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RAJIV GANDHI CENTRE FOR BIOTECHNOLOGY
AFFIX
Thycaud P.O, Thiruvananthapuram-695014, Kerala, India
Tel.0471 2529588, 2529400 Fax: 0471-2348096, 2346333
Website:www.rgcb.res.in, e-mail [email protected]
PHOTOGRAPH
APPLICATION FOR BIOTECHNOLOGY SKILL DEVELOPMENT PROGRAM
1
Name of the Candidate
2A
Complete Address for
Correspondence (with pincode)
2B
E-mail ID(Application will not be
Mr./Ms./Dr.
processed without valid e -mail ID)
2C
3
Telephone Numbers
Landline……………………………………..
Mobile………………………………………..
Permanent Address
(if different from above)
Date of Birth: --------------------------------4
Age, Date of Birth
Age as on January 1, 2015:
---------------------
5. Educational Background
Sl.No
Examination
Year of
Passing or
Course
Completion
1
SSLC/10th grade
2
HSC/12th grade
3
BSc or BVSc or BSc (Agri) or
B.Tech or MBBS
4
MSc or MVSc or MSc (Agri)
or MD
Any other degree or
Diploma(specify)
5
Institution, Board or
University
Main Subject (s)
Marks (percentage
or CGPA)
6: Choice of Domain
Select one domain from column 1
DOMAIN
Molecular Diagnostics
Bio Imaging
Analytical Science
Computational Biology and Bioinformatics
7. List of Essential Enclosures to be attached. Applications without these will be rejected.
1. Proof of Date of Birth
2. Self-attested proof of qualifying examination.
DECLARATION
I hereby declare that all the information provided above is correct to the best of my
knowledge. I shall produce all the original documents for verification at the time of
interview. I also understand that my application will be rejected if any of the details provided
are found to have been deliberately falsified.
--------------------------------------- Signature & Date
--------------------------------------Name
--------------------------------------E Mail ID
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