Ujjain Sahakari Dugdha Sangh Maryadit, Maxi Road, UJJAIN ‘Application for the post of Lady, Enckuraitm Lady Extensic Full Name ofthe candi PIYUSH kumAR IAIN [pg eae | 1 (In capital letters) 2 [Father's Name 3 | Category 4 | Date of Birth & Age 5 _| Address for correspondence 6 [Permanent Address. 7_| e-mail Address '8_| Mobile No. [9 | Academie Qualifications (School / College. Commencing Matriculation) ‘S.No | Name of Degree / Board / University] Yearof | Division | Subjects Diploma/Centificate Passing | /Grades Obtained i High School PR oe | TT W r ¢ Mot 4 B: 1 P-y;, Bhopal S 10 | Previous Employment (Please start with the most recent tracing back the history s Dates: Employer | Post Held with | Total | Reason No. Brief Outline of | Salary | for From To Duties/Nature Change ‘of work done 7 2,“Training (Please Tist only those courses relevant to this particular post.) 11[S. | Approx. Date ‘Course Title ‘Approx. | College oF No. Duration | Organization i 2 3 { 12 | Rete [References Please give the names of people who could provide a reference regarding your suitability for the post for which you are applying. One of these should be your Present or Most Recent Employer. (You should not give friends or relatives as referees.) Ra\soadin. Kase at sou Tine (Un am Tanyas 45 S001 UB HOO} BS89249) 9407) 48721 13 | Supporting Information: Please provide supporting information, outlining any experience, skills and knowledge relevant to the post for which you are applying. Aiele daoracurthosias Gregelisrt Foye SKE dre Ee art area en BB, WOT Pow We To WB 14 | Declaration To the best of my Knowledge and belief, the information contained in this form is accurate | understand that giving false information, of failure to supply details, will lead to termination of contract. : = : 5 eee | ears aa 2 son ‘Note: No application fee is chargeable for applying and appearing for the above interview.