SRINIX COLLEGE OF ENGINEERING
Ranipatna, Balasore, Odisha-756001
[Approved by AICTE & Affiliated to BPUT Odisha]


APPLICATION FORM FOR RECRUITMENT DRIVE 2019
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BASIC DETAILS
First name *

Middle Name

Last name *

Post Applied for *

Department* (Select Post Applied for first)

Select Gender*

Date of Birth*

Nationality*
Mother's Name*

Father's Name *

Reservation *

AADHAR No*

PAN No

Marital Status *

CONTACT DETAILS
Mobile Number*

Alternate Mobile Number

Email*

Permanent Address Line 1*

Corresspondence Address Line 1*

   
  Line 2

Line 2

   
  State*

  State *

   
  District*

  District*

   
  PIN*

  PIN*

   
               
ACADEMIC DETAILS
M.Phil (Tick, if Yes) PhD (Tick, if Yes) Previous Experience (Tick, if any. You are required to submit proof of past experience during interview)
Examination Passed Subject/ Specialization
Year of Passing
Board/ University
School/ College Name
Maximum Mark
Mark Secured
Class X*

*


(Fill this in case of dual PG degree)

UPLOAD SCANNED PHOTO & SIGNATURE
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I do hereby undertake that the information furnished above is true to best of my knowledge & I am ready to produce original document(s) of above information before the recruitment committee for verification. I also understand that the decision and selection process of the recruitment committee is final.