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ATI GOVERNMENT OF INDIA MINISTRY OF LABOUR & EMPLOYMENT Directorate General of Employment and Training ADVANCED TRAINING INSTITUTE,

GUINDY, CHENNAI-600032
PHONE: 044-22500252, 22501211 FAX: 044-22501460 E-MAIL atichn@vsnl.com

2010-11

FOR OFFICE USE ONLY


30% Xth (1) 05% XIIth ( 2) 05% Degree(3) 50% NTC (4) 60%NAC (5) 60%Diploma (6 ) Total 100% (*)

* 1+2+3+ (4 or 5 or 6)

Registration No

APPLICATION FOR ADMISSION IN CRAFT INSTRUCTOR COURSE (To be filled by the candidate) 1) Name in full (IN BLOCK LETTERS):

PHOTO 2) Date of Birth: 3) Nationality: 4) Fathers/Husbands Name: 5) Residential Address: Door No.: District : PIN Code: Name of the Street: City Contact Cell Phone No. Village /Area State E-mail

6) SEX

: Male/ Female If YES

7) Whether belongs to SC/ST/PH/EX/Category: YES / NO, (Certificate to be enclosed) 8) Details Previous Modules Completed: Name of the Module completed Engg.Technology Trade Technology -1 Trade Technology -2 Month and Year Result Pass / Fail

Admission No

Name of the institution & place

9) Module for which admission is required: (Refer prospectus for details) 10) Date of commencement of course (Refer prospectus for details)

ATI GOVERNMENT OF INDIA MINISTRY OF LABOUR & EMPLOYMENT Directorate General of Employment and Training ADVANCED TRAINING INSTITUTE, GUINDY, CHENNAI-600032
PHONE: 044-22500252, 22501211 FAX: 044-22501460 E-MAIL atichn@vsnl.com

2010-11

11) Qualification a) Academic : Sl.No Examination University/Board Passed


Xth XII Graduation

Year Class

% of Marks

Main Subject

(Attested Photostat copies of mark sheets, to be attached) b) Technical: Sl.No Certificate/ Trade/ Branch Institute attended Diploma 1 2 3 NTC NAC Diploma

Year of passing

% Remarks of Marks

(Attested Photostat copies of mark sheets, to be attached) 12) Payment Details of Registration Fee. IPO / DD No. Date Amount Name of the Bank/Post Office 13) Any other Particulars : I certify that the information given in item 1 to 13 is correct to the best of my knowledge and belief. In the event of my selection for admission to the institute, I undertake to abide by the rules and regulations and discipline of the institute

Date: Station:

Signature of the Candidate

Counter Signature of Deputing Authority with Seal


Last Date for Receipt of the filled in application for admission to the following quarters are

I quarter 25 October 2010


th

II Quarter 24 December2010
th

III quarter 25 March 2011


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