* Marked Fields Are mandatory

Registration Form for Trainee for Admission in Electrician Exam (Parikshu Panjiyan)

CANDIDATE DETAILS
In Which Subjects Does the Candidate Want to Appear in the Examination *
Candidate Name(In English)* Candidate Name(In Hindi) *
Father Name(In English)* Father Name (In Hindi)*
Date Of Birth (DD/MM/YYYY)*
Gender*
Email Id*
Mobile Number * Voter ID/PAN Card/Samagra ID/Driving Licence Number*
Address Details
Address *
State * District *
Pin Code*
DESCRIPTION OF THE NATIVE ADDRESS
From Date (DD/MM/YYYY)* To Date (DD/MM/YYYY)*
Domicile Address *
AT WHICH EXAMINATION CENTRE DOES THE CANDIDATE WISH TO APPEAR?
EXAMINATION CENTRE*
In which language (medium) the candidate wishes to appear for the examination
Medium*
EDUCATIONAL QUALIFICATION DETAILS
ELECTRICAL Experience Details
Photograph and Signature (.JPG file)(150KB) (Please mention current date on the photo)*