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Enrolment Form Final Version

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sunil2102004
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14 views

Enrolment Form Final Version

Uploaded by

sunil2102004
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Supported By: Implemented By:

'Skill Up'-Empowering the Next Generation


Course Applied For*- Enrolment Form
Employability Enhancement
Program
Personal Information
Salutation Mr. Ms. Mrs.
Name*

Date of Birth* M / F*
Category Code SC ST OBC MBC GEN
Father/ Husband/ Caretaker Name*

Religion Onboarding Source*:


Name of College/ ITI/ Any other instiitution*
Permanent Address* Please Affix

Candidate's

Taluka / Taluk / Block Recent Photograph *

District*

State* PIN*
Communication Address*

Taluka / Taluk / Block


District*
State PIN*
Mobile* Guardian Phone*

E-Mail ID*

Educational Qualification * Professional Qualification*


How Did You Hear About Us Occupation*
If Employed, Work Experience: Mother Name*
Employer Name & Address No.Family Members* :
Is Family Member Gov employee *: Yes No
Annual Family Income* Parent/ Guardian Occupation*:
Disability Type*: NA OH HI VI MH Others

Self Declaration
I …………….………...……….………..… daughter / son / wife of …………….……….…..…………..hereby state that I am willing to enrol
and complete this training program with Centum Foundation and not currently enrolled in any other training program. I acknowledge
and understand that this is a 60 hour training program and I need to attend sessions as per given time table and maintain atleast 80%
attendance to get successfully trained. I will be responsible for my own conduct during training and shall take care of my safety during
training. CF by no means shall be liable for any mishap during training. I also declare to join the placement opportunity given to me post
training completion.I hereby give my consent to Centum that my contact details and my personal data (including any sensitive personal
data) voluntarily submitted by me can be used by Centum During or Post Training for Project related work / Discussion feedback and
follow up.. I understand my rights under applicable data protection laws, including the right to access, rectify, erase, restrict processing,
and withdraw consent. I acknowledge that my data will be securely processed, may be transferred internationally or shared with third
parties, and will be retained only as necessary. Additionally, I also consent to being contacted by Centum and/or such third parties with
whom such data is being shared. I have read Centum's Privacy Policy (https://centumfoundation.in/privacy-policy/). By providing my
information, I agree to its collection, use, and processing as described.
I certify that the information furnished by me in the Enrollment Form is true and correct to the best of my knowledge and belief.
Yes No

Beneficiary Signature*: Date D D M M Y Y


Screening Centre:

If Selected, CFUnique ID*:


Annexure Check List
Copy of Class 10 marksheet Copy of last Educational Qualification
Copy of Aadhar Card Copy of candidate photo
Aadhar Number

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