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APPLICATION FORM

Personal Details:

Name: ______DAYANANDA T R_______________________________________________________________________(First) (Middle) (Last)

D.O.B.: ____01/05/1989________ Age: ___24_______ Gender: ______male_______Nationality:INDIAN____________________

PAN No.: ________________ Adhar Card No.: ______2370 4066 5918_________ Passport No.:___________________

Permanent Address: _____s/o T V Rajanna, Chittara, A Block, 3rd Cross,Swami Vivekananda Extn,Shimoga-577205

Temporary Address: ________c/o sri B V Ramakrishna, s/o late Sri Venkatappa, #57,71st cross, Rajajinager, 5th Block,Bangalore-560010

Residence Tel: _______9449426030____________________ Mobile: ______7760398585 __

Email ID: ______________________dayanandatr28@gmail.com_______________________ Blood Group:A+ _____

Emergency Contact Details:

Name: _Rajanna T V_________ Contact No.: ______9986474677_________ Relation:___Father__________________

Educational Details:

Qualification

School/InstituteName

Board/University Name PassingYear

Percentage/CGPA

10th Std. Visvesvaraya EglishHigh School

Karnataka Education Board 2005 75.84

12th/Diploma

Sacred Heart PUCollege

Department of Pre-UniversityEducation

2007 48

Graduation(B C A)

S R N M College forApplied Science

Kuvempu University 2010 68

PGDegree(MCA/ ME/M.Tech/PG)

T John Institute ofTechnology

Visvesvaraya TechnologicalUniversity

2013 75.4

CertificationCertification

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Any GAP in Education: __no_______ No. of year(s): ________

If yes, please specify: __________________________________________________________________

Scholastics Achievements (Ranks, Merit, Scholarships, Prizes, etc.) _______

__________ scholarships _____________________________________________________________________

Extra Curricular Activities ___playing Cricket, riding byk, surfing, photograpy, Travelling andTrucking._______________________________________________________

Family Background:

Name & Occupation D.O.B. AgeFather RAJANNA T V 12/11/195

756

Mother SHAKUNTHALA 20/05/1965

48

Brother

Sister

Spouse

Child

Miscellaneous:

Are you under any legal obligation to your current employer? Yes/NoIf yes, please clarify __________________No_________________________________________________

Have you at any time been convicted by a court of India for any criminal offence and sentencedto imprisonment, or any criminal proceedings are pending against you before a court in India, or

an order prohibiting your departure from India has been issued by a court? Yes/NoIf yes, please give details ______________________NO_________________________________________

Are you physically fit for employment? Yes/NoYes

Can we conduct your background verification? Yes/NoYes

Rate yourself on Communication Skills? ___5__ out of 10

Have you applied to MindCraft earlier? Yes/No. If yes, please mention the dateNo

Were you employed with MindCraft earlier ? Yes/No. If yes, please mention the dateNo

Declaration:

I certify that the above statements made by me are true, complete and correct. I agree that incase the company finds at any time that the information given by me in this form is not correct,true or complete, the company will have the right to withdraw my letter of appointment or toterminate my appointment at any time without notice or compensation.

Date: _____13/08/2013________

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Place: __Bangalore___________

Candidates Signature: _____Dayananda T R________________ Recruiters Signature:

__________________