Examination Details / परीक्षा विवरण

Applied for Examination / किस परीक्षा के लिए आवेदन किया*

--------Select Course Category-------- 1 Year 12 Month 18 Month 24 Month 3 month 3 Month 6 Months

-------Select Course Name------ Adavance Diploma In Computer Application(ADCA) Autocad COC Diploma in Computer Application (DCA) Diploma in Computer Hardware and Networking Diploma In Financial Accounting INDUSTRIAL SAFETY OFFICER OFFICE MANAGEMENT COURSE PGDCA Post Graduate Diploma In Computer Application (PGDCA) Typing Hindi and English

Applicant's Personal Details /आवेदक का व्यक्तिगत विवरण

Applicant's Full Name / आवेदक का पूरा नाम *	Mr./श्री Ms./ सुश्री
Father's Name / पिता का नाम *	Mr./श्री
Mother's Name / माता का नाम *	Mrs./श्रीमती

Gender / लिंग*

Select One Male Female

Date of Birth / जन्म दिनांक *
Category / वर्ग*	Select One General/सामान्य Scheduled Caste/अनुसूचित जाति Scheduled Tribe/अनुसूचित जनजाति Other Backward Class/अन्य पिछड़ा वर्ग
Date Of Registration *

Contact Details / संपर्क विवरण

Mobile / मोबाइल *

+91

Email / ईमेल पता *

Address Details / पता विवरण

Full Address / पता *
City Name / शहर का नाम *
State / राज्य *	-----------Select State--------------- Bihar Uttar Prdesh
District / जिला *	--------------Select Distt------------- AMBEDAKAR NAGAR Azamgarh BALIYA Deoria Faizabad Faizabad Ghazipur Ghazipur Gorakhpur Kanpur Dehat Mau Mirzapur Sant Ravidas Nagar VARANASI VARANASI VARANASI
Pin Code / पिन कोड *

Educational / Qualification Details / शैक्षिक / योग्यता का विवरण

Highest Educational Qualification / उच्चतम शैक्षिक योग्यता *	Select One Other Graduation or Higher Polytechnic Diploma Below 10th 10th Pass 10th + ITI 12th Pass
Year of Passing / उत्तीर्ण वर्ष *

Identification Details / पहचान की सूचना

Aadhar Card Number / आधार कार्ड संख्या*
Upload Photo / फोटो अपलोड *   (Only JPG,JPEG,PNG File Upload)

Declaration

* I, hereby declare that, I agree to abide by the rules.)