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Form 2012

This document contains an application form for admission to a part-time diploma program in engineering. The form requests information such as the applicant's name, address, date of birth, educational qualifications, employment details, and category. It provides instructions for submitting the completed form before the July 23rd deadline. The applicant, their guardian, and an official from their last institution must sign declarations confirming the accuracy of the information provided.

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39 views2 pages

Form 2012

This document contains an application form for admission to a part-time diploma program in engineering. The form requests information such as the applicant's name, address, date of birth, educational qualifications, employment details, and category. It provides instructions for submitting the completed form before the July 23rd deadline. The applicant, their guardian, and an official from their last institution must sign declarations confirming the accuracy of the information provided.

Uploaded by

skc198412
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GOVERNMENT OF NCT OF DELHI DEPARTMENT OF TRAINING AND TECHNICAL EDUCATION PITAMPURA: DELHI Form No APPLICATION FORM FOR ADMISSION

TO PART TIME DIPLOMA (4 YEARS) IN ENGINEERING FOR THE YEAR 20122013. Space for Photograph IMPORTANT INSTRUCTIONS Paste a recent passport size 1. Please read the instructions given in the information bulletin carefully. 4x4 cm. 2. Write all the particulars in DARK BLUE/BLACK ink and CAPITAL LETTERS clearly photograph of the size duly signed by Head of Institution and legibly. No column should be left blank. last attended by the candidate or 3. The application form should reach the designated office on or before attested by a Gazetted Officer. 23.07.2012 (04.00PM) Please do not pin or staple. 4. No application form received after the due date shall be accepted. 5. Please paste the PHOTOGRAPH neatly with gum or adhesive in such a way that the gum or adhesive does not over flow. Do not PIN or STAPLE the photograph. FOR OFFICE USE ONLY Rank No.. Merit % Eligible (Y/N) Category . .. Counter No Regn. No Polytechnic/Institute Ackn No. . Gen./Res Local/ Outsider .. Original Checked by Initials Name . 1. Applying for: Part-time Diploma Course in .. Engineering. 2. CANDIDATES NAME (in capitals only) (As given in Secondary School Certificate)

Admitted to course In ... . Roll No. Allotted .. Chief Admission Officer

3.

NAME OF FATHER/ GUARDIAN with Official Address (in capital only)

4.

COMPLETE POSTAL ADDRESS (in capital only) (Do not repeat name)

5. 7.

STATE (a) TELEPHONE RES:

6. PIN CODE

OFF:

b) E Mail ID

8. NATIONALITY Indian/ Other 9. SEX Male (M) / Female (F) 10. CATEGORY GENERAL/PD/SC/ST/OBC/DEFENCE/ (i), (ii), (iii), (iv), (v), (vi), (vii)/ STAFF (See para 7) 11. DATE OF BIRTH Day Month Year 12. REGION (a) Passed from an institution located in NCT of Delhi (b) Passed from an institution located outside NCT of Delhi 13. DETAILS OF EXAMINATION PASSED OR APPEARED Examination Board/ Subjects/ Aggregate University Trade Percentage of Marks obtained in all subjects 10th I.T.I./Diploma 12th/ Vocational Others(if any) 14. Sl.No. DETAILS OF EMPLOYMENT/TRAINING (FOR PART-TIME DIPLOMA COURSES) Salary Name & Address of the Post held Organisation with From Telephone No. Roll No. Year Name/ Address of Institutions Studied

Period To

DECLARATION I hereby solemnly affirm that the statement made and information furnished by me in this application form is true and correct. I have not kept any information secret. If it is found that any information furnished herein is fraudulent, incorrect or untrue in material particulars, I realize that I am liable to prosecution and that the admission to the course is liable to be cancelled. Signature of the Candidate Date: I have carefully read the information furnished by my son/daughter, ward and affirm that it is true and correct. Date: Signature of the Father/Guardian

I hereby certify that the information furnished by the aforesaid candidate is correct as per my school/college records. Signature of the Principal/Head of Institution last attended/Gazetted Officer Full Name: Office stamp of the School Date: 3 4 5 6...

15.

List of enclosures

1. 2.

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