Please Fill This Form

Your Name :

Father’s Name :

Mother’s Name :

Date of Birth :

Gender:

Local Address:

Permanent Address:

Phone No :

Mobile No :

E-mail ID

Experience if any may be added

Academic Record:-

Exam	Board/University	year	Division	Percentage
10th
12th
B.Tech Ist Sem
B.Tech IInd Sem
B.Tech IIIrd Sem
B.Tech IVth Sem
B.Tech Vth Sem
B.Tech VIth Sem
B.Tech VIIth Sem
B.Tech VIIIth Sem
B.Tech Agg%

Branch :

No. of Backlog :

ID/Roll No. :

Batch :

Software Skills :

Training/Workshop:

Extra Curricular Activities :

Achievement (if any) :

Preferred Sector (In Order of Preference) :

Upload Photograph

I certify that all the information given in the placement form is
true and to the best of my knowledge. I assure that I shall abide by all
the rules and regulation of the Institute, which are in vogue as well
as which come into force later.