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App Form Oth 062016

The document is an application form for various managerial positions at NSIC Ltd. It requests personal details like name, date of birth, education qualifications from Class 10 onwards, work experience of last 10 years, additional training undertaken, and payment details. The applicant needs to declare that they have read the guidelines, verified the details filled, and will submit the form along with required documents by the due date. The form needs to be submitted with a passport size photograph and self-attested copies of certificates.

Uploaded by

Amritanshu Mishra
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93 views

App Form Oth 062016

The document is an application form for various managerial positions at NSIC Ltd. It requests personal details like name, date of birth, education qualifications from Class 10 onwards, work experience of last 10 years, additional training undertaken, and payment details. The applicant needs to declare that they have read the guidelines, verified the details filled, and will submit the form along with required documents by the due date. The form needs to be submitted with a passport size photograph and self-attested copies of certificates.

Uploaded by

Amritanshu Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 6

Paste latest

passport size
photograph

APPLICATION FORM

Hand-written applications and/or any addition/deletion in the format of the Application


Form will lead to rejection of the candidature.
POST APPLIED
Chief Manager
(Technology)
Deputy Manager
(Business Development)
Deputy Manager
(Technology)
Deputy Manager
(Finance & Accounts)
Assistant Manager
(Business Development)
Assistant Manager
(Technology)

REQUIRED FIELD AS PER EXPERIENCE


Please (tick ) only one option. In case applying for more than one
field, submit a fresh Application Form)

Testing Mechanical

Non Destructive Training

Testing Chemical
Computer Training

Computer Aided
Engineering
PLC Robotics

Tool Room Training

Electrical

Quality Control Training

Incubation

Refrigeration & AC
Training
Design

Computer Aided Design

Assistant Manager
(Finance & Accounts)
Please copy the tick mark symbol and paste it wherever needed in the Application Form.
NOTE: Fields Marked * are Mandatory. In Case Mandatory fields are not filled, the Application
Form will be rejected.

A) PERSONAL DETAILS

1.

Name Of Applicant*
(in BLOCK letters)
Fathers/Mothers Name*

AMRITANSHU MISHRA

13-12-1984

4.

Date Of Birth*
(dd/mm/yyyy)
Aadhaar No.

5.

Category*

General

2.
3.

Dr. S.D. Mishra

SC

ST

OBC

Yes

No

7.

Whether belongs to
Person with Disability
Category *
Gender*

8.

Marital Status

Married

6.

9.

Whether belongs to
Minority Community*
10. E-mail*
11. Mobile*
12. Complete Current
Residential Address

13. Permanent Residential


Address Complete

Male

Female

Yes
eemishra@gmail.com
9839883322
House No.
Street Name
City
District*
State*
Pin code*
House No.

Transgender
Single
No

B 33/10-K-18-A-11 Mangalam Tower


Rohit Nagar, Nariya, Sunderpur, Lanka
Varanasi
Varanasi
Uttar Pradesh
221004
C/o Dr. Pratima Pandey, Pandey
Nursing Home, Bus Stand

Street Name
City
District*
State*
Pin Code*

Gopiganj
Sant Ravidas Nagar, Bhadohi
Uttar Pradesh
221303

B) EDUCATIONAL QUALIFICATION* (Xth Class onwards)


#

Name of
Examination / Degree
passed
(No abbreviation to be
used)

Full
Name
of Duration Date of Regular/ %age
Board/University/Institut (Only in passing Distance/
e (No abbreviation to be years)
Part-time
used)

Indian Certificate Of Council for the Indian


Secondry Education

(Class 10th)
All
India
School

School

Certificate

Examinations
Senior Central
Board

Of Allahabad

Technology

, Institute

Of

Biotechnology

25-05-

Regular 63.6

2002

Agriculture

Regular 73

2000

Certificate Secondary Education

Examination
Bachelor

07-05-

Deemed

07-09-

Regular 68.9

2007

University

4
C) Post-Graduation Diploma / Masters Degree*{Including CA / ICWA (CMA) / CA (Inter) /
ICWA(CMA)(Inter), as the case may be}
#

Full Name of Specialization


Masters
Degree / PG
Diploma
(No
abbreviation to
be used)
Post Graduate
Marketing

Full Name of Duration Date of Regular/


University / (Only in passing Distance/
Institute (No years)
Part-time
abbreviation
to be used)

%age

Jaipuriya

56.62

Diploma In

Institute Of

Management

Management,

Master of

Marketing

Lucknow
Shobhit

Business

Management

University

12-05-

Regular

2011

24-09-

Distance 61.78

2014

Learning

Administration
3
4

D) EXPERIENCE* (Starting from the present employer) {In case of CA / ICWA(CMA) / CA(Inter) /
ICWA(CMA)(Inter), as the case may be, Article-ship / Practical Training may be shown as experience}
#

Full Name of
Employer (No
Abbreviation to be
used)
Centum Learning

Designation

Duration
DD/MM/YYYY
From
To

Admin

25-11-

Centre Varanasi

Manager

2013

Present

Job profile
(Maximum 30
words)
Looking after Admin
duties, admissions,
Marketing,

Gross
Salary
(Per
month)
20,000

Promotion, Sales,
purchasing,
maintenance, hiring
2

Reliance Retail

Assistant

12-02-

15-11-

and training of staff.


Cash Team

Limited

Manager -

2013

2013

management and

Operations

20,000

Non Food section


Display, Sales,
Promotion, Team
management,

Future Retail Limited

Managemen

04-07-

05-04-

Training
Looking after

t Trainee

2011

2012

fashion section.

28,210

Managing Floor,
Marketing activities,
Team Management,
4

Pandey Nursing

Admin

01-07-

01-07-

Training, B2b Sales


Looking after the

Home, Gopiganj

Manager

2007

2009

operations of the

16000

hospital, marketing
and promotions of
the hospital in
nearby areas.
5

E) ADDITIONAL QUALIFICATION / TRAINING ATTENDED (of more than 3 months duration), if any
#
1
2
3
4
5

Full Name of Qualification / Training


(No abbreviation to be used)

Duration
(In months /
years)

Brief Description
(Maximum 30 words)

F) WHETHER WORKING AS PERMANENT / CONTRACT EMPLOYEE IN GOVT. / SEMI GOVT. / PSUS /


BANKS / LOCAL BODIES ETC.*?

Yes

Permanent

If Yes, Please mention the particulars of your HR Head / Personnel


Deptt.
Name ____________________________________________________

Contract
No

Address __________________________________________________
__________________________________________________________
Phone No. _________________________

G) HAVE YOU EVER APPEARED IN INTERVIEW FOR ANY POST IN NSIC DURING LAST 3 YEARS*?
If Yes, Please mention the name of the Post and Year of Interview

Yes
No

Post _________________________________________________________

Year _______________________________________________________

H) PAYMENT DETAILS*
Demand Draft
Number
Date

Name of the Issuing Bank

Address of the Issuing


Branch

Amount
(in Rs.)

Self- Declaration of applicant*


(a) I declare that I have carefully read all the Guidelines mentioned along with the
detailed advertisement hosted on NSIC website.
(b) I have verified the above details, and the details are in order to the best of my

knowledge & belief.


(c) I understand that merely filling this Application Form will not be treated a complete
YES
application. Therefore, I further declare that I will send this Application Form with selfattested copies of all documents as per pt. 4 & 5 of How to Apply (pt. IV of Guidelines)
to DGM (HR), NSIC Ltd. so that the same is received on or before 11.07.2016 upto 6.00
p.m.
Place of Submission*: _______________________
Date of Submission*: ________________________

_______________________
Signature of the Applicant*

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