AISECT SKILLS MISSION – MOBILIZATION/ QUESTIONNAIRE FORM
Date: ……………………. Location: ………………………………………………………
1. Name of Candidate : ……………………………………………………………………………………………………………… Paste your
2. Guardian’s Name : ……………………………………………………………………………………………………………… recent
3. Date of Birth (dd/mm/yyyy) : Gender : M F Other photograp
4. Caste : Gen OBC SC ST h
5. Religion : Hindu Muslim Christian Sikh Buddhist Jews Other
6. Physically Challenged : Yes No If yes, please specify …………………………………………………………
7. Mobile No : E-Mail Id: ………………………………………………………………..
8. Address : ……………………………………………………………………………………………………………………………………….
City:…………………………..District…………………………State…….……………….Pin Code:…………….
9. Government Id Proof Type* : Voter ID/Aadhar ID/Driving License ID/Passport Id
Government Id proof Id number*: ……………………………………………………………………………………………………………………
10. Educational Qualification : 5th to 8th 9th to 10th 11th to 12th ITI Polytechnic
Diploma Graduate Post Graduate Any other
11. Course Detail : Degree…………….Stream …………… Division/Grade …………... Passing year……/…../…….
Board/University …………………………………….. Course Type: Regular Part-time
12. Are you already employed/self employed? : Yes No
If yes then please provide following details:
a. Name of firm/organization : ……………………………………………………..........................................
b. Location of work : …………………………………………………………………………………………….
c. Current Designation : …………………………………………………………………………………………….
d. Current monthly salary : …………………………… e. Total Experience: ……………………………
13. Name as in bank pass book : ………………………………………………………………………………………………………………..
14. Bank name : ………………………………………………………………………………………………………………..
15. Bank account number : ………………………………………………………………………………………………………………..
16. IFSC code : ………………………………………………………………………………………………………………..
17. PAN number : ………………………………………………………………………………………………………………..
18. Preferred Sector : ………………………………………………………………………………………………………………………
19. Job Role 1: ………………………………………………………….. Job role 2: ………………………………………………………………………
20. Preferred Batch start date: ……/…../…….
Declaration: I hereby declare that, all the information, mentioned above, furnished by me are true & correct. If anything found wrong, my
registration is liable to cancel without refunding any amount. I also declare that have not received any reward amount, earlier, from any
government sponsored program. My registration can be rejected of cancelled also, if this project is withdrawn / postpone / cancelled by the
approving authority
Signature of the Candidate Signature of the Coordinator
Please select correct answers for following questions
(Leave blank if not applicable)