BARC/RP&AD/Opr(IR)/2019

Smart Technocrats & Consultancy Services (I) Pvt. Ltd

(Specialist in NDT, Consultancy, Third Party Inspection)
Plot No.05,Sector-18A,Nerul(W), NaviMumbai-400706
Ph:022-27706055,Mob: 9821683640 Email: sunilmukul@rediffmail.com
CIN No.U74140MH2008PTC187154
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Application for Admission to the Training Cum Certification

Course on Radiation Safety for Industrial Radiographer
(Approved by Bhabha Atomic Research Centre, Mumbai)

Affix a recent
1. Name in full (in block letters) : photograph

2. Permanent address : (3.5 cm x 4.5 cm)

3. Employer’s Name, Address, Phone :

and e-mail Address

4. Working under Present Employer : Since / /20

5. TLD Personnel Monitoring Badge No. :

and Date of Enrolment, if any

6. AERB Approval Letter (Ref. No.) :

of Trainee Radiographer, if any

7. Educational Qualification :
Examinations Name of the Class & Percentage
Year Subjects
Passed Board / University of Marks
Studied

Minimum Educational Qualification Criteria:

(a) 10+2 or equivalent examination passed with Science subjects, and Mathematics in 10th
standard or equivalent from a recognized Board; OR
(b) One year ITI course passed from a recognized Institute and Mathematics in 10th standard or
an equivalent from a recognized Board; and one year of experience in industrial job
(applicable only for ITI course of less than two years duration).
Attach self-attested copies of Certificates and mark list in support of educational qualification
8. Whether attended any Training Course on Radiation Safety for
Industrial Radiographer or RT-1 course in BARC earlier?: Yes/No

If YES, provide details of:

(a) Name of the training centre:

(b) Training Course No:

9. Course Fee Details (DD/Cheque):

It is certified that above information is correct to the best of my knowledge.

Place: Signature of the Candidate

Date:

Institution Seal Signature with name &

Designation of the
sponsoring official
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Instructions
1. Indian Nationals working in India (sponsored by Radiography Institution) are only eligible
for the course
2. Attach self-attested copies of the certificates in support of Educational Qualification
3. Application should be duly signed and stamped by the Sponsoring Authority
4. Incomplete application will be Rejected
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