CAREER CITY Career City, Office Number 432, 4th Floor, Mansingka

Square, Khandwa (MP) 450001

Vision to Reality Contact: +91 9424494793, +91 9109382562

Date: __ /__ /____

Registration Form
Personal Information:

First Name: Last Name:

Father Name: _____________________________ Mother Name: _______________________________
Street: _____________________________ City: _____________ State: ____________ Zip Code: _________
Mailing Address, if different from above: _______________________________________________________
Mobile Number: 1. 2.
E-mail Address:
Date of Birth: Gender: Male Female Primary Language: ________
Category: SC ST OBC GEN Nationality: Indian Other _____________________
National Identity Number: _______________________________ (Aadhar, PAN card, Voter ID, Passport etc.)

Are You: Student Job Seeker Employed Unemployed Other ___________________

Education History: 10th 12th Graduate Post Graduate Uneducated

Employment History:
S.No. Company Designation Time Period Annual CTC Leaving Reason
1.
2.
3.
Strengths & Skills
1. ____________________ 2. _____________________ 3. ______________________
4. ____________________ 5. _____________________ 6. ______________________
Applied for:
Career City Card Academic Solution Employment Other
Details: ____________________________________________________________________________________

Declaration:
I certify that the information I am about to provided is true and complete to the best of my knowledge.
I am aware that this self-declaration statement is subject to review and verification and if such information
has been falsified I may be terminated from the Career City services program for fraud and/or perjury.

Place : _________________
Date : Candidate Signature Branch Seal & Sign

Please note: All customer information is kept confidential. The Career City provides customer information only to authorized public service agencies. The
Career City Services is based on meeting and/or exceeding our goals... including our customers’ job placements. Therefore, we request that you notify us
when you take a job. I certify the information submitted here is true and accurate. I agree to abide by The Career City regulations and guidelines. I agree
to provide my job placement information to The Career City All rights reserved by AK Business Pvt. Ltd.