BHARAT SANCHAR NIGAM LIMITED

REGIONAL TELECOM TRAINING CENTRE

TH IRUVANANTH APURAM – 695 040

APPLICATION FOR THE TRAINING PROGRAMME ON

BSNL CERTIFIED OPTICAL FIBER COMMUNICATION ENGINEER Please affix one
Important Notes: (i) Before filling this form, read the brochure carefully. recent passport
(ii) All entries should be made legibly.
size Photograph
1 Name without
attestation
2 Father’s Name

3 Age and Date of Birth

4 Gender (Please put v mark) Male Female

5 Nationality

6 Address for Communication

7 Permanent address

Educational Qualification Branch/ Percentage of

8 (Indicate Degree/Course Completed) Specialisation Marks obtained

Brief description about work

9
experience (If applicable)
10 Mobile No 11 Email id

12 Batch Applied for

Whether hostel facility required?

13 Yes No
(Please put v mark)
14 Registration fee: (DD for Rs. 200/, in favour of A.O. (Cash), O/o CGM, BSNL, Thiruvananthapuram)

DD No. Date Name of Bank Branch Address Amount (Rs.)

(Applicant should write Name, Course applied for, on the reverse side of the Demand Draft)

DECLARATION
I do hereby declare that all the statements made in the application are true, complete
and correct to the best of my knowledge and belief.

Place:
Date: (Signature of the Applicant)