Centre for Converging Technologies, University of Rajasthan Jaipur 302 004.

Student registration form for campus placement drive – 2014

Personal details:

1. Registration Number (CCT will allot) Photograph

2. First name

3. Middle name

4. Surname/Last Name

5. Gender

6. Mothers’ name

7. Personal mobile number

9. Email id

10. Date of Birth

11. Native place (name of place/district)

11. Local address

12. Permanent address (Parent residence)

13. Fathers’ mobile number, landline number

(residence)

Academic details (Schooling/ Junior college/Diploma) with examinations passed, % marks and year of passing

S.No. Name of the Course Name of the

Board/University

Year of Passing Marks obtained Percentage %

1. S.S.C.

2. H.S.C.

3. Diploma in -----

4. UG-B.Tech/BCA/MCA/B.Sc.

9

Declaration by the student:

Above information is provided by me and it is correct and complete. I will provide the corresponding proof as

and when required for the verification of the same.

Signature of the student

Verified and forwarded by

Principal/Director/Placement Officer

(Please Affix the seal)