Candidate Basic Details: |
Candidate Personal Details: |
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|---|---|---|---|---|
| First Name * | ID Card Type * | |||
| Last Name | ID Card Number * | |||
| Gender * | Qualification * | |||
| Date of Birth * | Employment Exchange Number * | |||
| Mother Name * | Religion * | |||
| Father Name * | Category * | |||
Current Address Details: |
Permanent Address Details: |
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|---|---|---|---|---|
| C/O or S/O or D/O * | (Is Permanent Address Same As Current Address? *) | |||
| Village/ Town * | Village/ Town * | |||
| Street/ Landmark * | Street/ Landmark * | |||
| Post Office * | Post Office * | |||
| Pin Code * | Pin Code * | |||
| District Name * | District Name * | |||
Other Details: |
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|---|---|---|---|---|---|---|---|
| Is BPL Card Holder? * | YesNo | Is Antodaya Card Holder? * | YesNo | Is MGNREGA Card Holder? * | YesNo | ||
| Is Minority? * | YesNo | Is BoCW (Building and Costruction Worker)? * | YesNo | Is Tea Tribe Minority? * | YesNo | ||
| Are you Person with Disability? * | YesNo | Assembly Constituency * | Is City / Village? * | CityVillage | |||
Course Preference: |
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|---|---|---|---|---|
| Course Category * | Training Center (1st Preference) * | |||
| Course Name * | Training Center (2nd Preference) Optional |
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Educational Qualification: |
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|---|---|---|---|---|---|---|---|---|
| Examination | Board/ University | Marks Obtained | Division/ Grade | Year of Passing | ||||
| Computer Diploma/ Certificate: | ||||||||
Documents Upload |
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|---|---|---|
| 1 | Recent Pass Port Size Photograph | Pending Passport Photo Upload |
| 2 | Signature of Applicant | Pending Signature Upload |
| 3 | Age Proof (Admit Card HSLC/Pass Certificate) | Pending Age Proof Upload |
| 4 | Highest Qualifying Certificate | Pending Certificate Upload |
| 5 | HS (10+2) Marksheet | Pending Marksheet Upload |
Skill Development and Training on IT |
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|---|---|---|---|---|---|---|---|---|
Application Form | ||||||||
| 1 | Applicant Name | |||||||
| 2 | Gender | |||||||
| 3 | Date of Birth | |||||||
| 4 | Mother Name | |||||||
| 5 | Father Name | |||||||
| 6 | ID Card Type | |||||||
| 7 | ID Card Number | |||||||
| 8 | Qualification | |||||||
| 9 | Employment Exchange Number | |||||||
| 10 | C/O or S/O or D/O | |||||||
| 11 | Present Address | |||||||
| 12 | Permanent Address | |||||||
| 13 | Course Category and Name | |||||||
| 14 | Training Center (1st Preference) | |||||||
| 15 | Training Center (2nd Preference) | |||||||
| 16 | Educational Qualification | |||||||
| Examination | Board/ University | Stream | Division/ Grade | Year of Passing | ||||
| 17 | Computer Diploma/ Certificate |
| 18 | Recent Pass Port Size Photograph | Signature of Applicant | Age Proof | Highest Qualifying Certificate | HS (10+2) Marksheet | |||||
I HEREBY DECLARE THAT THE INFORMATION SUBMITTED BY ME IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE. I SHALL BE LIABLE FOR ANY DISCIPLINARY/PUNITIVE ACTION IN CASE ANY OF THE DETAILS ARE FOUND TO BE INCORRECT. |
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Thank You!
