION CODE

PRESENT K.V. CODE/ SHIFT OFFICE CODE

POST HELD & SUBJECT (ALPHABETS)

1. Name 1(a)

Title : Shri/Smt./Miss:

2. Whether Male/Female (M/F)

3. Date of birth (DD/MM/YYYY) 4 (i)

Date of appointment in the present post

(ii)

Date of joining in the Present Post: a.) In the present vidyalaya b.) In the present station c)

In Priority areas (applicable for those posted in North Eastern Region/A&N Islands Hard Station/Very Hard Station., for cases of combined stay in conjuction with present posting only) Details of last transfer/posting

5.

From Reason Code (See instruction at Sl.No.5 at page No.10)

6.

Grounds for seeking Transfer a) b)

(i) (ii) c)

Year Stn. Code

-

KV Code

PRIORITY CATEGORY FOR GRANT OF REQUEST TRANSFER(PCGR)

Medical Grounds (See Instructions) (Y/N) (Please see page 10) Death of Spouse within a period of 2 years as on 31.03.2009(Y/N) If Yes, Date of Demise (DD/MM/YYYY) Less than three years to retire (LTR) ground (Y/N) (due to retire on or before 31.03.2012)

(i) Date of retirement ..2.. d) Person who have completed their tenure in Priority areas (Y/N) (Applicable in case of present stay alone and combined stay in conjuction with present posting.) e)

Others (See instructions for following Codes): Category Code

Division Code

Entitlement Points

(i)*

V

H

S

0

4

4

0

(ii)*

N

E

H

0

5

3

0

(iii)

P

C

E

0

6

2

0

(iv)

P

W

S

1

0

1

5

Applicable (Y/N)

(see instructions for division code) (v)

L

N

S

0

7

(vi)

S

P

S

1

3

(vii)

L

A

H

1

4

(Please fill-up if applicable) 1 0 Total :

7.

Dated

For Office Use only(To be filled in by Regional Office) A)

Whether ‘MDG’ grounds accepted by Regional Medical Board (Y/N)

B)

Case of DSP verification done( whether accepted/not accepted) (Y/N)

C)

Case of LTR verification done( whether accepted/not accepted) (Y/N)

D)*

Whether Person completed tenure in Priority areas verification done (Y/N) (Cases of present stay alone and combined stay in conjuction with present posting.)

Signature of Assistant Commissioner

Note: 1. MDG/DSP/LTR /VHS/HS/NER verification certificate may kindly be filled up at RO level properly. It should be ensured that only accepted cases are to be indicated as ‘Y’ and not accepted as ‘N’ specifically. 2.* As regard completion of tenure in priority area crucial date as per office memorandum No.F.11-19/2004-KVS (Admn.-I) dated 26.03.2007, 17.07.2008 and 22/25-08-2008 for inclusion/deletion of Hard/Very Hard Station in the existing list may be kept in mind for allotment of entitlement points. 3. No entitlements points for PWS in /case of self employment of spouse.

..3.. 8.

Choice Vidyalaya(s) or Station(s) Instructions : Employees are eligible to apply either for Intra Station or Inter Station (within the Region) Sl.No. 8.1/8.2 OR Inter Region Transfers (outside the Region) Sl.No. 8.3 . Applications filled in for more than one type of transfers i.e. Sl.No. 8.1, 8.2 and 8.3 will be summarily rejected.

8.1 For Intra Station transfer – Choice Vidyalayas [within the same station (within the Region)] (Please see instructions)

K.V./ Office Code

8.2 For Inter Station transfer – Choice Stations [from one station to another ( within the Region)] (Please see instructions) (The teacher/employee coming under PCGR Category except MDG/DSPshall have to indicate five choices of different

STATION Code

stations where post of that category has been sanctioned)

8.3 For Inter Region transfer – Choice Stations [from one station to another (outside the Region)] (Please see instructions) (The teacher/employee coming under PCGR Category except MDG/DSP shall have to indicate five choices of different stations where post of that category has been sanctioned)

9.

STATION Code

Category of place where spouse is working

10. Have you given the declaration regarding the Employment and place of posting of spouse (Y/N) 11. Have you obtained a MC on the form (Y/N) 12. 13.

