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REGISTRATION FORM

TECH BEE HCL'S EARLY CAREER PROGRAM

PERSONAL INFORMATION

NAME Atul Kumar MOBILE NO 8528736318


Srivastava
FATHER'S NAME Anil Kumar FATHER'S Pvt
Srivastava OCCUPATION*

MOTHER'S NAME Shailja MOTHER'S Homemaker


Srivastava OCCUPATION

STATE Uttar Pradesh CITY Bahraich

DOB 15-01-2002 EMAIL ID* atulsrivastava595@gmail.com

GENDER Male Is Permanent Address Yes


same as Present Address?

PERMANENT Parental PERMANENT ADDRESS NAI basti BAKSHIPURA near diesel


ADDRESS DETAILS power house colony

PRESENT ADDRESS* Parental PERMANENT ADDRESS NAI basti BAKSHIPURA near diesel
DETAILS power house colony

LIVING IN PRESENT LOCATION 14


SINCE*

ARE YOU A PERSON WITH


DISABILITY (If yes please mention)

DO YOU LIVE WITH Yes ANNUAL INCOME Below 200000


YOUR FAMILY (Family)

QUALIFICATION

Qualification Stream Institution Grade % Board Year of


Passing

10th None Saraswati Vidya Mandir 71.1 UP State 2017


madhavpuri inter college bahraich Board

12th Science Government Maharaj Singh inter UP State 2020


college bahraich Board

OTHER CERTIFICATIONS IF ANY

NAME INSTITUTION COURSE DURATION VALIDITY

WILLINGNESS TO WORK IN SHIFTS* YES


Candidate Signature

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