APPLICATION FOR SKILL DEVELOPMENT

[See Section 4(1)] (Applicant to fill in as many details as known to him) Date of Submission of Application to the District Authority: Name of the District: Personal Details: 1. Name of Applicant 2. Father's/Husband's Name 3. Mother's Name 4. Gender (Male/Female) 5. Age (In Years and Months) 6. Date of Birth 7. Whether Resident of Chhattisgarh State (Yes/No) 8. Category (SC/ST/OBC/Unreserved) 9. Religion 10. Whether Differently abled Person (if Yes, mention the type) 11. Marital Status (Married/Unmarried) 12. Whether Belongs to BPL Category (Yes/No) 13. Employment Exchange Registration No. (if any) 14. Aadhaar Card No. (if any) 15. Whether Beneficiary of any Scheme of any Department/Board etc. (if Yes, please mention name of the Department/Board etc.) 16. Languages Known 17. Permanent Address (Village/City, Ward No./Gram Panchayat, Block, District, State, Pin Code) 18. Address for Correspondence (Village/City, Ward No./Gram Panchayat, Block, District, State, Pin Code) 19. Telephone No. for Contact (if any) 20. Mobile No. for Contact (if any) 21. E-mail (if any) 22. Occupation of the Applicant 23. Family Occupation 24. Annual Income of the Family 25. Academic Qualification: Table consisting of Name of Examination, Year of Passing, Name of Board/University, Percentage of Marks or Grade for 5th Standard, 8th Standard, 10th/Matriculation, 12th/Higher Secondary, Graduation, Post Graduation, Other. 26. Technical/Professional Qualification: Vocational Education and Training/ITI/Diploma/Engineering/Management/Medical and Nursing/Pharmacy/Other (S.No., Qualification, Trade/Branch/Stream, Name of Board/University, Duration, Year of Passing, Percentage of Marks or Grade). 27. Details of Skills Already Acquired: (S.No., Details of Skills Gained Formally/Informally/Traditionally/Inheritance, Sector, Name of Formal Skill Training, Duration, Whether having a MES Course Certificate (Yes/No)).