Type of disease certified in the MC overleaf Relationship of the patient with the applicant (Please see instructions at page No.12 for filling codes in Sl. No.9,11& 13)

Please fill up code Please fill up code

..4..

I, Shri/Smt./Kum .______________________________S/o W/o D/o _________________________do hereby affirm that the information given in Sl.No. 01 to 13 excepting Sl.No.7 of this application are correct and that the medical certificate (M.C.)/declaration given is/are bona-fide and I understand that wrong/suppressed information shall render me liable for disciplinary action.

Place:

Signature:

Date:

Name

Remarks: a)

:

Principal of the Vidyalaya in which the applicant is working should state:

Whether the teacher/staff member is working in excess to the sanctioned staff strength in the Vidyalaya State Yes/No (Y/N)

b) Whether the teacher/staff member has completed tenure In Priority Areas i.e. NER (including Sikkim)/A&N Island/Hard Station/Very Hard Station (Cases of present stay alone and combined stay in conjuction with present posting.) (Y/N) If Yes, number of completed years

Signature of the Principal with seal

..5.. MEDICAL CERTIFICATE ( To avoid disqualification, please do NOT use abbreviation. Fill in 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 KVS 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. 1. 2. 3. 4. 5. 6. 7. 8. 9.

In Case of Carcinoma : Name of Carcinoma with site effected: Date when it was detected first : Brief Histo-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 : B. In case of Renal Failure : 1. Name of the disease causing Renal Failure : 2. Evidences in support of Chronic Irreversible changes : 3. Number of Dialysis done with dates : 4. Single or both kidneys are involved : 5. Any surgery including Renal Transplantation done or not : C. In Case of Loss of Muscle Power: 1. How many extremities are affected : 2. Grading of Muscle Power at present : 3. Grading of Muscle Power at the onset of disease. 4. Duration of Loss of Muscle Power. 5. Any recovery after the onset till date : 6. Most direct cause of Loss of Muscle Power. D. In Case of Heart Diseases : 1. Name of the disease 2. Date of first detection 3. Coronary Artery By Pass Grafting surgery done or not: If yes, please mention: a) Date b) Name of Doctor – Surgeon c) Name of Hospital. E. In case of Thalassaemia: 1. Name of the disease (with specification-major or minor); 2. Date of first detection; 3. Whether blood transfusion required? Y/N 4. 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. Date of detection of the disease: 2. Duration of treatment undergone; 3. Name and designation of treating neurologist; 4 Whether admitted in hospital and if so, details thereof; 5. Progressiveness of the disease- please specify; (To be certified by a neurologist)

..6.. G 1. 2. 3. 4. 5.

In case of Motor-neuron disease 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

H

Any other disease with more than 50% physical and or mental disability. Name and date of detection of the disease which will be duly examined by respective Regional Medical Board.

1. 2.

Duration of treatment undergone/being continued in brief.

3.

Name and designation of the Doctor.

4.

Evidences in support of the disease.

(Signature of signing authority)

Name and signature of patient

Name Name of the Deptt. Name of Hospital Place Date Seal

: : : : : :

..7.. DECLARATION (Kindly fill the Information in bold letters. Strike out whichever is not applicable) I, __________________________________ solemnly declare that my spouse ________________ is presently Employed at/ under orders of transfer to ____________________________________________________ (Place)as __________________________(Designation) in ----_______________________________________ (Deptt./unit/branch) since ________________________ (Date). His/her full office address with Name and Designation of immediate superior/detail of self-employment is/are as follows: Name and Office/Registered Business Or Professional Address of Spouse

Name and Address of Immediate Superior Officer or Registration No. of Business/Profession

……………………………………………..

……………………………………………………

……………………………………………..

……………………………………………………

……………………………………………..

…………………………………………………… Signature of the Employee ______________________________________ Name ______________________________________ Designation _______________________________________ For Office use only in Kendriya Vidyalaya *(Strike out whichever is not applicable)

1.

*Disciplinary case is pending/contemplated/ not pending/not contemplated against Shri/Smt./Kum. _____________________________________________________

2.

