Application Form or CV Template with regard to "Empanlement of Asse

Name
(in capital letters)
Contact address

Mobile number
Alternate contact number
Emergency Contact
(Please mention the name of person to contact in case of any emergency along with his/her phone numbe

Email
Alternate E-mail
Date of Birth
Educational Qualifications

Professional Qualifications
Trainings/Certifications

Domain of Expertise
Please choose the relevant areas from the following list of domains and fill your response in the adjacent c
1. Command Control Communication and Intelligence System, communication network , communication
security systems, Signal Processing VLSI Technology (FPGA/CPLD).
2. Unmanned Systems, Power System Engineering
3. Processing of Composite Propellant Explosive chemical processing and systems.
4. Solid Propulsion Technologies, Composites, Aerospace Mechanisms, NDT Techniques, System Design
Analysis, Mission Design and Studies, Guidance Design and Control Systems Aerodynamic Decelerators,
Aerostat Systems. Knowledge of Aerospace Standard (AS9100D)
5. Mechanical systems, engine, transmission, running gear systems, armament systems, gun control syste
fire control system.
6. Electric/electronic systems, controllers, sensors and related technology.
7. Aerodynamics and Air-frame Design, Computational Fluid Dynamics, Solid, Liquid, Ramjet and Scramje
Propulsion, Precision Fabrication, Systems Analysis, as well as the Command and Control systems
8. Protective system like body armour, vehicle armour and helmets against small arm ammunition
9. Naval weapons and related underwater systeme (sonar, underwater mines, torpedoes, fire control syste
weapon launchers, targets, decoys

Total Years of Work Experience

(Please enter the total years of work experience in the adjacent cell)
Work Experience

Total Number of Manday experience in Audit / Assessment / Inspection

(Please enter the total years of audit / assessment / inspection experience in the adjacent cell)
Audit / Assessment / Inspection Experience
(Third party / Second party / First party with approx number of audits / assessments conducted/man-days

Please mention your affiliations with any Certification, Inspection, Validation & Verification Bodies

Please mention the affiliations of family members which may be threat to impartiality
Please mention any current activities/relationships that may be potential conflict of Interest
Two References

Declaration:
I hereby certify that the above information is true to the best of my knowledge. (Yes / No)
Signature:
(Name)
Date:
Place:
Note: Please email your filled application (in the prescribed excel format) along with supporting documents
certificates and professional qualification certificates) at samar@qcin.org with the subject “Empanelment o
ssessors for SAMAR Defence Manufacturers"

Office Address:
Residential Address:

Name:
Contact number:

1. Degree / Program Name:

Specialization:
Institute / University:
Year of passing:

2. Degree / Program Name:

Specialization:
Institute / University:
Year of passing:

...and so on.
(If you have more than 2 qualifications, please copy and paste the
above template and fill the details for the rest of the qualifications)

1. Qualification Name:
Specilization:
Institute / Organization:
Year of passing:

2. Qualification Name:
Specilization:
Institute / Organization:
Year of passing:

...and so on.
(If you have more than 2 qualifications, please copy and paste the
above template and fill the details for the rest of the qualifications)
1. Name of the training / certification:
Institute / Organization:
Year of training:

2. Name of the training / certification:

Institute / Organization:
Year of training:

...and so on.
(If you have more than 2 trainings / certifications, please copy and
paste the above template and fill the details for the rest)
1. Name of the organization:
Tenure:
Designation:
Roles & responsibilities:

2. Name of the organization:

Tenure:
Designation:
Roles & responsibilities:

...and so on.
(If you have more than 2 trainings / certifications, please copy and
paste the above template and fill the details for the rest)

1. Name of the systems Audit / Assessment / Inspection:

No. of man-days:

2. Name of the systems Audit / Assessment / Inspection:

No. of man-days:

.... and so on
(If you have more than 2 audit / assessment / inspection, please copy
and paste the above template and fill the details for the rest)

1. Name:
Address:
Contact number:

2. Name:
Address:
Contact number:
ents (degree certificates, certification / training certificates, work experience
nt of Assessors for SAMAR project”