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    Application For Admission To Pgdeg Programme 2020: Affix A Recent Passport Size Photograph

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    somnath dawn
    This document is an application form for admission to the PGDeG Programme in 2020 at the Indian Institute of Information Technology & Management - Kerala. The application requests personal details of the applicant such as name, date of birth, address, contact information, educational qualifications, employment details, experience in e-Governance, extracurricular activities, distinctions and achievements, and a declaration signed by the applicant.

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    Application For Admission To Pgdeg Programme 2020: Affix A Recent Passport Size Photograph

    Uploaded by

    somnath dawn
    55 views3 pages
    This document is an application form for admission to the PGDeG Programme in 2020 at the Indian Institute of Information Technology & Management - Kerala. The application requests personal details of the applicant such as name, date of birth, address, contact information, educational qualifications, employment details, experience in e-Governance, extracurricular activities, distinctions and achievements, and a declaration signed by the applicant.

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    PGDeG-2020-Application-Form.docx

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    This document is an application form for admission to the PGDeG Programme in 2020 at the Indian Institute of Information Technology & Management - Kerala. The application requests personal details of the applicant such as name, date of birth, address, contact information, educational qualifications, employment details, experience in e-Governance, extracurricular activities, distinctions and achievements, and a declaration signed by the applicant.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    55 views3 pages

    Application For Admission To Pgdeg Programme 2020: Affix A Recent Passport Size Photograph

    Uploaded by

    somnath dawn
    This document is an application form for admission to the PGDeG Programme in 2020 at the Indian Institute of Information Technology & Management - Kerala. The application requests personal details of the applicant such as name, date of birth, address, contact information, educational qualifications, employment details, experience in e-Governance, extracurricular activities, distinctions and achievements, and a declaration signed by the applicant.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    INDIAN INSTITUTE OF INFORMATION TECHNOLOGY &

    MANAGEMENT - KERALA

    IIITMK Building, Technopark Campus, Thiruvananthapuram – 695581


    Affix a recent
    Application for Admission to PGDeG Programme 2020 Passport
    Size
    Photograph

    First Middle Last


    Name:

    Father’s name
    Permanent Address Present Address

    Pin Code Pin Code


    Phone with STD code Mobile
    E-mail

    Date of Birth Age


    Place of Birth, District & State

    Marital Status Married: Yes/No Gender Male / Female


    ID Card Type
    Nationality:
    ID Card No.

    Languages Known

    Mother Tongue

    Religion
    SC/ST
    Whether belong to OBC
    Ex-Servicemen
    Whether physically Yes / No If Yes give details: Disability category:
    handicapped? % of Disability:
    Whom to contact in case Name: Relation:
    of Emergency Contact no
    1.
    Identification Marks
    2.
    Govt. of India State Govt. PSU
    Category of Ministry / Dept Employee
    Application Industry Open Others
    Please tick mark Category
    Educational Qualification ( starting from highest qualification)
    Examination Discipline/ School/ Board/ Year of Marks Class/
    passed Specialization College/ University Passing in % Grade
    Institute

    Employment Details
    Name and Contact
    Department / Name and Contact
    Designation Department Details of Reporting
    Office Address Details of HoD
    Officer

    NOC Details No. & date (attach NOC)


    Details of Work Experience (Starting with the most recent)

    Employer
    Total
    details Date
    Date of Years/Month Salary
    (Address, Designation of Work Profile
    Relieving s of Drawn
    Contact No, Joining
    Experience
    Email ID)
    Brief summary of your e-Governance experience, if any
    (Use additional sheet, if required)

    Extracurricular activities and details of membership of Professional Bodies

    Distinction, Honors, Achievements, Awards received (academic and


    community)

    Any Additional Information

    I hereby declare that the information given above is true to the best of my
    knowledge.

    Signature of the Date


    Applicant

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