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Refresher Course Enrollment Form

The document is a trainee enrollment form for industry-oriented technology/refresher courses at the CSIR - Central Electrochemical Research Institute in Karaikudi. It collects personal information, educational qualifications, contact details, and payment information from applicants. Additionally, it includes a section for certification by a sponsoring authority if applicable.

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neon0007
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12 views2 pages

Refresher Course Enrollment Form

The document is a trainee enrollment form for industry-oriented technology/refresher courses at the CSIR - Central Electrochemical Research Institute in Karaikudi. It collects personal information, educational qualifications, contact details, and payment information from applicants. Additionally, it includes a section for certification by a sponsoring authority if applicable.

Uploaded by

neon0007
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

CSIR - CENTRAL ELECTROCHEMICAL RESEARCH INSTITUTE

KARAIKUDI - 630003

INDUSTRY ORIENTED TECHNOLOGY / REFRESHER COURSES

TRAINEE ENROLLMENT FORM


Select your qualified certificate course Serial Numbers and write in the appropriate column.
Course Code Title of the course Duratio Time Venue
n
10:00 AM - CSIR -
04:00 PM CECRI,
Karaikudi

1. Name of the Applicant / Trainee :


Affix your
2. Father / Husband's Name : recent
passport
size
3 . Date of Birth (DD/MM/YYYY) : photograph

4. Gender : Male / Female / Others

5. Whether Physically Disabled : Yes / No

6. Highest Educational Qualifications :

7. Photo ID Number (Please attach copy) :


(Aadhar / PAN/ Voter ID / Passport)

8. Mobile Number : 8.1. Alternate Mobile Number:

9. Email Address :

10. Postal address (either Official or Personal):

10.1. Pin-code : 10.2. District : 10.3. State :

11. Trainee's Domicile : Rural / Urban

12. Experience :
Employer Date of Joining Date of Leaving Post Held
13. Whether accommodation need: Yes / No

14. Name of Sponsoring Agency & its Address :

15. Payment Details :


15.1 Mode of Payment: Demand Draft Wire (e-) transfer
15.2 Name of the Bank __________________________ Date : ______________
15.3 DD No:______________________________________________ (or)
e-transfer ID / UTR No:_________________________________
15.4 Amount Rs.__________________________

Place: _________ Signature of the Applicant


Date:__________

CERTIFICATE OF SPONSORING AUTHORITY


(if the candidate(s) sponsored by industry / organization)

Certified that Sri / Ms / Dr.______________________________ is employed as _____________


____________________ in our company / Institute since________.

Place: (Signature of the sponsoring authority)

Date: Designation:

Address:

Seal:
_____________________________________________________________________________________________

FOR OFFICE USE ONLY

WHETEHR ENROLLED : (YES / NO)

Signature of Skill Nodal Coordinator

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