APPLICATION NO:

(To be filled by the JKC Coordinator)

COMMISSIONERATE OF COLLEGIATE EDUCATION JAWAHAR KNOWLEDGE CENTER MONITORING CELL, HYDERABAD

APPLICATION FORM FOR RECRUITMENT OF FULL-TIME MENTOR (TECHNICAL)

1. Name of the Candidate (in Capital Letters) 2. Date of Birth 3. Address for Correspondence

: Affix Passport Size Photo

: :

Contact No E-Mail ID(in capital letters) 4. Educational Qualifications 5. Percentage of Marks With Division: SSC INTER DEGREE PG 6. Previous experience if any 7. Social Status (SC/ST/ BC /OC) 8. Other Information if any 9. Whether the following are enclosed a. Self attested Bio-data :YES NO

: : :

: : : : : : : :

b. Self attested Xerox Copy of Highest Qualification Certificate: YES c. One Passport Size Photo(in addition to the one affixed above):YES

NO NO

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND TRUE.

Date:

Signature of the Candidate

(Enclosing One Copy of Bio-Data & Xerox Copy of Certificate of Highest Qualification Duly Self Attested Is Mandatory) JKC OFFICE USE: VERIFIED CERTIFICATES : YES NO NO

ADMITTED FOR WRITTEN TEST : YES

Signature of the Coordinator

Signature of the Principal/Chairman With office seal