NIELIT Gorakhpur, Extension Centre, Lucknow

A-1/9, Sumit Complex, Vibhuti Khand,

Gomti Nagar, Lucknow –226010
Tel/Fax 0522-2720589, 0522-2720590

Performa Application Form

Post Applied for : ---------------------------------------------------------------

Affix Passport
Willing to work any where in INDIA: Yes No
size photograph here

*Detail of Bank Demand Draft/ Cash of Rs. 500/-:

DD No/ Receipt No (If Cash): _______________ Date _______________
Drawee Bank: ___________________________
(Favoring “NIELIT Lucknow”, Payable at Lucknow)

Name of the Candidate :----------------------------------------------------------------

Adhaar Number : ---------------------------------------------------------------

Category : ---------------------------------- (SC/ST/OBC/General)

Father’s Name : ---------------------------------------------------------------

Date of Birth (dd/mm/yyyy) :---------------------------------------------------------------

Age as on Today’s Date Years Months

Mailing Address : -----------------------------------------------------

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Email id : --------------------------------------------------------------

Contact telephone no. :----------------------------------------------------------------

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Educational Qualification 10th class onwards (Attach copies of certificates):

Sr.No. Qualification/ Degree/ Name of University Year of %Age/Grade

Diploma /Institution Passing
1.

2.

3.

4.

5.

Software Skills:
S.No Skill Name (DOT Net, Last Used Skill Level (Beginner, Experience (in
JAVA, C++ etc.) (Month, Year) Intermediate, Advance) years)
1
2
3

Hardware Skills:

Brief Description of experience (Start with your latest job):

Sr. Name of Organization Duration Period Brief Description of duties
No. Worked in. From To
1.

2.

3.

Experience in years & months:

Preferred Place of Posting : 1.__________________2.____________________3.___________________

(District Name)

Certified that all the information furnished above by me is correct to the best of my knowledge.
*The registration fee of Rs.500/- is non-refundable

Place: Signature of Candidate

Date :

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