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EXECUTIVE PROGRAMME FOR WORKING PROFESSIONLS

BATCH - II (2011 - 12) APPLICATION FORM

 
APPLICATION FOR: EPWP Source of Information
1. Name (In Block Letters) *
2. Father’s / Husband’s Name
3. Date of Birth* (dd-mm-yyyy)
4. State* 5. Sex:* 6. Marital Status
7. Mailing Address (In Block Letters)
City Pin Mobile +91 Email

8.  Educational Qualification (In order of X, XII, Graduation, Post Graduation)
Qualification Year of Passing Course Completed Board / University % / CGPA received Rank / Scholarship secured (if any)
X
XII
Graduation
Post Graduation

9. Total Work Experience (Completed Years & Months as on 01.06.2011) Year Month


10. Work Experience Details:
Order Name of Organization Designation Held Number of Years / Months
Current
Previous 1
Previous 2
Previous 3

11. Payment Details

ONLY DD WILL BE ACCEPTED TOWARDS PAYMENT. Mode of Payment :

Draft\Cheque\Reference number Bank DD\Cheque\Transfer Date Amount
(dd-mm-yyyy)
How do you propose to finance the fees for EPWP Programme?

STATEMENT OF PURPOSE

This personal statement is designed to assist the Admissions Selection Committee learn more about you and your motivation for undertaking the EPWP programme.
(If you are typing in your response - please type in each individual line and then move to the next line)
(a) What are your current responsibilities and long term professional goals?

(b) What are your reasons for seeking to undertake the EPWP Programme from XIMB and how will the course help you achieve your professional goals?
(c) What strategies will you need to implement in order to meet the demands of the rigorous EPWP Programme?

Instructions for filling up the form

  1. Sex: Fill up M or F for Male or Female
  2. Marital Status: Fill up as M for Married or S for Single
  3. Mailing Address: This is the address to which all communication will be sent from XIMB. Hence, fill it up carefully, including the Pin code.
  4. Academic Background: Fill ER for Engineering, SN for Science, AR for Arts, CM for Commerce, AG for Agriculture and OR for Others
  5. Fill in the total work experience in completed years and months as on 1st June 2010
  6. Educational Qualification:  Fill in all the details starting with 10th standard
  7. Work Experience: To be filled in by all candidates (excluding summer training & other experiences relating to your Graduation/ Post graduation)
  8. CHECKLIST FOR ENCLOSURES:
    a. Self attested passport size photos (2 in numbers)
    b. Attested copies of all testimonials and certificates relating to qualification and experience
    c. Two self addressed (in BLOCK letters) stickers
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