NATIONAL INSTITUTE OF TECHNOLOGY, ARUNACHAL PRADESH

TECHNICAL EDUCATION QUALIFY IMPROVEMENT PROGRAM - III

APPLICATION FORM

APPLICATION FOR THE POST OF

1. Name in Full:

(In Block Letters)

2. a) Fathers Name:

b) Mothers Name:

Gender: M / F

Affix self-attested recent colored passport photo

3. i) Address for correspondence:

Phone No. Mobile No.

E-mail address:

Fax No.

ii) Permanent Address:

4. Nationality:

Date of Birth : dd/mm/yy Age: Years Months

5. Category:

PWD

In case of OBC, whether belong to Non creamy layer Yes / No

6. Particulars of Educational Qualifications

Sl. No.	Degree Obtained & Branch / Specialization (specify)	Name of the University/Institute	Year of Passing	% of Marks/ CGPA	Class/ Division
1	HSC
2	Higher Secondary
3	Graduation
4	Post-Graduation
5	Other

7. Particulars of Technical/ Professional Qualifications (Mark sheets should be enclosed):

Sl. No.	Examination Passed	Name of the Board/ University/Institute	Year of Passing	% of Marks/ CGPA	Class/ Division
1
2
3

8. Experience and details of employment, if any (Certificate should be enclosed):

Sl. No.	Name of Organization	Name of Post	Period	Nature of Work Handled

9. Professional Qualifications: (a) Typing Speed (in computer)

wpm

(b) Proficiency in working MS Word, Excel, Power point: Very

Good/ Good/ Average (strike off whichever is not applicable)

10. DETAILS OF TESTIMONIALS / CERTIFICATES / DOCUMENTS ENCLOSED:

N.B.: Every application must be accompanied by self-attested photo copies of documents in support of claims made by the candidate in respect of date of birth, academic qualifications, practical training, experience, caste etc.

1.		2.
3.		4.
5.		6.
7.		8.

Name & Signature of the Candidate: Date:

DECLARATION BY THE APPLICANT

I, the undersigned, hereby declare that I have carefully read and understood the instructions and particulars provided by the Institute and affirm that all information that I have furnished is true to the best of my knowledge and belief.

I understand that I alone will be responsible for any consequences arising out of incorrect and / or incomplete information furnished in this application.

Place:

Date:

Signature of applicant : _

Name:

FOR OFFICE USE ONLY

1. Application received on:

2. Remarks

3. Selected for the Trade Test: YES / NO

4. Selected for the Interview: YES / NO

4. Contact details of Candidate: (a) E-mail:

(b) Mobile No: