personal information - national institute of industrial ... form _nitie v1.0 … · web...

APPLICATION FORM V1.0PGPEX-VLFM: 2017-18

PERSONAL INFORMATIONNAME First name. Middle name. Last name. Gender Male

Father’s Name First Name. Middle name. Last name.

Affix self-attested recent colour photograph

Mother’s Name First name. Middle name. Last name.

Nationality Choose an item. Mother tongue. French,

Birth Details Name of birth village/ town/city Birth country Date of Birth

Passport details**(Course includes compulsory abroad visit. Attested copy must be attached with application)

Click here to enter text. Name of Issuing country Click here to enter text. Date of expiry.

Marital Status Single Click here to enter text. Country of permanent residence.

CONTACT INFORMATIONPresent Business

AddressName of present company Business E-mail Email id.

Present company address Phone Landline phone number. STD code

City/District Click here to enter text. Fax Insert Fax number STD code

State Click here to enter text. Mobile Insert mobile number with country code.

Postal Code Click here to enter text. Country Name of country

PERMANENT ADDRESSPermanent Address Name Personal E-mail Email id.

Phone Landline phone number. STD code

City/District Click here to enter text. Fax Insert Fax number Insert Fax number

State Click here to enter text. Mobile Insert mobile number with country code.

Postal Code Click here to enter text. Country Name of country

Preferred Email ID for communication* Communications regarding sponsored candidates will be done on Company email id and contact address

*Company email id ☒Personal email id ☐

Preferred Address for communication

*Company Address ☒Permanent Address ☐

Post Graduate Program for Executives – Visionary Leaders for Manufacturing (PGPEX-VLFM)

APPLICATION FEE Rs. 2,500/- (Non-refundable) for Indian nationals and USD 100/- for NRI / Foreign Nationals/ Applications sent from outside India. Demand Draft should be drawn in favor of “NITIE, Mumbai”, payable at Mumbai, India.

Demand Draft

Demand Draft Number DD number Date DD Date.

Name of Bank DD issuing bank. Branch Bank Branch.

Online mode

Name of Account: NITIE, Mumbai

Name of Bank: State Bank of India (SBI)

Branch: NITIE- SBI, Vihar lake, Powai, Mumbai, India

A/C no. IFSC code Transaction id: Insert transaction id

Date: Select date of transaction

FUNDING OF PROGRAMThe tuition fee for the PGPEX-VLFM is Rs. 12, 50,000/- (Indian Rupees Twelve lakhs a n d fi ft y t h o u s a n d only), subject to revision. Rs. 50,000/- (Rupees Fifty thousand only) has to be paid as refundable caution deposit at the time of registration. The tuition fee does not include boarding and lodging at respective institutes, travel between NITIE and IITD and international travel and related expenses.

How Do you propose to pay for this course (Tick applicable)

Own Fund ☐ Bank loan* ☐ Company Sponsorship ☐ Others ☐____Click here to enter text.________

How did you come to know about the programcourse (Tick applicable)

Colleagues ☐ Top Management ☐ Advertise ☐ Social media Twitter ☒LinkedIn ☐ Google plus ☐Facebook ☐Others _______Click here to enter text._______

Category of Application course (Tick applicable)

Self-Sponsored (Resigning from present job)a ☐

Self-Sponsored (On study leave) b ☐

Sponsored c ☐

(a) “Sponsored”: Candidates applying under Sponsored category must submit letter of intent of sponsorship issued by the employer with the application form and submit attested copy of letter/bond from the employer containing the details of terms and conditions and extent of sponsorship on or before registration.

(b) “Self Sponsored – Study Leave”: Candidates in service applying under this category must submit with application form, attested copy of the application for study leave bearing signature and seal of the employer along with letter or endorsement of consent of the employer on the application.

(c) “Self Sponsored – Resign”: In case of candidates who plan to resign from service, letter of resignation and release from employer is to be produced in original on or before registration.

ACADEMIC CREDENTIALS Exam/ Degree University/Board CGPA /

PercentageDivision Year of

Passing

Secondary (Class 10 or equivalent)

Click here to enter text. Click here to enter text.

Click here to enter text.


Higher secondary (12th equivalent)




Diploma (if applicable)

Click here to enter text. Specialization- Insert specialization




Under Graduate Engineering / AMIE B.Tech ☐ B.E.☐


Specialization- Insert specialization




Masters / Post graduate degree (if any)M. Tech ☐M. E. ☐M. S. ☐MBA ☐OTHERS ☐

Click here to enter text. Specialization- Insert specialization




TOEFEL / IELTS For International candidate,

only

Registration Number Click here to enter text.

Test Date: Click here to enter a date.

Score Percentile

Verbal Click here to enter text. Click here to enter text.

Quantitative Click here to enter text. Click here to enter text.

Overall Click here to enter text. Click here to enter text.

AWA Click here to enter text. Click here to enter text.

WORK EXPERIENCE Aggregate full time work- experience(In completed years and months as on 1 s t S e p t e m b e r 2 0 1 7 )

Click here to enter text. years Click here to enter text. months

Managerial work-experience(In completed years and months out of aggregate work-experience given above)

Click here to enter text. years Click here to enter text. months

Your current employer

Company Name Click here to enter text.

