º¢±Š³¬÷ - ¨ÁÂÁ¢ý §Å¾¢Â¢Âø ¬öÅ¸õ CSIR - CENTRAL ELECTROCHEMICAL RESEARCH INSTITUTE ¸¡¨ÃìÌÊ / KARAIKUDI - 630 003 º¡ýÈ¢¾ú ÀÂ¢üº¢¸û / certificate courses Å¢ñ½ôÀ ÀÊÅõ Application form ¯í¸ÇÐ ¾Ì¾¢ì¸¡É º¡ýÈ¢¾ú ÀÂ¢üº¢¨Â §¾÷× ¦ºöÂ «¾ü¸¡É ¸ð¼ò¾¢ø ¦ºöÂ×õ. Select your qualified certificate course please put  mark in the appropriate column. S. NO 1 º¡ýÈ¢¾ú ÀÂ¢üº¢Â¢ý ¦ÀÂ÷ Name of the certificate course «¡¢Á¡É À¡Ð¸¡ôÒì¸¡É Å÷½í¸û ÁüÚõ âîÍì¸û Paints & coatings for corrosion protection 2 ¸¡¡¢Â «Á¢Ä Á¢ý¸Äõ - ÀÃ¡Á¡¢ôÒõ, À¡Ð¸¡ôÒõ Lead acid battery - care and Maintenance 3 Á¢ýÓÄ¡õâîÍ ÁüÚõ ¯§Ä¡¸ âîÍ ¿¢¨È× Electroplating and metal finishing 1. Å¢ñ½ôÀ¾¡Ã¡¢ý ¦ÀÂ÷ Name of the Applicant : Affix your recent passport size photograph : 2. ¾¸ôÀÉ¡÷ / ¸½Å¡¢ý ¦ÀÂ÷ : Father / Husband's Name : 3. À¡Ä¢Éõ Gender : 4. À¢Èó¾ §¾¾¢ ÁüÚõ ÅÂÐ Date of Birth & Age (as on 30.11.2016) : : 5. «ïºø Ó¸Å¡¢ : ¿¢¨ÄÂ¡É Ó¸Å¡¢ : À¢ý§¸¡Î À¢ý§¸¡Î ¨¸§Àº¢ ±ñ: Á¢ýÉïºø: Mobile No.: Email id: 5. ÌÊÔ¡¢¨Á 6. Nationality : ¾¢ÕÁ½ ¿¢¨Ä : ¾¢ÕÁ½õ ¬ÉÅÃ¡ / ¬¸¡¾ÅÃ¡ Marital Status : Married / Unmarried 7. ÅÌôÒ ÁüÚõ À¢¡¢× (º¡ýÚ þ¨½ì¸×õ) : Category (BC/MBC/DNC/SC/ST/FC) : (Pl attach proof) 8. ¸øÅ¢ò ¾Ì¾¢ Educational Qualification : §¾÷× ¿¢¨Ä ÀûÇ¢ / ¸øæ¡¢ / ¿¢ÚÅÉõ À¡¼í¸û Subjects Á¾¢ô¦Àñ Å¢Øì¸¡Î ÀÊò¾ ¬ñÎ Examination School / College / Institute % of Marks Year of Study Å¸¢ò¾ À¾Å¢ Àò¾¡õ ÅÌôÒ 10 Std ÀÉ¢¦Ãñ¼¡õ ÅÌôÒ 12 Std ¦¾¡Æ¢üÀÂ¢üº¢ ITI þÇí¸¨Ä Àð¼õ / Àð¼Âõ B.Sc / Diploma 9. «ÛÀÅõ Experience 11. : : À½¢ÂÇ¢ôÀÅ÷ §º÷ó¾ §¾¾¢ Å¢Ä¸¢Â §¾¾¢ Employer Date of Joining Date of Leaving Post Held ¿¸ø þ¨½ôÒ¸û List of Documents to be enclosed : (Xerox copies only) Àò¾¡õ ÅÌôÒ Á¾¢ô¦Àñ «È¢ì¨¸ / Xth Std Mark statement ÀÉ¢¦Ãñ¼¡õ ÅÌôÒ Á¾¢ô¦Àñ «È¢ì¨¸ / XIIth Std Mark statement ÀûÇ¢ Á¡üÚîº¡ýÈ¢¾ú / School Transfer Certificate Àð¼õ / Àð¼Âîº¡ýÈ¢¾ú / Degree / Diploma Certificate ºã¸îº¡ýÈ¢¾ú / Community Certificate «¨¼Â¡Ç ÁüÚõ Ó¸Å¡¢îº¡ýÈ¢¾ú / ID & Address Proof 12. À¢È Å¢„Âí¸û Any other relevant matter : ¯Ú¾¢¦Á¡Æ¢ / Declaration: §ÁüÌÈ¢ôÀ¢ð¼ Å¢ÅÃí¸û «¨ÉòÐõ º¡¢Â¡É¨Å ±ýÚõ, ¾ÅÚ ²§¾Ûõ þÕôÀ¢ý ±ýÛ¨¼Â Å¢ñ½ôÀõ ¿¢Ã¡¸¡¢ì¸ôÀÎÅ¾üìÌ ¯ðÀÎ§Åý ±ýÚõ ¯Ú¾¢ ÜÚ¸¢§Èý. I hereby declare that, all the particulars made in the application are true to the best of my knowledge and belief. In the event of any information being found false at any stage, my candidature is liable to be rejected. þ¼õ Å¢ñ½ôÀ¾¡Ã¡¢ý ¨¸¦Â¡ôÀõ Place : …………….. Signature of the Applicant §¾¾¢ Date : ……………