Form & Registration Fee @ Rs.100/- FOR OFFICE USE 1. Form No. GOVERNMENT OF INDIA 2. Regn No. Dt.:

MINISTRY OF LABOUR & EMPLOYMENT 3. DD No. Dt.: ADVANCED TRAINING INSTITUTE

SION, MUMBAI 400 022

AVTS BIODATA FORM 1. Name (In Block letters) :__________________________________________________________________ 2. Date of birth / age :_______________Male/Female :_________ ST/SC/OBC/Gen/Others:_________ 3. Residential Address with :__________________________________________________________________ Telephone no. __________________________________________________________________

E-mail Id _________________________________________Mobile No._____________________________ 4. Academic Qualification (S.S.C./H.S.C./B.A./B.Com./B.Sc.) :-

Class / Std. Passed Year of passing Name of Board / University

5. Technical Qualification (National Trade Certificate/National Apprentice Certificate/DIPLOMA/DEGREE in Engineering Field):- Name of Institute/College Trade/ Diploma/Degree Year of Passing Duration of Course

6. Practical Experience :- Name of Employer

/organization / company Nature of works done Period Gross

salary Reasons for leaving /

changing the job. From To

7. AVTS Short-term Course in which admission is sought ( Separate Application is to be made for each course):- Name of the Course Duration in Weeks From To

Signature of Applicant __________________________ If sponsored, Name & address of the Sponsoring Authority : ____________________________________________

____________________________________________

________________________________________

Signature of Sponsoring Authority with stamp

Date : ______________ Place : _________________

ACKNOWLEDGEMENT

ADVANCED TRAINING INSTITUTE, SION, MUMBAI 400 022. Received Form No.____________ & Registration vide No. _______________ dated __________________.

Also received Cash Receipt /DD vide No. _____________ dated ______________ @ Rs.100/- towards cost of Form & Registration for AVTS short-term course on ___________________________________________________ form_____________ to _______________ Name of Applicant:__________________________________________

Signature with Official seal

To Name & Address of Participant ______________________________________

______________________________________

______________________________________

______________________________________

Course Name___________________________ ______________________________________

From ______________ to _________________

NOTE :- 1. Copy of Final year Technical education Marksheet/certificates

should be enclosed with the application form in proof of experience and qualification.

2. The Form & Registration fee charges @ Rs.100/- should be payable by DD in favour of The Director, ATI, Mumbai