Under Department of Political Science 30, Mother Teresa Sarani (Park Street), Kolkata 700 016 Phone: +91 33 2255 1288/89, e-mail: careersxc@gmail.com PHOTOGRAPH Affix your latest passport size photograph Name of the Candidate Address for Correspondence (Leave a blank between each unit of address House No. Street Name, PO, etc City/District State Country Pin Code/Zip Code Mobile number of the Candidate Telephone (with STD Code) Date of Birth Gender E-mail Address Employment Status Do you belong to any of the following categories? Date: Place: Signature of the Candidate Male Female Employed Unemployed ST/SC/OBC SXC Student Christian Disabled Details of Completed Educational Qualifications Qualification Examination Name, Institution Name, City Stream/Honours Year of Passing Grade/ Percent Intermediate/10+2 Graduation Post Graduation Details of Currently Pursuing Educational Qualifications Qualification Examination Name, Institution Name, City Stream/Honours Roll No Year of Appearing Details of Employment, If Any Name of Present Employer (with address and Contact No.) Designation Experience Under Graduate Course in Human Rights ducation COLLEGE I.D. CARD FORM St. Xavier's College (Autonomous) 30, Mother Teresa Sarani, Kolkata 700016 Phone : 22875995/22551288 Website : www.sxccal.edu PHOTOGRAPH Affix your latest passport size photograph Name of the Candidate Name of Parent/Guardian Mobile number of the Candidate Address & Correspondence (Leave a blank between each unit of address House No. Street Name, PO, etc) City/District State Country Pin Code/Zip Code Telephone (with STD Code) E-mail Address Blood Group Signature _____________________________________________________ Date of Birth Roll No. Course Under Graduate Course in Human Rights Education Session August 2013 DEPARTMENT OF POLITICAL SC. Date: .................................... St. Xaviers College (Autonomous) 30, Mother Teresa Sarani, Kolkata - 700016 Demand Draft/ Pay Order No. ................................ STUDENTS COPY Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above Name of the Candidate Payment Type DEPARTMENT OF POLITICAL SC. Date: .................................... St. Xaviers College (Autonomous) 30, Mother Teresa Sarani, Kolkata - 700016 INSTITUTIONS COPY Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above Name of the Candidate DEPARTMENT OF POLITICAL SC. Date: .................................... St. Xaviers College (Autonomous) 30, Mother Teresa Sarani, Kolkata - 700016 BANKS COPY Paid to the credit of St. Xaviers College A/c No. 95852010004418 as per details above Name of the Candidate Verified by:________________________ Cashier:________________________ Verified by:________________________ Cashier:________________________ Verified by:________________________ Cashier:________________________ Payment Type Demand Draft/ Pay Order No. ................................ Payment Type Demand Draft/ Pay Order No. ................................ Course Under Graduate Course in Human Rights Education Session AUG-13 Amount Roll No. Course Under Graduate course in Human Rights Education Session AUG-13 Roll No. Course Under Graduate course in Human Rights Education Session AUG-13 Roll No. Amount Amount Cash Demand Draft/ Pay Order Cash Demand Draft/ Pay Order Cash Demand Draft/ Pay Order