1/15/2017 :: Application Form For Employment ::
Registration No. : 336556
I. POSITION DETAILS
Name of Post : EXECUTIVE TRAINEE (ELECTRICAL)
Pay scale : Rs. 2490050500
Grade : E2
II. PERSONAL DETAILS
1. GATE2017 Registration Number
(Enter GATE2017 Registration No. which is : EE17S66050093
mentioned on your GATE2017 admit card )
2. Name (Name should be filled up as appearing in your GATE 2017 admit card)
First Name : DEEPAK
Middle Name : KUMAR
Last Name : EKKA
3. Date of Birth : 25/06/1992
4. Father's Name : JAMES EKKA
5. Category : SCHEDULED TRIBE
6. Name of Caste / Tribe (In case of
: ORAON
SC/ST/OBC)
7. Other Category, If Applicable
(i) Persons with disabilities : NO
(ii) ExServiceman : NO
Domiciled in J&K between 01.01.1980 and
(iii) : NO
31.12.1989
8. Details (In case of PWD)
(i) Type of Disability : NA
(ii) SubCategory of Disability : 0
(iii) Percentage (%) of Disability : 0
9. Details (In case of ExServiceman)
(i) Rank : NA
(ii) Corps / Regiment Number : NA
(iii) Date of Commission : NA
(iv) Date of Discharge : NA
(v) Date of start of precommission training, : NA
if any
(vi) Education of Military : NA
(vii) Length of service : 0 YEAR(S) 0 MONTH(S) 0 DAY(S)
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1/15/2017 :: Application Form For Employment ::
10. Nationality : INDIAN
11. Religion : CHRISTIANITY
12. Sex : MALE
13. Marital Status : SINGLE
14. Present Postal Address
(i) 1st Address Line : H.NO 113/114 MISSION CHOWK
(ii) 2nd Address Line : DENGIBHADI ROAD
(iii) 3nd Address Line : JYOTINAGAR
(iv) City : SUNDERGARH
(v) District : SUNDERGARH
(vi) State : ORISSA
(vii) PIN Code : 770001
(viii) Telephone (Landline) : STD Code: 0 Number: 0
(ix) Telephone (Mobile) : 0
III. Education & Experience Details
1. Essential Qualification Details :
Examination / College / Year of Year of Percentage
Branch/Discipline/Specialization Board / University Type
Degree Passed Institution Joining Passing of Marks *
K.V.S
SSC (10th) CBSE 10TH 2007 2008 CBSE 87.4 FULL TIME
SUNDERGARH
D.P.S
HSC (10+2) CBSE 12TH 2009 2010 CBSE 91.8 FULL TIME
DAMONJODI
BE / B TECH /
ELECTRICAL NIT ROURKELA 2010 2014 NIT ROURKELA 84.1 FULL TIME
BSc(ENGG)
2. Post Qualification Work Experience Details :
I. Do You have any post qualification work experience : NO
II. Current / Last Company Name NA
III. From Date (DD/MM/YYYY) NA
IV. To Date (DD/MM/YYYY) NA
IV. DECLARATION
I certify that –
a) I am not employed in Govt. /Statutory Organization /Public Sector Undertaking.
b) In case of my employment in Government / Statutory Organization / Public Sector Undertaking, I will produce No Objection
Certificate (NOC) from my organization at the time of Interview, if called for.
I declare that all information given in this application form are true to the best of my knowledge and belief. If any of the
information is found incorrect or distorted at any stage, I shall have no objection to cancellation of my candidature.
DEEPAK KUMAR EKKA
(Name & Signature)
Date: 15/01/2017
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