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Opgc: Executive Trainee - Mining - 2012 Application Form

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OPGC 2012: Online Application For Executiv e Trainee

OPGC : EXECUTIVE TRAINEE - Mining - 2012 Application Form

Application No.: 313835 *

* Application for the Post of : EXECUTIVE TRAINEE - Mining

Personal Particulars Name (as it appears * in your SSLC/SSC certificate) * Address for Communication Mr. RAJ CHAKRAVARTY RAJ CHAKRAVARTY A-51, MS SWAMINATHAN HALL, NIT ROURKELA

* City/District * State

ROURKELA ORISSA

* Pin Code

769008

Contact No. with STD Code * Nearest Railway Station ROURKELA MALE 24-Jul-1990 HINDUISM djraj1990@gmail.com

Mobile No * Nationality

0965856094 INDIAN

* Gender * Date of Birth * Religion * E-mail ID Qualifications Details * Engineering Degree * Institution * Engineering Degree Status

Alternate E-mail ID, if any

B. Tech. NIT ROURKELA Appearing in Qualifying Month & Year of * Exam Passing Apr-2013

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OPGC 2012: Online Application For Executiv e Trainee

* Branch

Mining

* Percentage / Class in / Engineering Degree

Employment Details * Are you Employed? If Yes, Type of Organisation Designation General Information * Category Are you a Person * with Disabilities (PWD)? Written Test Detail * Written test center Bhubaneswar GENERAL If Yes,Indicate type of disability and Percentage of disability NO Name of the Organisation Pay Scale (CTC for others)

NO

Demand Draft Details (if not exempted) * DD No. * DD Amount 791672 100/* DD Date * Name of the Issuing Bank 8-Jan-2013 State Bank of India

Declaration I hereby declare that I have verified the details indicated above and also confirm that all the information submitted is correct to the best of my knowledge. At any stage, if it is found that any of the above information is incorrect and/or is suppressed, the management of OPGC shall have the right to take action, as deemed fit.

Application No. 313835 Place Date Signature of Applicant (To be signed prior to despatch) Kindly save this page by using 'SAVE AS' option given in the browser before taking the print out. Print (Please Print the form for Further Reference) An acknowledgement message has now been sent to your given Email-ID. Please check.
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OPGC 2012: Online Application For Executiv e Trainee

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Important Instruction for Candidates: 1. Attach your passport size photograph (without attestation) in the space provided below. 2. Endorse your signatures in the space provided below. 3. Application Form received without two photographs, signatures at two places and Demand Draft of 100/- will be rejected. 4. Send the duly completed Application form along with Demand Draft at the following address on or before 25 January 2013: Post Box No.3076, Lodi Road, New Delhi-110003. 5. Do NOT send any copy of the certificate alongwith the duly completed application form. Original certificates of the short listed candidates will be scrutinized / verified at the time of interview.

Application No.: 313835

Name: RAJ CHAKRAVARTY Address: RAJ CHAKRAVARTY A-51, MS SWAMINATHAN HALL, NIT ROURKELA ROURKELA -769008 ORISSA

Test Date: 03 March 2013 (Sunday) (Tentative)

Signature of Applicant (in the space provided)

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OPGC 2012: Online Application For Executiv e Trainee

Please Cut & Affix the Address Label given below on the envelop for sending print version of Online Application Form along with Demand Draft at the following address on or before 25 January 2013: --------------------------------------------------------------

OPGC-2012: Application for the Post of EXECUTIVE TRAINEE - Mining

Discipline: Mining To POST BOX NO. 3076 , LODI ROAD, NEW DELHI-110003.

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