S.R.D.F / Y.S.

P
Rojgar Kaushal Prashikshan Kendra

Ward No.4
V.P.O Bhanjal Lower
Tehsil Ghanari Distt UNA
Himachal Pradesh
Pin Code: - 177213
APPLICATION FOR REGISTRATION AS TRAINEE
TO BE COMPLETED IN BLOCK LETTERS
PARTICULARS OF TRAINEE:
1. Name: ……………………………………………………………………………………………………………………..

2. Father/Husband name….............................................................................................

3. Date of Birth……………./………../………….4. Enrolment Number:

5. Marital Status: Married Single Male Female

6. Residential address:
………………………………………………………………………………………………………………………………….....
……………………………………………………………………………………………………………………………………..
7. Contact Number ………………………………….. 8. Alternate Number………………………………….
9. Experience, if any……………………………………………………………………………………………………….
10. Father/Husband Occupation: …………………………………………………………………………….......
11. Blood Group…………………………………………………………………………………………………….........

……………………………… ………………………………..
SIGNATURE DATE
FOR OFFICAL USE ONLY

Checked by………………………………………………………… Date……………………………………………………..

Remarks:
………………………………………………………………………………………………………………………………………………