Application format for applying for the training of New AI Technician. Apply for (Tick Here): New trained AIT Needed Training for being New AIT Paste your latest Colour Photographs here and attest by CVO / Veterinary Officer (your area) Contact No FORM: XB0026 Paste your latest Colour Photographs here and attest by Gram Pradhan (Your villages) CVO/VO Gram Phadhan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1. Name of the applicant: ____________________________________________________________ 2. Father’s Name ___________________________________________________________________ 3. Applicant’s date of birth: ___________________________________________________________ 4. Address: Village:____________________________ PO: ________________________________ Block __________________Tahsil____________________District____________________________ Pin Code________________ MobileNo___________________Landline:________________________ 5. Educational Qualification (From 10th onwards) Qualification/ diploma/ degree Year of passing 10th MM .YYYY 12th MM. YYYY Graduation MM. YYYY Post Graduation MM .YYYY Board/University % marks 6. Experience as AI Technician in years: _________________________________________________ 1|P ag e Visit: http://www.koshishsevafoundation.org 7. Training Details: Name of Training Institute Duration Grade From To DD.MM.YYYY DD.MM.YYYY 8. Full Address of Training Institute___________________________________________________________________________ __________________________________________________________________________________ _______________________________________________________________PIN ________________ 9. Contact No of Training Institute: +91 ____________________Mobile +91____________________ 7. Average no. of AI per month: _______________________________________________________ 8. Details of villages in which AI Technician is presently operating in descending order (higher to lower) SN Name of the village 1 2 3 4 5 6 7 8 9 10 Name of Gram Panchayat SN Name of the village Name of Gram Panchayat 11 12 13 14 15 16 17 18 19 20 Undertaking: I hereby undertake that the information provided above is correct to the best of my knowledge. Date: DD.MM.YYYY 2|P ag e Signature of Candidate Visit: http://www.koshishsevafoundation.org Documents Needed: Once you have submitted your online/off line application, you have to attach following documents to support your application: 1. Latest Curriculum Vitae/Bio Data 2. Mark sheet: 10th 11th 12th others ___________ 3. Domicile Certificate 4. Experience Certificate (from latest to previous) 5. NOC (If you are working with NDDB or other breeding organization and needed for starting new centre only) 6. Two colour photographs OPTION 1 SEND YOUR HARD COPY WITH ALL DOCUMENTS TO: KOSHISH SEVA FOUNDATION MH17 PALLAVPURAM PHASE II , MODIPURAM, MEERUT 250110, UTTAR PRADESH INDIA PHONE: +91 121 2575335 FAX: +91 121 2575336 OPTION 2 YOU CAN SEND US SCAN COPY TO US: [email protected] For Office Use only: Application Status: Interview Date: Accepted Rejected on Hold Remark If Any _____________________________________________________________________ __________________________________________________________________________________ 3|P ag e Visit: http://www.koshishsevafoundation.org