Office Use

ARTHUR C CLARKE INSTITUTE FOR MODERN TECHNOLOGIES

Application For “Embedded Control Systems” (Microprocessor /

Microcontroller) for Industry Process Control and Automation – Mechatronics
Course [ECSC]

Name of Course
________________________________________________________________________
Name in full
________________________________________________________________________
Organization/Employer
____________________________________________________________________
Organization Address
____________________________________________________________________

____________________________________________________________________
Tele. No. _______________ Fax No. _________________ E-mail
__________________
Current Position _____________________________________________________________________
Home Address
_____________________________________________________________________
_____________________________________________________________________
Contact Tele. No. (Home/ Mobile) ________________________
Identity Card No. ________________________

Qualification Degree Diploma Certificate G.C.E.(A/L),

(O/L)

Experience (briefly describe previous experience, identifying types of systems with

which you have worked.)
__________________________________________________________________________________________
__________________________________________________________________________________________
_______________________________________

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Applicant’s Signature ______________________________ Date
________________________

Supervisor’s Signature ______________________________ Date

________________________

Name of Supervisor __________________________ Title of Supervisor

______________________

Organization _______________________ Supervisor’s Direct Tel. No.

_______________

APPLICATIONS SHOULD BE SENT TO THE COURSE COORDINATOR OF THE RELEVANT COURSE.

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