Application Form For Academic Associate
Application Form For Academic Associate
Examination Passed
University /
Institution
Subjects
Year of
passing
Class /
Division
PGDIT
IIT Kharagpur
Information Technology
2005
1st
BTech
UPTU
Information Technology
2004
1st
12th
CBSE
PCMB
1998
1st
10th
CBSE
PCMB
1996
1st
Ibilt Technologies
Spanco Limited
Period of Service
From
June 2005
Jan 2007
To
December
2006
Till Date
Professional
Growth
Senior Software
Engineer(Business
Analyst/Presales Technical
Consultant)
Need to do Phd
& interested in
research
12.
13. Any other information you may wish to add including publication, if any (use separate sheet,
if necessary): No
14.
15.Declaration -I declare that the foregoing information is correct and complete to the best of
my knowledge and belief and nothing has been concealed/ distorted. If I am found to have
concealed/ distorted any material information, my appointment shall be liable to summarily
termination without any notice. If offered appointment, I will join on specified date and
subsequently take up IIMIs assignment anywhere as and when required.
Date: __19/01/2009_____________
Umed Kejariwal
Place: ___Mumbai_____________
Candidate
Signature of the