Application form & Instruction Sheet

1. NIELIT (Formerly DOEACC) announces following courses for SC/ST/Minority community in Jharkhand: Sr No 1 2 3 4 5 Course Name Certification in Programming languages in JAVA Certificate Course in Financial Accounting Certificate Course in Linux Programming Certificate Course in PC Hardware & Networking Certificate Course in Computer Applications Duration 3 months 3 months 3 months 3 months 3 months
th

Eligibility 12 12 12
th

th

th

10 Pass / ITI / Diploma th 10 Pass / ITI / Diploma

2. All the eligible candidates are requested to submit their applications forms, strictly as per format available here on or before 01/05/2012. They can also collect application form in person from the following institutes. A] Ranchi i) Basant Dynamics: 472, Pepee Compound, Near Guru Nanak HS School, Ranchi, Pin 834 001. Contact No. : (0651) 233-1945, 090312655-06. ii) Sajjad Institute of Information Technology (SIIT) : Syndicate Lane, Behind J.J.Sales, Tata Road, Kantatoli Chowk, Ranchi, Pin 834 001. Contact No. : (0651) 2530522, 2532060 B] Jamshedpur iii) Kanak InfoTech Systems: 12 School Road, Pramathnagar Parsudih, Jamshedpur, Pin 831002, Contact No. : (0657)2298031 iv) Jupiter Systems software: II Floor Pratap Tower, J Road, Bistupur, Jamshedpur, Pin 831001. Contact No. : (0657) 2249889 / 2249151 C] Dhanbad v) Shree Computers: Thana Chakk, Beside Shri Press, Panchagari Bazar, P.O. - Katrasgarh, Dhanbad, Pin 828113. Contact No. : (0326) 2372503 vi) Smart Age Computers: 2nd Floor, Anjana Complex, Bartand, Dhanbad, Pin 826001, Contact No. : (0326) 26452206, (0326)2200109 3. Only candidates from SC/ST/Minority Community can apply for these Courses with genuine Certificate from the competent Authority. Like for SC/ST candidates the Certificate from Backward Class Department of Jharkhand will be considered valid. 4. At any stage, if it is found that a student has taken admission with false declaration or with declaration from an incompetent authority for the purpose mentioned here, then candidature will be cancelled. In case the Certificate by NIELIT has been issued then the same will also be revoked. 5. Attestation of photocopies of Mark sheet / Grade Card / Certificate need to be done from competent authority as described in Application form. 6. A student can take admission in only one course under this project. Thus a student, if admitted in one course cannot take admission in another course. Any violation will be dealt strictly. 7. To fill up the application form, the students should mention and submit any or all of their Identity details (like Voter Id Card, PAN Card, Driving License etc.). After being admitted in one course, use of different ID proofs in different application for admission in multiple courses will be treated as an offence and will be dealt strictly.

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8. Candidates must ensure that no column is left blank or wrongly filled in the application form as the information furnished therein would be used for deciding the eligibility and suitability of the candidate for the courses. Applications not filled correctly, completely and as per the instructions - are liable to be rejected. NIELIT will not entertain any claim after such rejection.

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National Institute of Electronics & Information Technology (NIELIT) [Formerly DOEACC Society]
(An Autonomous Scientific Society of Department of Electronics & Information Technology, Ministry of Communication & Information Technology, Govt. of India )

Jadavpur University Campus Kolkata-700032

2414-6054/6081/6082 APPLICATION FORM NO: To The Director NIELIT (Formerly DOEACC Society) Jadavpur University Campus Kolkata 700032 Sir, With reference to your advertisement, I would like to enroll myself as a candidate for the following course (To be filled in the BLOCK Letter) 1. Name of the Course Applied for: (Please select the proper Course Name from Instruction page) Fax: (033)2414-6549 website:www.doeacckol.in

Paste a passport size photograph here and sign it across.

