BOARD OF APPRENTICESHIP TRAINING

(NORTHERN REGION)
Plot No. 16, Block 1-A, Lakhanpur, Kanpur 208 024(U.P.)
Application for Apprenticeship Training under Apprentices Act. 1961
For use by freshly passed out candidates (Diploma Holders Only)
1.

Name of Candidate
(in block letters).....

2.

Fathers Name............

3.

Address for correspondence...

....Pin..
Phone No.... Mobile No.....E-mail ID
(With STD Code)

4.

Date of Birth. Age.. Male/Female....

5.

Scheduled Caste/Tribe/OBC/PH/Minority (Give Details)..........................................

6.

Particulars of Diploma Examination passed :

Diploma

7.

Branch of
Diploma

Institution from
Where passed

University/Board

Year of
Passing

Marks obtained/
Max. Marks

% of Marks

Choice of training place.

Certified that (i) I have not passed above examination under Sandwich Course
(ii) I have not had any job/training experience after passing the above examination.
Date :
Certified that the above particulars are correct.
Date :
Date Recd.

Signature of Candidate

Signature of Head of Institute

(with official seal)
For use by the Office of the Board of Apprenticeship Training, Kanpur-208 024.
Regn.
INTERVIEW
Offered
Joined
No.
Date

For Office Use

Ref. BT/AA-10/
Dated
Sl. No. for Interview
Category : Degree
Computer Code No.
Branch : Mech./Elect./Civil/Electro

Date of Interview
Place of Interview
Asstt. Director.

Candidate to fill his address

O.I.G.S.

To,

Pin Code..