[ Codes tr ay] Coes tory Cais orSh) Codes tor 3) | Codes Tor ta | Bacay Gaz 7} ReseachOvsiemen | 7 Sai F Wate & Santay | | Pros a Sowa Dasani | — 8 Shae oe 6 — Vavare 0 0 OT ‘hers 10] iudes monthly salary and allowances and money value of poks 4. f self employed provide details of your self employmentiparticipation in family enterprises since obtaining diplomaldegree a) Description of the area of activity b) Date of commencement: Month___Year___ ¢) Location: Village. Town. qd) Financial Assistance Received if Any. () Source: Bank Credit( ) Money Lender( ) Other () Please Specify (i) Amount (RS, Less than 50,000 ( ) 60,00-99,999( ) 1,00,000 & above(_) 5. IDENTIFICATION PARTICULARS (@) NamelAddress of Respondent (b) Details of Qualifications: [ SNo. Course(s)/ Nature of Course] tnstitution’s Name and | Year of Passing | Division/ Grade | | Discij Part time / Full time Address i } _ | [ l l ei 6, GENERAL PARTICULARS i), Phone No. with STO Code, Mobile Email Address: ji). Age (as on date): ___ (years) i, Sex Male ( _) Female ( ) iv). Whether you belong to any reserved category: GEN ()SC(__) ST (_} OBC. (_) Minority (_) Whether you belong to: Ruralarea() Urban area( ) vi). In which state you completed your schooling. vi) Are you presently registered with any placement providing servicelemployment exchange Yes -)-No. () vil). Have you undertaken any educationtraining after completing your diplomaldegree? Yes( ) No. ( ) If Yes, Please indicate the following: [Type of Education/Training Duration (months) Place of Study ‘Apprenticeship Training Company Training a i Other (Spec) Dee ‘Signature Name & Address