BOARD OF APPRENTICESHIP TRAINING (NORTHERN REGION) Plot No. 16, Block 1-A, Lakhanpur, Kanpur – 208 024(U.P.) Application for Apprenticeship Training under Apprentices Act. 1961 For use by freshly ed out candidates (Diploma Holders Only) 1.
Name of Candidate (in block letters)…………………………………………..……………………………………………………...
2.
Father’s Name…………………………………..…………………………………………………………..........
3.
Address for correspondence…………..…………………………………………………………………………. …………..………………..……………………………………………………………Pin..…………………… Phone No………..…………..… Mobile No……...………………..E-mail – ID……………………………… (With STD Code)
4.
Date of Birth……………………….……… Age…………….………. Male/Female…………………..……..
5.
Scheduled Caste/Tribe/OBC/PH/Minority (Give Details)…………………………..........................................
6.
Particulars of Diploma Examination ed :
Diploma
7.
Branch of Diploma
Institution from Where ed
University/Board
Year of ing
Marks obtained/ Max. Marks
% of Marks
Choice of training place……………………….………………………………………………………
Certified that (i) I have not ed above examination under Sandwich Course (ii) I have not had any job/training experience after ing the above examination. Date : Certified that the above particulars are correct. Date : Date Recd.
Signature of Candidate
Signature of Head of Institute (with official seal) For use by the Office of the Board of Apprenticeship Training, Kanpur-208 024. Regn. INTERVIEW Offered ed No. Date
For Office Use Ref. BT/AA-10/ Dated Sl. No. for Interview Category : Degree Computer Code No……………………………. Branch : Mech./Elect./Civil/Electro…………… ………………………………………………… Date of Interview Place of Interview Asstt. Director.
Candidate to fill his address O.I.G.S.
To, …………………………………………… …………………………………………… …………………………………………… …………………………………………… Pin Code…..………………………………