BHARATIYA VIDYA BHAVAN’S
S.P.JAIN INSTITUTE OF MANAGEMENT & RESEARCH, MUMBAI
Post Graduate Executive Management Programme (PGEMP)
(To be filled in by the applicant)
For Office Use only:
Date of Application received: __________
Application fee details: _______________
Interview held on: ___________________
Will join in Batch No: ________________
Affix a self attested
photograpgh
Authorized Signatory
(On behalf of PGEMP Department)
SECTION A
Personal Details
LAST NAME:_________________________FIRST NAME:______________________________
MIDDLE NAME_______________________
ADDRESS:____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
AGE: _________
DATE OF BIRTH:__________________
DD / MM / YY
MARITAL STATUS:______________
SEX :MALE / FEMALE
NUMBER OF CHILDREN:________________________
NATIONALITY: ________________________________________________________________
TELEPHONE NO.______________
RES:_____________________
FAX:____________________________
E-MAIL:__________________
Academic Record
S.S.C / H.S.C / Graduation / Post Graduation / Professional Qualification (Start With Latest):
CLASS
SPECIALISATION
YEAR OF
PASSING
% MARKS
or CGPA
NAME OF INSTITUTE
UNIVERSITY / BOARD
Please Give Particulars Of:
ACADEMIC / PROFESSIONAL
ACHEIVEMENT
(If Any )
EXTRA CURRICULAR ACTIVITIES
Details of Current Organization
NAME OF THE ORGANIZATION: __________________________________________________
ADDRESS: ____________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
NATURE OF BUSINESS: _________________________________________________________
TELEPHONE NO.:_____________________FAX:___________________E-MAIL: ____________
NAME OF THE PERSON YOU REPORT TO: _________________________________________
DESIGNATION OF THE PERSON: _________________________________________________
Work Experience Details
(Start With Current):
NAME & ADDRESS
OFTHE ORGANISATION
DESIGNATION
&
DEPARTMENT
JOB PROFILE
(roles &
responsibilities)
DURATION
ANNUAL
SALARY
(Gross)
CADRE /
GRADE
Please Indicate the Functional Areas that you have worked in during your career
AREA
OVERALL EXPERIENCE
(Years)
EXPERIENCE IN CURRENT
ORGANISATION (Years)
OPERATIONS
FINANCE
MARKETING
HRD
GENERAL MANAGEMENT
Do you have any medical conditions which may prevent you from completing this course, or which
may adversely affect your performance in the course? If yes, please give details
____________________________________________________________________________________
______________________________________________________________________________________
Give Particulars of your Career Progression in your Current Organization
What is your Career Plan / Objective?
What are your expectations from the Post Graduate Executive Management Programme?
Which PGEMP batch would you want to join?
1.
2.
3.
4.
5.
Batch 47 – May 2014
Batch 48 – September 2014
Batch 49 – November 2014
Batch 50 – January 2015
Batch 51 – February 2015
SECTION B
1. Describe a professional situation that resulted in failure. How did resolve the situation and
did it impact your management style? If yes, how? (Limit – 150 words)
2 Describe an ethical dilemma you faced in your professional career. How was it resolved and
what did you learn from the experience? (Limit – 150 Words)
SECTION C
PGEMP is a very rigorous program with examinations and other forms of continuous
evaluation. It also requires a good understanding of various management concepts and
theories. How do you plan to adjust to a high pressure academic situation after being away
from formal studies for many years and how can SPJIMR be assured that you will complete the
program on time? Please discuss your post-PGEMP short- and long-term professional goals.
How will your professional experience, when combined with PGEMP, allow you achieve those
goals? (Limit – 200 Words)
Signature of the Applicant: _________________________
Forwarding Certificate
(To be taken on company letter head)
We hereby certify that the candidature of Mr. / Ms._________________________________________
who is working in our organization as______________________________ and has applied for your
Post Graduate Executive Management Programme.
We will extend necessary support as mentioned on the website to Mr. / Ms._____________________
including
 Providing support with relevant company information to facilitate “Customized Learning” by
participant.
 Give leave to participants for attending on – campus contact sessions (9 days per quarter).
 Nominating Mentor/s to scrutinize and independently grade the Application Exercise
assignments related to company.
Name: ____________________________
Signature: _________________________
Designation: _______________________
Seal: ______________________________
Date: ______________________________
Undertaking to be given by Particpants
To,
The Chairperson
Post Graduate Executive Management Program
S.P. Jain Institute of Management & Research,
Munshi Nagar, Dadabhai Nagar,
Andheri (w), Mumbai – 400 058
I ,Mr./ Ms. _________________________, presently working with ________________
______________ as -------------------------------------------------------- in ---------------------------------------department at ----------------------------------------------------------- location wish to state that I have gone
through your website and am aware of all the requirements of the Post Graduate Executive
Management Program and wish to apply for the same.
I have also apprised my company HR & my seniors of the requirements of the program and they are
fully supportive. Based on these discussions I can state that:
1. I am confident of getting the required leave from my company to attend the 9- day contact
each quarter.
2. I am confident that I will have a mentor in my company who will scrutinize and independently
grade the application assignments related to the company and extend necessary support to
me. Also, I will submit the required details of the mentor to the institute.
3. I assure the Institute that I will be able to devote time & energy which the program demands
4. Payment of the fee for the program will be made by________________________
5. I have attached ___________________________ certificate (NOC/employment certificate)
from my company along with my application form.
Thanking you,
Yours faithfully,
Signature of applicant
List of documents to be submitted
Attested/truecopies mark sheets of
Document

SSC

HSC

Graduation

Post Graduation (if any)

Professional qualification (if
any)
Submitted (Y/N)
Checked (Y/N) For
office use only
Proof of employment
Name of Organisation (Start
With Current)
1.
2.
3.
4.
5.
Duration
Submitted (Y/N)
Checked (Y/N)
For office use
only