NUCLEAR POWER CORPORATION OF INDIA LIMITED

(A GOVERNMENT OF INDIA ENTERPRISE)

APPLICATION FORM ET-2016

SPECIMEN SIGNATURE
REGISTRATION NO
1._____________________________________
ETES121314
2._____________________________________

1. DISCIPLINE APPLIED FOR : Electronics

2. NAME : Mr.GANESH MAHADEV SURANGE

3. DATE OF BIRTH : 29-06-1990 (25 years,10 months,17 days)

4. FATHER'S NAME : MAHADEV NARAYAN SURANGE

5. MOTHER'S NAME : SHOBHA M

6 .GENDER : Male

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7 .NATIONALITY : Indian

8 .MARITAL STATUS : Single

9. RELIGION : HINDU

10 .MOTHER TONGUE

11. CATEGORY

12. MOBILE NO

13. EMAIL ID
13 : MARATHI

: GEN

: 9743335222

: ganeshmahadevganesh@gmail.com
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14. STATE/UT OF DOMICILE : KARNATAKA

NO 380 3RD MAIN ROAD 9TH CROSS, KAVIKALAYOUT BANGALORE,

15. ADDRESS FOR CORRESPONDENCE :
BENGALURU, KARNATAKA-560026, INDIA -

16. NEAREST RAILWAY STATION : MAJESTIC

ES

17.Are you a dependent of those who died in the riots of 1984(Dep 1984)? : No

18.Are you physically domiciled in Kashmir division of Jammu Kashmir state from 01/01/1980 to 31/12/1989? : No

19.Whether you are a dependent of defence perssonel killed in action(DODPKIA)? : No

20.Are you physically disabled? : No

ET

21.Educational Qualification:
Are you appearing for your final year exam in April/May/June 2016? : No

Year of
Type Degree Discipline College/Institute Board/University Year of passing Aggregate(%)
Enrollment

Electronics &
BE
UG Telecommunicatio PESIT VTU 2008 2012 78.8
FullTimeCourse
n

Any Other Information

22.Work Experience

Organization Type Designation From To

ASOCIATE SOFTWARE
SANDVINE TECHNOLOGIES Private 01-03-2015 31-03-2016
ENGINEER

Application Fee Status :PENDING

UNDERTAKING

I declare that the particulars given in the online application form are correct and if at any stage of the recruitment process including after recruitment or joining, it
is detected that I have provided wrong information or submitted false documents or suppressed relevant information and do not meet the eligibility criteria of this
advertisement, my candidature will stand rejected without any notice.

I agree to abide by the rules and regulations of Nuclear Power Corporation Of India Limited, Mumbai.

..................................................

D Gen Dt.5/6/2016 11:23:49 AM Signature of the Applicant

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