Enquiry Form

Format S-1

HCL CAREER DEVELOPMENT CENTRE

ENQUIRY FORM
FOR OFFICE USE ONLY
CNTR CODE

DATE

ENQUIRY NO.

ENQUIRY NO.
D

TO BE GIVEN BY HCL CDC

FINAL REMARKS __________________________________________________

NAME OF STUDENT (FULL NAME

AS MENTIONED IN YOUR CERTIFICATES)

FIRST NAME

MIDDLE NAME

(USE BLOCK LETTERS ONLY.

LAST NAME

LEAVE ONE CELL EMPTY BETWEEN FIRST, MIDDLE AND LAST NAME)

RESIDENCE PHONE NO.

MOBILE NO.

9 1
E-MAIL ID (MANDATORY)

FATHERS / GUARDIANS NAME

FIRST NAME

MIDDLE NAME

LAST NAME

RESIDENCE PHONE NO.

MOBILE NO.

9 1

CURRENT ADDRESS
HOUSE/FLAT /BLOCK NO.

( USE BLOCK LETTERS ONLY .

NAME OF BUILDING/VILLAGE/PREMISE

ROAD/STREET/POST OFFICE

LEAVE ONE CELL EMPTY AFTER EVERY SECTION)

AREA DETAIL

DISTRICT/ CITY/TOWN

STATE

PIN CODE

PERMANENT ADDRESS
HOUSE/FLAT /BLOCK NO.

( USE BLOCK LETTERS ONLY .

NAME OF BUILDING/VILLAGE/PREMISE

ROAD/STREET/POST OFFICE

LEAVE ONE CELL EMPTY AFTER EVERY SECTION)

AREA DETAIL

DISTRICT/ CITY/TOWN

STATE

PIN CODE

HOW DID YOU COME TO KNOW ABOUT HCL CDC?

NEWSPAPER

NEWSPAPER INSERT

CANOPY

PRESENTATION/SEMINAR

BANNER/HOARDING

CABLE AD

FRIENDS/FAMILY

TV

WEBSITE / E-M AILER

OTHER (PLEASE MENTION)

______________________________________________________________________________________________________________
Ver 1.0

HCL CDC Enquiry Form

Page 1 of 2 Pages

Enquiry Form

Format S-1

GENDER

MALE

DATE OF BIRTH

FEMALE

ACADEMIC DETAILS
MCA

BE/B TECH

POST GRADUATE

GRADUATE

UNDERGRADUATE

OTHER (PLS. SPECIFY) _________

START FROM THE LATEST ACADEMIC DETAILS I.E. FROM HIGHEST QUALIFICATION TO SECOND HIGHEST AND SO ON.
COMPLETED/
QUALIFICATION
SCHOOL/COLLEGE
BOARD/UNIVERSITY
PURSUING

EXP./ YEAR OF

COMPLETION

GRADE /
% MARKS

DETAILS OF IT PROGRAMS DONE

1.

PROGRAM __________ NATURE OF PROGRAM ________________________ INSTITUTE _____________YEAR _________

2.

PROGRAM __________ NATURE OF PROGRAM ________________________ INSTITUTE _____________YEAR _________

PROFESSIONAL EXPERIENCE
WORKING (GIVE DETAILS)

SERVICE

NON-WORKING (FRESHER)

SELF EMPLOYED

NAME OF PRESENT ORGANISATION ___________________________________ YOUR DESIGNATION _____________ ________

TOTAL EXPERIENCE SO FAR ______ YRS. _NATURE OF JOB ____________________________________SALARY ________/-MONTH
ADDRESS OF ORGANISATION ____________________________________________________________________________
URL _______________O FFICE CONTACT NO. ____________________ E-MAIL ID __________________________________

CAREER PREFERENCE
HARDWARE

NETWORKING

SOFTWARE

DATABASE ADMIN

ANY OTHER (PLS. SPECIFY) _________________

PROGRAM PREFERENCE

PART TIME

CAREER PROGRAM

HCNE (3 YRS.)

MODULAR PROGRAM

CCNA

MCSE

HCE (1 YEAR)
RHCE

DATE

FULL TIME

HCSE

ANY OTHER (PLS. SPECIFY) _____________

COMBO

ANY OTHER (PLS. SPECIFY) ____________

STUDENT SIGNATURE
D

PLACE ______________________

________________________

FOR OFFICE USE ONLY

PROGRAM RECOMMENDED__________________________ SLOT PREFERENCE_____________________

COUNSELLING REMARKS ______________________________________________________________
________________________________________________________________________________
COUNSELLORS NAME ____________________________ COUNSELLORS SIGNATURE ________________

FINAL REMARKS (ENROLLED / WONT JOIN)

Ver 1.0

HCL CDC Enquiry Form

Page 2 of 2 Pages