RULES/DETAILS/ APPLICATION FORM FOR FELICITATION OF TEACHERS/NURSES WHO HAVE COMPLETED 25 YEARS OF SERVICE AS A TEACHER/ NURSE

(a)    This felicitation of teachers/nurses is being done as part of the Golden Jubilee Celebrations of the Samajam. Similar felicitation was conducted during the Silver Jubilee year in 1986. Those who were felicitated on that occasion are not eligible for this felicitation.

(b)   This felicitation is restricted to only Samajam members or their spouses or their unmarried daughters.

(c)    Persons eligible for felicitation should be a valid member of the Samajam as on 1^st April, 2011.

(d)   The applicant should have completed 25 years of continuous service or will be completing 25 years of continuous service as on 31^st December, 2011 as a Teacher/Nurse in a recognized school/college/hospital/nursing home

(e)   Valid documents duly signed/attested indicating the length of service should be attached along with this application.

(f)     Validity of membership to the Samajam shall be governed by the Bye-laws (Rules & Regulations) of the Samajam.

APPLICATION FORM

(1)    Name & address of the applicant:                            Shri/Ms. _______________________________    

  ________________________________

(2)    Whether a valid member of the Samajam            YES/NO                If YES, membership No._______

(3)    Name & address of husband/wife/father/mother           _______________________________

(4)    Whether a valid member of the Samajam            YES/No                 If YES, membership No._______

(5)    Details of employment:

(a)    Name & address of the Institution                                  ________________________________

(b)   Date of joining the Institution                                           ________________________________

(c)    Whether still working in the institution                        ________________________________

(d)   Completed years of service                                                                _______________________________

(e)   Year of retirement                                                                     ______________________________

(f)     Completed years of service at the time of retirement  ______________________________

(g)    Current designation

(h)   Designation at the time of retirement

(i)     Subjects taught

(j)     Awards/Prizes received from Government/other

Organizations

(k)    Any other information which you wish to share:

(l)     Documents attached

Signature of the applicant