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Andaman and Nicobar Islands/UT
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh/UT
Chhattisgarh
Dadra & Nagar Haveli & Daman & Diu/UT
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir/UT
Jharkhand
Karnataka
Kerala
Ladakh/UT
Lakshadweep/UT
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry/UT
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
The Government of NCT of Delhi/UT
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
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No.
Degree
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College/University/Institution
Month and Year of Passing
Percentage of marks obtained(%)
Division/Grade
Degree Certificate
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Pass
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Note:(Details of previous and present employment held, if any, in chronological order starting from present position)
Sr.no
Name of the Organisation
Position Held
From (DD/MM/YYYY)
To (DD/MM/YYYY)
Experience
Nature of Duties
Pay Scale/Gross Salary Rs
Type of Organisation
Experience Certificate
1.
Currently Working
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Central Government
State Government
Autonomous Body
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Social Org.
NGO
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2.
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Central Government
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3.
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4.
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Private
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5.
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Total Experience:
Whether you have worked on any Government Project? :
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Documents
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Passport Size Photo (JPG/PNG) (Max 200 KB size) :
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Current Sign (JPG/PNG) (Max 200 KB size) :
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3.
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Please upload your CV/Resume (PDF/JPG/PNG) (Max 200 KB size) :
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4.
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Social Outreach (Participation in socially relevant activities to be proven with evidence) (JPG/PNG/PDF) (Max 5 MB size) :
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Skills- Program Management (Please rate yourself on your proficiency on the given scale)
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Low
1
2
3
4
5
High
Skills- Policy, research and report writing (Please rate yourself on your proficiency on the given scale)
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Low
1
2
3
4
5
High
Skills- Data Analytics (Please rate yourself on your proficiency on the given scale)
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Low
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2
3
4
5
High
Skills- Government stakeholder management (Please rate yourself on your proficiency on the given scale)
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Low
1
2
3
4
5
High
Have you ever been detained/convicted by police authority or court of law?
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Yes
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What motivated you to apply for this fellowship? Please limit your response between 250-300 words:
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Other Information:
I hereby certify that the foregoing information is correct to the best of my knowledge and belief. I have not suppressed any material fact or factual information in the above statement. In case I have given wrong information or suppressed any material fact or factual information, then my services are liable to be terminated without giving any notice or reasons thereof. I am not aware of any circumstances which might impair my fitness.
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