*The Medical Certificate/declaration given in the application itself is from the competent authority.

3.

*Certified that the details including entitlement points furnished by the applicant have been verified from the service records and found correct.

4.

*She/he was on leave/absent/absent without pay during ________________________ and is still away/not away from duties. (Period) Signature Name of the Principal Office Seal

____________________________ _____________________________

Note: 1 Sl.No. 1 to 6 and 8 to 13 have to be checked and verified by the Principal from the service records. They should take personal interest/care and ensure that the entries made by the applicant are correct before countersigning. Any wrong information filled in by the applicant and duly countersigned by the Principal will attract disciplinary action against the individual as well as countersigning authority. 2. Assistant Commissioners have to ensure that the correct required points are given in Sl. No.5, 6(e), 7 and implement note 1 above in letter and spirit with respect to entries to be checked by the respective Principals within their Region 3. Employee Code Number also to be checked.

..8.. INSTRUCTIONS FOR FILLING UP APPLICATION FOR TRANSFER GENERAL

(i)

Transfers are regulated in a limited time frame. A single cancellation of transfer is enough to upset the schedule/chain and hamper the prospect of a group of needy persons getting transfer. Transfer, once effected, will not be cancelled. The employees are disuaded in their own interest from taking chance with the intent of obtaining cancellation later.

(ii)

All columns must be legibly filled in Block letters using alphabetical/numerical code, wherever prescribed. No enclosures are allowed except where specifically asked for. Medical Certificate/Declaration should be obtained/made on the appropriate page of the application form itself. Name of the Vidyalaya where the employee is working presently must be expressed in Code. Present region code, present station code, present K.V. code and shift/present office code must be filled in, from the codes given in the list of codes. In case of Non-teaching staff, the office code/KV code should be filled in accordance with the list of codes for office/KV code annexed. Note: Write 1 for I shift and 2 for II shift in the appropriate box. In case there is only one shift in the Vidyalaya, the teachers/staff working in these Vidyalayas will write 1 in the box provided for shift.

(iii)

POST HELD: These boxes given in the Top row on the front page of the application may be filled in from the abbreviations given below. POST

SUBJECT

e.g. Trained Graduate Teacher

Maths

T G T

M A T

Trained Graduate Teacher

Biology

TGT

BIOL

Trained Graduate Teacher

English

TGT

ENGL

Trained Graduate Teacher

Hindi

TGT

HIND

Trained Graduate Teacher

Sanskrit

TGT

SANS

Trained Graduate Teacher

Social Studies

TGT

SOST

Post Graduate Teacher

Biology

PGT

BIOL

Post Graduate Teacher

Chemistry

PGT

CHEM

Post Graduate Teacher

Physics

PGT

PHYS

Post Graduate Teacher

Maths

PGT

MATH

Post Graduate Teacher

English

PGT

ENGL

Post Graduate Teacher

Hindi

PGT

HIND

H

..9.. Post Graduate Teacher

History

PGT

HIST

Post Graduate Teacher

Geography

PGT

GEOG

Post Graduate Teacher

Commerce

PGT

COMM

Post Graduate Teacher

Economics

PGT

ECON

Post Graduate Teacher

Comp.Sc.

PGT

COMP

Post Graduate Teacher

Sanskrit

PGT

SANS

Primary Teacher

PRT

PRT

----

Head Master

HDM

HDM

-----

Miscellaneous

Drawing teacher

MSC

DRGT

Miscellaneous

Physical Edn.teacher

MSC

PETR

Miscellaneous

Yoga teacher

MSC

YOGA

Miscellaneous

Work Exp.teacher

MSC

WETR

Miscellaneous

Music teacher

MSC

MUST

Miscellaneous

Librarian

MSC

LIBR

Non-Teaching Staff

Assistant

NTS

ASST

Non-Teaching Staff

UDC

NTS

UDCL

Non-Teaching Staff

LDC

NTS

LDCL

Non-Teaching Staff

Lab. Asstt.

NTS

LAST

Non-Teaching Staff

Lab Attdt.

