| 1. |
Full Name In Capital
Letters
|
___________________________________________ |
| 2. |
Designation |
___________________________________________ |
| 3. |
Sponsoring Authority |
|
|
a) Circle |
___________________________________________ |
|
b) Division |
___________________________________________ |
| 4. |
Date of Birth |
___________________________________________ |
|
a) Age on the start
of Course :
|
___________________________________________ |
|
(Required to be less
than 55 years for Short Term Course & 50 years for Long
Term Course)
|
|
| 5. |
Sex |
___________________________________________ |
| 6. |
Address for
Communication
|
___________________________________________ |
|
(with Pin Code) |
___________________________________________ |
|
Telephone Number |
___________________________________________ |
|
Fax Number |
___________________________________________ |
|
Email |
_____________________________________________ |
| 7. |
Is the subject of
this Course/ Workshop related to your present nature of work ?
|
___________________________________________ |
| 8. |
Has nominee attended
any other similar training course ? If yes, give details.
|
___________________________________________ |
| 9. |
Details of Computer
Courses completed if any
|
___________________________________________ |
|
Nominee's Signature
|
Signature of sponsoring authority
|
