Personal Details Form PGPM - PGP-HRM - Pgp-Im 2013-15

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MANAGEMENT DEVELOPMENT INSTITUTE, GURGAON PERSONAL DETAILS FORM FOR PGPM/PGP-HRM/PGP-IM 2013-15 Please fill in Block Letters

CAT REG NO:......................................................................................................... Name (as per X class certificate):................................................................................. Fathers Name:. Mothers Name:.... INTERVIEW: DATE ............................................ TIME:.............................................. VENUE CITY: ............................................................... PANEL. Passport Date of Birth D D M M Please tick () wherever applicable Female Indian Mailing Address Male NRI Y Y Y Y Single PI PIO Yes No, if Yes, Passport No:- ..

Paste a passport size photograph in the space provided

Married Foreign National

City State

Academic Qualification Qualification Name of the Institution/Professio nal Body State / UT Secondary School (X) Sr. Secondary School (XII) Graduate

Name of the Board / University

Year of Completion

Marks (%) or CGPA

Degree with Discipline

Degree
Post-Graduate Degree Professional Degrees

Work Experience (Furnish details of full-time jobs starting fi rst with the present job (excluding training periods) engaged in, after completion of Bachelors Degree) (use a separate sheet if required) Name of organization Designation of the Person Reporting to Period from To dd/mm/yy Emoluments per annum (in Rs. Lacs) Turnover of Organization (in Rs. Lacs)

Designation

Nature of Duties

Total Experience

as on 31 December 2012

st

YEARS

- MONTHS

Academic/Professional Awards/Medals/Prizes/Scholarships/Certificate/Honours, etc. (Excluding those for extra-curricular activities) Name of the Award Awarding Institution Level (State/National) Basis of Award Year

Major Extra-Curricular Activities/Hobbies Activity Role Level (State/National) Year From To Honours (if any) Remarks

Declaration All entries made in this application from are true to the best of my knowledge and belief. I am willing to produce original certificates in support thereof if asked to do so at any stage. I agree to abide by decisions of Management Development Institute, Gurgaon on all matters regarding this application. PLACE

DATE D D M M Y Y Y Y (Signature)

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