You are on page 1of 3

DOEACC SOCIETY, CHANDIGARH CENTRE

Branch Office Lucknow


A-1/9, Sumit Complex, Vibhuti Khand,
Gomti Nagar, Lucknow 226010
Tel/Fax 0522-2720589, 0522-2720590

Performa Application Form


Post Applied for : --------------------------------------------------------------Willing to work any where in INDIA: Yes

Affix Passport
size photograph here

No

*Detail of Bank Demand Draft/ Cash of Rs. 350/-:


DD No/ Receipt No (If Cash): _______________ Date _______________
Drawee Bank: ___________________________
(Favoring Director DOEACC Society, Chandigarh Centre, Branch Office, Lucknow
Payable at Lucknow)

Name of the Candidate


:---------------------------------------------------------------Fathers Name

: ---------------------------------------------------------------

Date of Birth (dd/mm/yyyy)

:---------------------------------------------------------------

Age as on 21/09/2011
Mailing Address

Years
:

Months

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Email id

: --------------------------------------------------------------

Contact telephone no.


:----------------------------------------------------------------

Page 1 of 3

Educational Qualification 10th class onwards (Attach copies of certificates):


Sr.No.

Qualification/ Degree/
Diploma

Name of University
/Institution

Year of
Passing

%Age/Grade

1.
2.
3.
4.
5.
Software Skills:
S.No Skill Name (DOT Net,
JAVA, C++ etc.)
1
2
3

Last Used
(Month, Year)

Skill Level (Beginner,


Intermediate, Advance)

Experience (in
years)

Hardware Skills:
Brief Description of experience (Start with your latest job):
Sr.
No.
1.

Name of Organization
Worked in.

Duration
From

Period
To

Brief Description of duties

2.

3.

Your best three choices of locations where you prefer to be deployed:


1.

___________________________

2.

_____________________________

3.

______________________________

Experience in years & months:


Certified that all the information furnished above by me is correct to the best of my knowledge.
*The registration fee of Rs.350/- is non-refundable
Place:

Signature of Candidate

Page 2 of 3

Date :

Page 3 of 3

You might also like