2. Name of Candidates: FIRST NAME MIDDLE NAME SURNAME 3. Fathers Name/Guardians Name:

4. Address:

P.O. CITY/ VILLAGE DIST STATE PIN

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5. Date of Birth:

6. Contact no Details:

i) Mobile No:

ii) Land Line No:

STD CODE PHONE NO

iii) E-Mail Id (if any): 7. Sex:

____________________________ 8. Category:

SC
9. Marital Status:

ST

Minority

General

10. Occupation:

11. Religion: 12. (a) Identity Type:

Voter ID

PassPort

PAN

Driving Lisence

10th Exam Registration Card Others(Specify)

(b) Identity/ Registration Number: ______________________ 13. Academic/Professional Qualification: QUALIFICATION BOARD/UNIVERSITY INSTITUTE/SCHOOL NAME VIII X XII ITI Diploma Graduation Post Graduation Others 14. List of Enclosures:

Admit card for school leaving exam

STREAM/SUBJECTS

PASS YEAR

% OF MARKS

1. Date of Birth Proof ( 10TH Class Certificate/Birth Certificate*)

(*In case is not available attested copy as per ANNEXURE-I issued from head of the school)

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2. SC/ST/Minority Certificate (Attested copy of Caste certificate /Minority Certificate issued from the
competent issuing authority)

3. Residential Certificate (Attested copy of Domicile Certificate/Driving License/Voter ID/Passport) 4. Photo Identity (Attested copy of Pan Card/Voter ID card/Driving License /Passport/Board Exam
Registration card/ others)

5. Three recent color photograph 6. Documents attested by following authorities will be considered only
a) Bank Manager b) Block Development Officer e) Gazetted Officer f) High School Headmaster h) Post Master i) Sub Divisional Officer c) College Principle f) Magistrate d) Deputy Magistrate g) Municipal Chairman

I declare that all information furnished above is true to the best of my knowledge and belief. In case any of the information given above is found incorrect, I will abide by the decision of the Society. I also ensure that I did not registrar myself in any other courses conducted by NIELIT (FORMERLY DOEACC) Society for Training program to improve employability of SC/ST & Minority Community and Women candidates in Jharkhand. Yours faithfully

Date: ________________

(Signature of the Applicant)

Checked & Verified by (Name of Participating Institute):

Signature of the Authority:

ANNEXURE-I

(This declaration is optional and is true only if the candidate has not passed any Board Exam)

I. Certified by the Head of the School where candidate has studied in Class -VIII during _ ___________ : This is certified that Master/Ms S/o, D/o Shri...............................................................................................was studying in the School since (year) and he/she has passed /appeared for his/her Class VIII examination from this school. As per school record his/her date of birth is ... (In figures) .. (In words) He/She belongs to SC/ST/Other category and his/her caste is. This is also certified that entries made by the applicant in the application form are correct as per school record.

Date: .

Signature of the Head of School (With official stamp)

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Instructions for filling Application Form Number

Format of Application Form Number
Serial Number

City Code

Centre Code Session Code

City Code City Code J R D Centre Code Centre Code 01 02 03 04 05 06 Session Code Session Code 01 Centre Name Basant Dynamics Sajjad Institute of Information Technology Jupiter System Software Kanak Infotech Shree Computer Smart Age Computer City Name Jamshedpur Ranchi Dhanbad

Serial No. for this Session should start from 001. In case if the application form is distributed by the institute, application form number may be given by the institute authority according to the above procedure. In case a candidate submits an application form downloaded from the Doeacc website then while accepting the form application number may be given by the institute. Applicants may be given a receipt while receiving the application form. Application form received by a participating institute should be stored and preserved under safe custody till further instructions are issued. All forms accepted by the participating institute may be checked & verified at the time of receiving the application. The checking & verification field of the application form may be duly signed after verification. An authorized person of the institute can only do this job. In case you need any clarification please send query through mail. We will give you a relevant reply. Example : First student applying from Basant Dynamics against the advertisement date 15/04/2012 then his/her FORM ID will be R 0 1 0 0 0 1 1

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