Apprenticeshiptraining: Fluid Control Research Institute

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APPRENTICESHIPTRAINING

CONFIDENTIAL
P & A Ref. No:

FLUID CONTROL RESEARCH INSTITUTE


(An Autonomous R & D Institute under Ministry of Industry)
Dept. of Heavy Industry, Government of India Photo
Kanjikode West, Palakkad 678 623, Kerala, India
Phone: 0491-2566206, 2566120, 2566119 Fax: 0491-2566326,
Email:[email protected]
Graduate Engg Diploma Engg
Apprenticeship Training :
Branch of Study :

Name in Full :
(BLOCK CAPITAL)

Father's Name & :


Occupation

Present Address :

Permanent Address :

:
Email

Mobile No :

Passport Number : Date till valid:

Age* & Date of Birth: :

Marital Status :

Nationality :

State of Domicile :
&Mother Tongue

Religion / Caste :

Scheduled Caste /
Scheduled Tribe :
Read :
Languages known Write :
Speak :

Have you ever been Interviewed earlier in FCRI :

ACADEMIC RECORDS*
Year Course & Specialization School/College / Class &
University & Institute Percentage of
Marks
From To

Short term courses / Professional :


Training Programmes*

Give (Two references (not related to you) who are well acquainted with your
background, service career and character etc.
1. Name :
Occupation :
Address :
2. Name :
Occupation :
Address :

DETAILS OF YOUR FAMILY MEMBERS


Member Name Occupation (if Present postal Permanent
employed give address Home address
official address)

Father (Name in
full address if any)

Mother

Wife/Husband

Brothers/Sisters

Any relevant information that you may wish to furnish


DECLARATION

I hereby certify that the particulars furnished as above are true, correct and
complete in all respects. I agree and accept reservation that at any time, if any of
the particulars is found to be untrue, incorrect and /or incomplete, my
appointment in the Institute, may be terminated without notice.

Signature
Place :

Date :

*Please attach Copy of supporting documents.

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