NTS

LATN

Non-Teaching Staff

Senior Steno

NTS

SRST

Non-Teaching Staff

Junior Steno

NTS

JRST

Non-Teaching Staff

Hindi Translator

NTS

HITR

Non-Teaching Staff

Staff Car Driver

NTS

DRIV

Non Teaching Staff

Group ‘D’

NTS

GRPD

Except Primary Teachers and Head Masters/Head Mistress all others would use both the block of the boxes. Primary Teachers and Head Masters/Head Mistress may leave the second block of boxes blank. Sl. NO.1: NAME

..10..

Write full name without any prefix like SHRI/SMT/KUM. One box is meant for one alphabet. Add additional box, if necessary. Leave one box blank between initials and name. e.g. Shri Ajay Kumar Ram will be written as A K R A M Or A J A Y K U M A R R A M Sl.No.1 (a): Please mention the title appropriately i.e. Shri/Smt./Miss Sl. NO.2: WHETHER MALE/FEMALE Write M for Male and F for Female. Sl. NO. 3 / 4 (i) & (ii) (a),(b) & (c): Date of Birth/Date of Appointment in the present post/ DATE OF JOINING THE PRESENT K.V./STATION (IN THE PRESENT POST/DATE OF JOINING IN PRIORITY AREAS) These columns are to be filled in Christian era, the date followed by month and year in “DD MM YYYY” format. For example, Third September, Nineteen Eighty Four will be written as 0 3 0 9 1 9 8 4 (Date of appointment in the present post should exclude any service on ad-hoc contractual basis.) Sl. NO. 5 DETAILS OF LAST TRANSFER: The reason col. has to be filled in by the Code No. as detailed below: Code No. Explanation

1. 3. 4. 5. 6. 7. 8.

Transfer on Surplus grounds (Excess to requirement) in Public interest due to withdrawal of post/closure of stream/K.V. Transfer in Public interest on displacement (for accommodating the request of other teacher/staff) Transfer in Public interest on Administrative Grounds. On direct appointment On promotion including selection through departmental examination. On request transfer (other than those transferred on MDG/DSP/LTR ground) Request transfer on MDG, DSP and LTR ground Transfer under para 9.1(A) of KVS transfer guidelines.

9.

Other grounds including return from long leave.

2.

Sl. NO. 6 : GROUNDS FOR SEEKING TRANSFER The grounds envisaged in the transfer guidelines have been assigned Category Codes (alphabetical). Division Codes (numerical) having entitlement points as follows: GROUNDS (e) OTHERS i) Very Hard stations

CATG CODE

DIVISION CODE

VHS

04

ii) North East and NEH Hard Stations

05

iii) Physically challenged employee iv) Ladies not having spouse

PCE

06

LNS

07

Staff posted in declared Very hard stations completed/going to complete their tenure of 2 years as on 30.06.2009 (Please see note (iii) page-9) Staff posted in 07 NE States, Sikkim, A&N Islands and declared Hard Stations completed/going to complete their tenure of 3 years as on 30.06.2009 Visually and orthopedically handicapped persons Unmarried/Divorced/Widowed Lady

ENTITLE-MENT POINTS 40

30

20 15

..11.. v) *Posting with spouse

PWS

09

Category of Employee Priority spouse(as per para 12.4 of Transfer Guidelines) Spous I e in II KVS

10

Spouse in Central Govt.

08

11

12

vi) On completion of more than 3 years stay at the present station except those covered under VHS and NEH vii) Lady teachers who are posted to places more than 500 Kms away from their home town.

SPS

13

LAH

14

10

III

Spouse in Central Autonomous Bodies /PSUs Spouse in State Govt./State Autonomous Bodies/ PSUs

IV

V

Spouse working in an Org. other than IIV above Other grounds on completion of 3 years 01 for each year of Stay, as on 31.03.2009/30.06.2009 as stay exceeding 3 applicable. years subject to maximum of 20 points

10

*The self employed spouse does not fall under the ground PWS (posting with spouse), therefore will not get any entitlement points for the same. Note:i) The above Codes are just indicative of the grounds and not to be construed as the order of priority. Applicants having more than one ground amongst the above may indicate their choices in Category Code, Division Code and Entitlement Points accordingly. ii)

While calculating the period of stay, the period or periods of absence from duties exceeding 30 days (45 days in case of NE Region, Sikkim and A&N Islands) at a stretch other than on maternity leave, training or vacation is to be excluded.

iii)

Listed Stations as Hard/Very Hard as per Annexure 2 of transfer guidelines.

