JOB APPLICATION FORM

Mechanical Engineer
Designation/Position Applying For:

Note! All entries should be in capital letters.

Sohail K Koppal
1. Name of Candidate:
2. Father’s Name: Khajamainuddin Koppal
3. Father’s Occupation: KSRP Department Religion: Muslim

4. Date of Birth: Day 21 Month 01 Years 2002

5. Place of Birth: Lingsugur, Karnataka Age: 21
6. Current Address: (On the closing date for application)
Behind ozone hotel om nagar, Dharwad. Years, Months, Days
580004-Karnataka. India.

7. Permanent Address: Behind ozone hotel om nagar, Dharwad. 580004- Karnataka. India.

8. Contact No. 9686293788 Whatsapp 9686293788

9. Domicile: District: Dharwad Province:
10. No. of Children (in case of Married).

11. Have you ever been convicted and sentenced by any court of law? If so, State the reason(s) for your conviction
: No
12. Have you ever been dismissed from service? If so, give the grounds thereof and relevant facts.
: No
13. Academic Qualifications:
Level of Div/ Month /
University / Board etc %age Subject taken
Examination GCPA Year
Matric / O Level / Diploma K.H.K INSTITUTE OF ENGG 70% Mechanical Engg 10/2020
FA / FSc / A Level
BA / BSc / B.Com / BCS
MSc / MA / MCS
MPhil / PhD
KLE INSTITUTE OF 68% Mechanical Engg 05/2023
Others (BE) TECHNOLOGY. HUBLI.

14. How have you been employed (give particulars below):

Dates Nature of Pay / Scale
Department Reason of Leaving
Joining Leaving Employment & Salary
15. List of Testimonials (Attested Copies) attached to this application Form:
Aadhar Card
1. ....................................................................... Driving Licence
2. ............................................................................
3. Pan card
....................................................................... 4. ............................................................................
5. ....................................................................... 6. ............................................................................
7. ....................................................................... 8. ............................................................................
9. ........................................................................ 10. ............................................................................
11. ........................................................................ 12. ............................................................................
13. ........................................................................ 14. ............................................................................
15. ........................................................................ 16. ............................................................................

DO NOT FORGET TO SIGN THESE DECLARATIONS

DECLARATION – 1
(If you are a Muslim Candidates)

Sohail
Dated: 17/08/2023
Signature of the Candidate

IMPORTANT:
Please make sure before submitting this form that it is complete and
The required documents are enclosed. Incomplete forms will not be processed.

DECLARATION – 2
(For all candidates)
I hereby declare that all the entries in this Application Form and all the additional particulars (if any)
furnished along with it are true to the best of my knowledge and belief. If any information is found
incorrect I shall be liable for imposition of any penalty set out in the Company (Efficiency and Discipline)
Statutes in force.
17/08/2023 Sohail
Dated:
Signature of the Candidate