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Application Form - Cadet

This document is an enrollment application form for CINEC Campus (Pvt) Ltd in Sri Lanka. The form collects personal details of the applicant such as name, date of birth, address, contact information, next of kin details, educational history including school(s) attended and qualifications, extracurricular activities, a statement of interest, and references. The bottom section is for office use only and includes fields for course code, batch details, date, registration number, pre-qualifications, and signatures.

Uploaded by

Nelum Perera
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
61 views

Application Form - Cadet

This document is an enrollment application form for CINEC Campus (Pvt) Ltd in Sri Lanka. The form collects personal details of the applicant such as name, date of birth, address, contact information, next of kin details, educational history including school(s) attended and qualifications, extracurricular activities, a statement of interest, and references. The bottom section is for office use only and includes fields for course code, batch details, date, registration number, pre-qualifications, and signatures.

Uploaded by

Nelum Perera
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CINEC Campus (Pvt) Ltd

Millennium Drive, IT Park, Malabe. Sri Lanka.


Tel: 0112413500 / 0114486400 Fax: 0112413505 Web: www.cinec.edu

Office Use
ENROLMENT APPLICATION FORM
Ref :
Navigation Cadet (Bsc Maritime Science - PI) Photo
Batch No: Engineering Cadet Training (Bsc Marine Eng - PI)
Foundation Course (Nav / Eng)

PLEASE COMPLETE ALL SECTIONS / USE BLOCK CAPITALS

1 Personal Details:
Title : Capt/Mr/Ms
Name in full (underline surname)

Date Of Birth(DD/MM/YYYY): ID/PP/CDC:

Sex: M/F Nationality:

Home address:

Postal code
Telephone: Moblie:

E-mail address:

2 Next of kin:

Name:

Address:

Relationship: Telephone:
3 School (s) attended
............................................................................... From To
............................................................................... From To

4 Educational
G.C.E. (O/L):Year G.C.E. (A/L):Year
Index No Index No

Subject Grade Subject Grade


1. ............................................................... 1. .....................................................
2. ............................................................... 2. .....................................................
3. ............................................................... 3. .....................................................
4. ............................................................... 4. .....................................................
5. ............................................................... 5. .....................................................
6. ...............................................................
7. ...............................................................
8. ...............................................................
9. ...............................................................
10. ...............................................................

5 Extra Curricular Activities


................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
....................................................................................................................................
6 Statement : State briefly as to why you decided to take up a career in this field
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
....................................................................................................................................

7 Non-related Referees
Name ................................................................. Tel. No
Address ........................................................................................................................

Name ................................................................. Tel. No


Address ........................................................................................................................

I do hereby declare that the above particulars are true and correct.

Date: ........................................... Signature of applicant ....................................

OFFICE USE ONLY


Trainability & Suitability of the applicant: ...................................................
Pre qualifications
Course Code Batch Date Registration No: Remarks
(Cert no/Dates)

Checked by: ........................................ HOD’s Signature: ...................................


Date: ................................................... Date: ...................................................

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