Empanelment Form
Applying for type of Resource person
*
Value Required!
Select
Principal Trainer
State Master Trainer
State Trainer
First Name
*
Value Required!
Middle Name
*
Value Required!
Last Name
*
Value Required!
Gender
*
Value Required!
Select
Male
Female
Marital Status
*
Value Required!
Select
Married
Unmarried
Date of Birth
*
(DD/MM/YYYY)
Value Required!
Age - till 1st Aug 2019
Permanent Residential Address
Street Address/Village
Block or Taluka
City/District
State / Province
Postal / Zip Code
Country
Current Residential address
Same as Permanent Address
Street Address/Village
Block or Taluka
City/District
State / Province
Postal / Zip Code
Country
Mobile Number
*
Value Required!
10 Digit required
Alternet Mobile Number
10 Digit required
Email ID
*
Value Required!
Invalid Email Format
PAN Number
Aadhar Number
Qualification
*
Value Required!
Select
Graduate
Post Graduate
PHD
Other
Qualification Details
*
Name of Degree
University Name
Class
I
II
III
Current Working organization -
“ If applicable ”
Name
Address
Working Location
Position
TOTAL WORK EXPERIENCE - (AS ON 31ST AUGUST)
Type of engagement with Organization
Select
Fulltime
Part time
Consultant
Project Basis
Freelancer
Other
*
(In Years)
Value Required!
*
(Months)
Value Required!
*
(Days)
Value Required!
Total Experience as Trainer
*
(In Years)
Value Required!
*
(Months)
Value Required!
*
(Days)
Value Required!
Expertise Domain
*
Domain Experience (In Years)
Social Mobilization and Institution Building
Training and Capacity Building / Participatory Training Methodology
PRI / GPDP
CBO/ Community Federation Management
Financial Inclusion / Financial Literacy
CBO Book Keeping and accounts/ Finance Management
Health, Nutrition and Sanitation
Gender and Law
Livelihoods (Farm)
Livelihoods (Non-farm)
Social Audit / PRA
Enterprises Development (Branding/ Sales/ Marketing Etc)
Other (Please Specify)
Total experience in above Domain
*
(In Years)
Value Required!
Upload CV in given prescribed format
*
File Required!
Only PDF|DOC|DOCX files are allowed!
Submit
Note:-
1.
*
fileds are mandetory.
2. If any person wants to apply for more than one category of resource person, will have to fill application seperately.
3. Applicant may fill experience in more than 2 domain can be considered his interest in mulitiple domain/ Themaitic.
4. Upload resume/cv in below given formate only.
1. CV Formate in Doc file formate (Click here for Download)
2. CV Formate in Pdf file formate (Click here for Download)
