ROLL NO:

(Office use only)

I}HARAT ELECTRONICS LIMITED

.IALAHALLI POST, BANGALORE _ 560 013
(CENTRE FOR LEARNING & DEVELOPMENT)

Application for Graduate Apprenticeship Training

t. Narne ol the canci iclatc

(ln capital letters as pcr SSLC Marks card)

2. Father's Name

J. Mother"s Nante

Date Year

4. Date of Birth
m mn-r-]-l
5. Category SC/ST/OBC/GEN

6. Physically Hand icappcd Yes / No

7. Community

8. Gender Male / Female

9. Address for Cotttttttrtticirtiort

Pin Code:

10. E mail lD

Phone: Mobile:
I I . Name & Place ol collcsc sltrdied

12. Branch ol'Engirree lirrg

I 3. Qualification Detiri ls
("/")
Marks Month & Year
Education \lar N'larks Min Marks
Obtained
Percentage
of Passing
Obtained
SSLC

PUC
Senr - l

Sem-ll
Senr-lll

BE/
Sern - lV
B.TECH Senr- \'
Senr - \'l

Sem - \/ll
Sem - \ lll

14. Class Grade in Ill: Il I I:('ll : Distinction / First class i Second Class

15. If yoLrr Father ' l\lothcr I ltrsband is errployed :

in BEL rnention tlte il rluttc.

Staff No. & Dept. [)ivision

DECLARATION BY THE CANDIDATE

a. I declare that I havc cornplctecl nty.'degree / diploma and applying tbr training within three years ftonl tlte
date of complction.
b. I hereby declare rlrirr lll tltc entries rnade in this fbrrn are trLle and correct to the best olrny knowledge and
in case of rny err'..rrtc()u\ cnlries tbLtnd later. rny training rnay'be cancelled.

PLACE:
DATE: SIGNATURE OF CANDIDATE