Sl. NO. 7 : SI.NO. 8.1

To be filled up at Regional Office level as per rules. For Intra Station Transfers (within the Region) Code Numbers of five choice KVs/Office according to your order of preference Sl.No. 8.2 and 8.3 should be left blank.

..12.. Sl. NO. 8.2:

For Inter Station Transfers (within the Region) Code Numbers of five choice stations according to your order of preference. Sl. No. 8.1 and 8.3 should be left blank. (The teacher/employee coming under PCGR Category except MDG/DSP shall have to indicate five choices of stations where post of that category has been sanctioned)

Sl. No. 8.3:

For Inter Region transfers (outside the Region) Code numbers of five choice stations can be filled in, according to your order of preference subject to the grounds chosen, choice station is permissible. Sl. No. 8.1 & 8.2 should be left blank.

Note: (i) Employees are eligible to prefer only one application in triplicate FOR INTRA STATION OR INTER STATION TRANSFER (WITHIN THE REGION) OR IN QUADRUPLICATE FOR INTER REGION TRANSFER (OUTSIDE THE REGION). Any application form found filled in for more than one type of transfer i.e. Sl.No. 8.1, 8.2 and 8.3 would summarily be rejected. Sl. NO.9:

CATEGORY OF PLACE WHERE SPOUSE IS WORKING.

The Codes prescribed are: Code PARTICULARS 1. Spouse working at or under orders of transfer to the station of choice, or nearby. 2. Spouse working at the same station where applicant is currently working. 3. Choice stations bear no relation to the place where spouse is working. Sl. NO.10 In case the answers is in the affirmative write Y: Otherwise Write N. Sl.No.11 In case the answers is in the affirmative write Y: Otherwise Write N. The Medical Certificate or declaration is to be obtained on the body of the application itself. Only Cancer, Paralytic Stroke, Renal failure, coronary artery disease where by-pass surgery has been actually done, Thalassaemia, Parkinsons’ disease or Motor-Neuron disease for self, Spouse and dependent children are considered as valid for transfer on medical grounds when facilities for treatment are not available at the station of posting (duly certified by a Govt. Medical Officer not lower than the rank of a Civil Surgeon). Sl. NO.12 :

TYPE OF DISEASES: AS PER ANNEXURE- I of transfer guidelines w e f 14.3.2006

CODE

TYPE OF DISEASE

CN PS RF CA TS

CANCER PARALYTIC STROKE RENAL FAILURE CORONARY ARTERY DISEASE WHERE BYPASS SURGERY HAS BEEN ACTUALLY DONE THALASSAEMIA

PK MN

PARKINSONS’ DISEASE MOTOR-NEURON DISEASE

OD

ANY OTHER DISEASE

Sl. NO.13 : RELATIONSHIP ..13.. This column is applicable where transfer is sought on Medical Grounds and Sl.No. 11 and 12 are also filled in. The relationship of the patient with the applicant should be indicated in the following Codes: SF SP CH

-

Self Spouse Dependent Children

PHYSICALLY CHALLANGED EMPLOYEE- Explanation Transfer of employees with visual and Orthopedic disabilities, provided they fulfill the following conditions: (a)

Blind Employees having vision less than 3/60 or field vision less than 10 both the eyes as certified by the Head of the Ophthalmologic Department of Government Civil Hospital.

(b)

Orthopedically handicapped employee who has a minimum of 40% permanent partial disability of either upper or lower limbs or 50% permanent partial disability of both upper and lower limbs together, as certified by the Head of Orthopedics Department of a Government Civil Hospital according to the standards contained in the manual for Orthopedic Surgeon in Evaluating Permanent Physical Impairment brought out by the American Academy of Orthopedic Surgeons, USA and published by Artificial Limbs Manufacturing Corporation of India, Kanpur.