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Advertisement No. IITM/R/3/2016 Dated 27.06.2016
APPLICATION FOR TECHNICAL TRAINEE AT CENTRAL ELECTRONICS CENTRE 2016-2018
For office useRegistration No. / Paste Passport size Photograph
1. / Name (in Block letters) / :
2. / Father’s Name / :
3. / Date of Birth and Age (Enclose copy of SSLC certificate) / :
4. / Nationality / :
5. / Address for Communication / :
6. / E-mail address
Telephone / Mobile No. / :
:
7. / Permanent Address / :
8. / Whether SC/ST/OBC please tick the appropriate box (enclose copy of certificate from competent authority. Please note BC or MBC certificate is not valid if you Claim OBC) / : / UR / OBC / SC / ST / PD
9. / Details of Demand Draft (No application fee for SC / ST / PD Candidates)
Demand Draft Number and Date / Bank / Amount
Rs.100/-
P.T.O.
: 2 :
10. Details of Academic Record of the applicant in the qualifying Exam. (Enclose Diploma Certificate and mark list of all semesters / years)
Examination passed / Name of the Institution / Month and year of passing / Marks Obtained * / Class / Division / Rank obtained(a) / SSLC
(b) / HSC
(c) / Diploma in Electronics Engg./ Electronics & Communication Engg.
(* Give the percentage of marks on the basis of which class was awarded).
11. / Marks obtained in Diploma Course* :FIRST YEAR / SECOND YEAR / THIRD YEAR
III Semester / IV Semester / V Semester / VI Semester
Subject / Marks / Subject / Marks / Subject / Marks / Subject / Marks / Subject / Marks
12. / Previous Experience , if any (Enclose experience certificate) / :
DECLARATION : I hereby declare that the particulars given in this form are true and correct. At any stage if any of the information furnished by me is found to be false or incorrect, suitable action may be taken against me.
PLACE :
DATE : / SIGNATURE OF THE APPLICANT
* / Enclose copies of SSLC, Diploma and Mark Statements from I Year, III Semester to VI Semesters Certificates, without which the application will be summarily rejected.