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CII MEDHA SKILL INSTITUTE HE PH
REGISTRATION FORM
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* Indicates required question
SOURCE OF INFORMATION
*
YOUTUBE
FB/WAP/SOCIAL MEDIA
EMPLOYMENT EXCHANGE
APPLICANT'S FULL NAME
*
(AS PER ADHAR CARD)
Your answer
GENDER
*
MALE
FEMALE
Required
ADDRESS
*
Your answer
PHONE NUMBER
*
Your answer
EMAIL ID
*
Your answer
DATE OF BIRTH
*
DD-MM-YYYY
Your answer
FRESHER/EXPERIENCED
*
FRESHER
EXPERIENCED
Required
LAST QUALIFICATION
*
Your answer
YEAR OF PASSING
*
DD-MM-YYYY
Your answer
APPLICANT'S GUARDIAN NAME
*
Your answer
GUARDIAN OCCUPATION
*
Your answer
APPLICANT'S RELATION WITH GUARDIAN
*
Your answer
GUARDIAN CONTACT NUMBER
*
Your answer
MONTHLY FAMILY INCOME
*
Your answer
WHICH COURSE ARE YOU INTERESTED
*
PHLEBOTOMY TECHNICIAN (ONLY 10+2 PASSED)
HOSPITAL EXECUTIVE (GRADUATE FROM ANY STREAM)
CUSTOMER RELATIONSHIP MANAGER
Required
STATUS
*
SINGLE
MARRIED
Required
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