Enquiry Form Format S-1 HCL CAREER DEVELOPMENT CENTRE ENQUIRY FORM FOR OFFICE USE ONLY CNTR CODE DATE M M Y Y ENQUIRY NO. ENQUIRY NO. D D M M Y Y Y Y TO BE GIVEN BY HCL CDC FINAL REMARKS __________________________________________________ NAME OF STUDENT (FULL NAME AS MENTIONED IN YOUR CERTIFICATES) FIRST NAME MIDDLE NAME (USE BLOCK LETTERS ONLY. LAST NAME LEAVE ONE CELL EMPTY BETWEEN FIRST, MIDDLE AND LAST NAME) RESIDENCE PHONE NO. MOBILE NO. 9 1 E-MAIL ID (MANDATORY) FATHER’S / GUARDIAN’S NAME FIRST NAME MIDDLE NAME LAST NAME RESIDENCE PHONE NO. MOBILE NO. 9 1 CURRENT ADDRESS HOUSE/FLAT /BLOCK NO. ( USE BLOCK LETTERS ONLY . NAME OF BUILDING/VILLAGE/PREMISE ROAD/STREET/POST OFFICE LEAVE ONE CELL EMPTY AFTER EVERY SECTION) AREA DETAIL DISTRICT/ CITY/TOWN STATE PIN CODE PERMANENT ADDRESS HOUSE/FLAT /BLOCK NO. ( USE BLOCK LETTERS ONLY . NAME OF BUILDING/VILLAGE/PREMISE ROAD/STREET/POST OFFICE LEAVE ONE CELL EMPTY AFTER EVERY SECTION) AREA DETAIL DISTRICT/ CITY/TOWN STATE PIN CODE HOW DID YOU COME TO KNOW ABOUT HCL CDC? NEWSPAPER NEWSPAPER INSERT CANOPY PRESENTATION/SEMINAR BANNER/HOARDING CABLE AD FRIENDS/FAMILY TV WEBSITE / E-M AILER OTHER (PLEASE MENTION) ______________________________________________________________________________________________________________ Ver 1.0 HCL CDC Enquiry Form Page 1 of 2 Pages Enquiry Form Format S-1 GENDER MALE DATE OF BIRTH FEMALE D D M M Y Y Y Y ACADEMIC DETAILS MCA BE/B TECH POST GRADUATE GRADUATE UNDERGRADUATE OTHER (PLS. SPECIFY) _________ START FROM THE LATEST ACADEMIC DETAILS I.E. FROM HIGHEST QUALIFICATION TO SECOND HIGHEST AND SO ON. COMPLETED/ QUALIFICATION SCHOOL/COLLEGE BOARD/UNIVERSITY PURSUING EXP./ YEAR OF COMPLETION GRADE / % MARKS DETAILS OF IT PROGRAMS DONE 1. PROGRAM __________ NATURE OF PROGRAM ________________________ INSTITUTE _____________YEAR _________ 2. PROGRAM __________ NATURE OF PROGRAM ________________________ INSTITUTE _____________YEAR _________ PROFESSIONAL EXPERIENCE WORKING (GIVE DETAILS) SERVICE NON-WORKING (FRESHER) SELF EMPLOYED NAME OF PRESENT ORGANISATION ___________________________________ YOUR DESIGNATION _____________ ________ TOTAL EXPERIENCE SO FAR ______ YRS. _NATURE OF JOB ____________________________________SALARY ________/-MONTH ADDRESS OF ORGANISATION ____________________________________________________________________________ URL _______________O FFICE CONTACT NO. ____________________ E-MAIL ID __________________________________ CAREER PREFERENCE HARDWARE NETWORKING SOFTWARE DATABASE ADMIN ANY OTHER (PLS. SPECIFY) _________________ PROGRAM PREFERENCE PART TIME CAREER PROGRAM HCNE (3 YRS.) MODULAR PROGRAM CCNA MCSE HCE (1 YEAR) RHCE DATE FULL TIME HCSE ANY OTHER (PLS. SPECIFY) _____________ COMBO ANY OTHER (PLS. SPECIFY) ____________ STUDENT SIGNATURE D D M M Y Y Y Y PLACE ______________________ ________________________ FOR OFFICE USE ONLY PROGRAM RECOMMENDED__________________________ SLOT PREFERENCE_____________________ COUNSELLING REMARKS ______________________________________________________________ ________________________________________________________________________________ COUNSELLOR’S NAME ____________________________ COUNSELLOR’S SIGNATURE ________________ FINAL REMARKS (ENROLLED / WON’T JOIN) Ver 1.0 HCL CDC Enquiry Form Page 2 of 2 Pages
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