APPLICATION FORM FOR ACADEMIC ASSOCIATE

Area Applied for: ____Information System_________

1. Name in Full: _____Umed Kejariwal___________________________________________________

2. Fathers/ Spouses Name: __Shri R.A. Kejariwal___________________________________________

3. a) Date of birth: 14th March,1980_______________

b) Age on 01 January 2009: 28____years _9__months

4. a) Mailing Address: Flat No: 501, Good Relation Housing Cooperative Society ,Opposite Borba Devi Mandir near Govandi Station, Govandi (E), Mumbai_________________________________

Phone/Mobile &Email: +919819674489,

umedkejariwal@rediffmail.com_____________

b) Permanent Address: Neel Gagan, Chowk Ghazipur (UP), 233001___________________________

5. a) Gender (M/F): ___M____ b) Marital Status: _Married_______

7. Nationality: __Indian__________

8. State of Domicile & Home Town: ____Uttar Pradesh__________________

9. Educational Qualifications (in reverse chronological order):

Examination Passed University / Institution

Subjects Year of passing

Class / Division

PGDIT

BTech

12th

10th

IIT Kharagpur

UPTU

CBSE

CBSE

Information Technology

Information Technology

PCMB

PCMB

2005

2004

1998

1996

1st

1st

1st

1st

10. Work Experience (in reverse chronological order):

Name of the Employer Period of Service Position /Designation & Scaleof Pay Reason for leaving

From ToIbilt Technologies

Spanco Limited

June 2005

Jan 2007

December 2006

Till Date

Software Engineer

Senior Software Engineer(Business Analyst/Presales Technical Consultant)

Professional Growth

Need to do Phd & interested in research

11. Knowledge of Computer & Office Equipments:

Technologies: UML, OOAD, Web services, J2ME, J2EE, Struts, Hibernate, XML, Ajax, C, C++, Software Tools: Rational Rose, Visio, MS Project, Power Point,Eclipse, Dreamweaver, VSS, TOAD, ER Studio Methodologies: RUP, Iterative & Increamental, WaterfallApplication Server/DB: Tomcat, WebSphere, Oracle, MySQL, SQL Server, DB2

12. Details of Training/Workshop Attended: No

13. Any other information you may wish to add including publication, if any (use separate sheet,if necessary): No

14. Details of relative(s) associated with IIM Indore: No

15.Declaration -I declare that the foregoing information is correct and complete to the best of my knowledge and belief and nothing has been concealed/ distorted. If I am found to have concealed/ distorted any material information, my appointment shall be liable to summarily termination without any notice. If offered appointment, I will join on specified date and subsequently take up IIMIs assignment anywhere as and when required.

Date: __19/01/2009_____________ Umed Kejariwal

Place: ___Mumbai_____________ Signature of the Candidate