Scribd
Upload
24 views

Indian Institute of Enterprise Management LTD Last Date of Registration

This document is an application proforma for distance learning courses offered by the Indian Institute of Enterprise Management. It requests personal details such as name, gender, date of birth, nationality, and contact information. It also asks for academic details including examination results, work experience, achievements, and references. By signing, the applicant agrees to abide by the rules and regulations of the programs and uphold the standards of the Indian Institute of Enterprise Management.

Uploaded by

hiteshcparmar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
24 views

Indian Institute of Enterprise Management LTD Last Date of Registration

This document is an application proforma for distance learning courses offered by the Indian Institute of Enterprise Management. It requests personal details such as name, gender, date of birth, nationality, and contact information. It also asks for academic details including examination results, work experience, achievements, and references. By signing, the applicant agrees to abide by the rules and regulations of the programs and uphold the standards of the Indian Institute of Enterprise Management.

Uploaded by

hiteshcparmar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

APPLICATION PROFORMA

INDIAN INSTITUTE OF ENTERPRISE MANAGEMENT LTD LAST DATE OF REGISTRATION


DISTANCE LEARNING COURSES

PERSONAL DETAILS 1. Name (As it Appears on school Records / office records etc.) _________________________________________________________ Surname First Name Middle Name 2. Gender (Male / Female)______________ Status (Single / Married) _______ 3. Date Of Birth (Day / Month / Year ) ____________________________ 4. Nationality _____________________ Mother tongue____________________

Please attach your recent passport size photograph here

5. Fathers / Husbands / Guardians Name ( Please Strike out which ever is not applicable) ________________________________________________________________________ Surname First name Middle Name 6. Fathers / Husbands / Guardians Occupation ______________________________ Company Name _______________________ Present Designation ________________ 7. Correspondence Address _____________________________________________ ___________________________________________________________________ ___________________________________________________________________ Pin Code: E Mail Id: 8. Course Selection (Specify the Name) _________________________________ a) Post Graduate Diploma in Lean Sigma ------------------------b) Six Sigma Master Black Belt Course----------------------------c) Six Sigma Black Belt Course --------------------------------------d) Lean Expert Course--------------------------------------------------e) Other Courses (Specify) --------------------------------------------Telephone No.:

ACADEMIC DETAILS Examination taken (please list in chronological order including examinations with results pending)
Examining body Board/University Name of The Institution/College/School Exam Date

Month

Year

Subjects/Speci alizations

Results/Grades/Per centages

WORK EXPERIENCE (Please list in chronological order including industry Name, Location & Designation) Name of The Location Business Date of Date of Designation Gross Industry Segment joining Leaving Package per Annum

SUMMARY OF ACHIEVEMENTS Area Achievement Academic Industrial Others TWO REFERENCES SI No 1 2 DECLARATION BY THE CANDIDATE Name Designation

Year

Recognized/Given By

Relation to Candidate

E-Mail ID

Contact Number

I certify that all information provided on this application proforma is complete and accurate. I agree to familiarize myself with all the rules and regulations of the programs set forth by Indian Institute of Enterprise Management Ltd. in the prospectus and abide by them. I would uphold the standards and respect the principles of IIEM as an organization of higher learning. Signature: Date :

You might also like