Boat Nr 4d149

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…..………………………………