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EHS-Application-Form in sap

The document is an application form for the Centre for Environment Health and Safety (CEHS) program, requiring accurate completion of personal, academic, and work experience information. It includes instructions for submission, payment details, and a declaration of truthfulness. Applicants must also provide scanned copies of relevant testimonials and will receive a full refund if their application is rejected.

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mech2007
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9 views

EHS-Application-Form in sap

The document is an application form for the Centre for Environment Health and Safety (CEHS) program, requiring accurate completion of personal, academic, and work experience information. It includes instructions for submission, payment details, and a declaration of truthfulness. Applicants must also provide scanned copies of relevant testimonials and will receive a full refund if their application is rejected.

Uploaded by

mech2007
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Centre for Environment Health and Safety (CEHS)

APPLICATION FORM

Please Note:
1. Please complete all the information accurately.
2. It is assured that your data will be stored in a secure way and will only be shared with placement
and authorised government agencies upon your request. This form is a deemed consent for the
same.
3. For details for the programme, please visit cehs.igmpi.ac.in Pay the Programme fee on:
www.igmpi.ac.in/programmefeemodes.html as per the details given on "Programme fee details".
4. Full refund will be made if the Institute rejects any application.
5. You are required to enclose soft (scanned) copies of all relevant testimonials along with the
registration form.

The completed application form should be emailed to the Director, Centre for Environment
Health and Safety (CEHS), IGMPI, C-6, Qutab Institutional Area, Near Old JNU Campus, New Delhi-
110016, India to email ID [email protected]
Phone: +91 11 26512850

Application Details
Amount Rs.:
Demand Draft/CHQ No.:
Dated:
Affix a recent
Bank:
coloured passport
NEFT reference no: size photograph
Credit/debit card transaction ID:

Registration Number

(Leave this space blank)

*Crossed DD or Cheque should be in favour of “Institute of Good Manufacturing Practices India”


payable at New Delhi. Please write your name and address at the back of DD/Cheque. Applicable
examination fee needs to be paid at the time of your admission itself along with the programme fee.

PERSONAL INFORMATION

1. Programme:
2. Mode:
3. Full Name:
4. Address of correspondence (in capital letters)
Postal code/Zip code
5. Mobile no.:
6. Date of Birth:
7. Gender:
8. Mother’s Name:
9. Father’s Name:
10. Email Id:
11. Phone no with STD code.:
12. Nationality:
13. Category:
(SC: Scheduled Caste; ST: Scheduled Tribe; PH: Physically Handicapped; EWS: Economically
Weaker Sections; Ex-servicemen)

WORK EXPERIENCE

14. Work Experience (If any)


i. Total work experience: Year Months
ii. List all your work

From To Total Name the Designation Brief job profile


completed organization
months

ACADEMIC QUALIFICATIONS

15. Pre-Bachelor’s Degree Examination(s):


Std. School/ Board/ Year % Marks Class/
Institute University completed Obtained Division
10th
High School
12th
Intermediat
e

16. Bachelor’s Degree Examination(s):


Degree Obtained Subject/Specialization

College/Institute University

Year Marks considered for award of Class/Division in Bachelor’s


From To
CGPA/ % of Marks obtained/ Grade
(DD/MM/YYYY) (DD/MM/YYYY)
17. Post-Graduation Degree/Diploma (if any):
Degree Obtained Subject/Specialization

College/Institute University

Year Subject % of Marks obtained


From To
(DD/MM/YYYY) (DD/MM/YYYY)

18. Professional qualification (if any):


Degree Obtained Subject/Specialization

College/Institute University

Year Subject % of Marks obtained


From To
(DD/MM/YYYY) (DD/MM/YYYY)

DECLARATION

I have carefully filled up all the information and agree to abide by the decision of the IGMPI, New Delhi authorities
regarding my registration. I certify that the particulars given by me in the form are true to the best of my
knowledge and belief.

Date Name:
Place Signature:

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