Industry Click here to enter text.

Address Click here to enter text.

Postal Code Click here to enter text.

State Click here to enter text. Country Click here to enter text.

Tel. Click here to enter text. Fax Click here to enter text.

E-Mail Click here to enter text.

Website Click here to enter text.

Total employees Click here to enter text.

Annual sales (INR) Click here to enter text.

Main field of Activity Click here to enter text.

Your current job

Job title / Designation Click here to enter text.

Area of expertise Click here to enter text.

No. of years in this position Click here to enter text.

No. of reportees Click here to enter text.

Assets under your arrangement


Your direct supervisor

Name, Designation, Postal Address, Email and Phone details


To whom does he/she reportClick here to enter text.

Last Pay DetailsPlease enclose copy of the last pay certificate for the month preceding the month of submission of application.

Basic Click here to enter text.

D.A. Click here to enter text. Total Click here to enter text.

Other Information Click here to enter text.

Is your employer prepared to provide you with facilities/access to undertake in-company project during final months of the program?

Choose an item.

Your Job Description

FORMTEXT Please give a description of your exact job, including nature of work, major responsibilities etc. (If possible, draw an organization chart and give your job description. Use extra sheets, if necessary)..

CAREER SUMMARY

1.

Name of organization Click here to enter text.


Complete address including contact numbers Click here to enter text.

Website address Click here to enter text.

Starting date Click here to enter a date.

Ending date Click here to enter a date.

Last designation Click here to enter text.

Functional area of work Click here to enter text.

Last drawn salary Click here to enter text.

International exposure (if any) Click here to enter text.

Reason for leaving Click here to enter text.

2.












3.












ACTIVITIES AND INTERESTS – COCURRICULAR, EXTRACURRICULAR

Activities/ Interest Key involvements/achievements





AWARDS AND CERTIFICATESAward/Certificates Awarded By Domain Year of Award

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.



STATEMENT OF PURPOSE (WORD LIMIT 500 WORDS)The Statement of Purpose and Objectives for joining PGPEX-VLFM - is your opportunity to inform the faculty of your motivation, passion and potential to contribute in the field of manufacturing.

Start writing from here and restrict to 500 words limit

DESCRIPTIVE QUESTIONS (300 WORDS EACH)

What do you feel most passionate about in your life?

Please identify and write a point in your life when your

passion helped you to capture an opportunity?

Start writing from here and restrict to 300 words limits.

Describe any two instances in your career where the

situation was highly stressful and unfavorable. What were a few steps taken by you to move out of such adverse

situation during mentioned two instances?


Based on your work experience tell us about a

time when you managed the team effectively and a time

when you failed in doing so?


REFERENCESTwo letters of recommendation in the format given must be sent to the Institute within the application deadline date. The recommenders should separately seal the envelopes and sign on the flap.Please list below the name and complete address of the recommender. Each should be well acquainted with your intellectual abilities, academic performance, and personal character. At least one of these two letters should be by someone from industry who is familiar with your professional achievements.

Recommender 1 Recommender 2

Name Click here to enter text. Click here to enter text.

Complete addressClick here to enter text. Click here to enter text.

Organization Click here to enter text. Click here to enter text.

Relationship with applicant Click here to enter text. Click here to enter text.

Email Click here to enter text. Click here to enter text.

Mobile Click here to enter text. Click here to enter text.

Phone Click here to enter text. Click here to enter text.

Fax Click here to enter text. Click here to enter text.

.

APPLICATION SUBMISSIONPlease send the completely filled in application form along with two recommendation letters, required documents if any, and application fee, in the form of Demand Draft drawn in favor of “NITIE, Mumbai” payable at Mumbai, India, to the following address, preferably by SPEED POST:

VLFM OfficeC/O SRIC OfficeAdministrative Building

NITIE, Vihar lake RoadMumbai 400087

E-Mail: vlfm.office[at]nitie.ac.in

The completed application form in all aspects along with DD / online payment details in hard copy and email in pdf format should reach NITIE, Mumbai by 8th MAY, 2017.

DECLARATION

I certify that the information provided here is true and complete to the best of my knowledge. If this application leads to an offer of admission, I understand that false or misleading information may result in the cancellation of my candidature.

Name of Candidate First name, middle name, last name.

Signature Place-Click here to enter text.

Date: Click here to enter a date.

PLEASE NOTE

Email Ids

For Admission related query, candidates correspondence and program related doubts

vlfm.office[at] nitie.ac.in

For letter of recommendation and sponsorship communication [email protected]

Wrongly communicated email may delay responses.

Last Date of Submission 8th May 2017

mailto:[email protected]

CHECK LISTSr. No

☐ Application form is duly filled

☐ Self-attested copies of all academic, career, awards credentials

☐ Self-attested copy of passport is attached

☐ Online payment/ DD details are correctly filled

☐ Self-attested recent pay slip is attached

☐ Sponsorship letter (in case of sponsored candidates)

personal information - national institute of industrial ... form _nitie v1.0 … · web...

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