Haryana Vishwakarma Skill University...Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016) Haryana Vishwakarma Skill University

Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

APPLICATION FORM

1. Course Name:____________________________________________________

2. Name of the Candidate: Mr./Ms.____________________________________ (As per Matriculation certificate) in Capital letters

3. Father’s Name: Sh.________________________________________ (As per Matriculation certificate) in Capital letters

4. Mother’s Name: Smt.______________________________________ (As per Matriculation certificate) in Capital letters

5. Date of Birth: ___ /___ /_______ 5. Gender: Male/Female___________

6. Nationality:__________________ 7. Religion:______________________

8. Aadhaar No (Desirable):____________________ 9. Contact No.:__________________

10. Category:__________ (Gen./BC-A/BC-B/SC) (HARYANA)/AIC/J&K migrant/Dudhola domicile

11. Correspondence Address: ______________________________

12. Person with Disabilities(DA/PwD)(Yes/No):___________

13. Belongs to any minority category(Yes/No)________ (If yes, please specify):__________________

14. Qualifying examination passed (Details of examination):___________ From (Haryana/Other state)__________ District:_______________ Year of pass________

15. Haryana Domicile (Yes/No):___________

16. Qualification Details:

Sr. No.

Examination Board/ University

Passing (Year & Month)

Subject/Trade/Specialization % of Marks/ Grade/CGPA

01 10th

02 10+2

03 Diploma

04 Others (Any)

Date: Candidate Signature

Place: Candidate Name:

Recent Coloured Photo

Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

आवेदन पत्र

1.पाठ्यक्रम का नाम: ____________________________________________________

(माध्यममक/हाई सू्कल प्रमाण पत्र के अनुसार नननननननननन नननन)

2. आवेदक का नाम: ____________________________________

3. पपता का नाम: श्री_____________________ ___________________

4. माता का नाम: श्रीमती ______________________________________

5. जन्म तिति (dd/mm/yyyy के अनुसार): _____/_______/___________________

6. प िंग: पुरुष मपि ा

7. राष्ट्र ीयता: __________________

8. शे्रणी: __________ (Gen./ BC-A/ BC-B/ SC) (HARYANA) /AIC/ J&K Migrant/Dudhola Domicile

9. टेलीफ़ोन: __________________ 10. ई-मेल: _____________________________

10. पत्राचार का पता:________________________________________________________

______________________________________________________________________________

__________________________________________________________________________________

तिला: __________________ PIN: __________________ राज्य _______________________

11. पिक ािंग आवेदक______________________________(DA/PwD) (हााँ / नही ीं)

12. क्या आप अल्पसिंख्यक िगग के अिंतगगत आिे िै? (हााँ /नही ीं)

(यपि िािं, तो कृपया पनपिगष्ट् करें ): __________________

13. ययययययय परीक्षा का तववरण : कक्षा ___________ उत्तीणण होने का

वर्ण,___________________

(हररयाणा/अन्य राज्य)_______________ तिला:_____________________________________

Affix recent coloured

passport size photograph

Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

14.हररयाणा अतिवासी (हााँ / नही ीं) ___________

15. शैक्षतणक योग्यिा तववरण:

Sr. No.

परीक्षा तशक्षा बोर्ण

उत्तीणण होने

का वर्ण

तवर्य अींक( % ) /

गे्रर् /

सीिीपीए (CGPA)

a. 8th

b. 10th

c. 10+2

d. तर्प्लोमा

e. अन्य

(योग्यिा)

ययययय के हस्ताक्षर

ययययय का नाम

तिति: स्िान: