Page 1 of 4 Application No: Application for Admission to B.Tech Degree (Evening) Course-2012
8. Presently Employed in Kerala- Yes / No
10. Address for communication 11. Office Address 12. e-mail :
• Please ensure that a valid e-mail ID is given and check the mail for future announcements 13. Qualifying Examination Details:
13(c) Marks obtained:- (aggregate marks obtained in all Semesters/years in the Diploma Examination)
14. Details of Experience after passing the qualifying examination
Total Eligible Service for weightage of marks: Yrs Months
15. Application Fee - Payment Details
`500 / 250 16. Institutional Preference DECLARATION (To be filled by the candidate)
………………………………………………………………….hereby solemnly and sincerely affirm that, the
statements made and the information furnished in my application and in the enclosures thereof submitted by me are
true to the best of my knowledge and belief. Should it, however, be found that any information furnished thereto isn’t tr
ue, I realize that I am liable to criminal prosecution and agree to forgo my seat.
Place: Date: PRESENT EMPLOYMENT & CHARACTER CERTIFICATE
CERTIFIED that, Shri/Smt…………………………………………………………….Son/daughter of
shri/smt……………………………………………………………………………………………………….residing at
.……………………………………………………………………………………………………………………………
……………………………….(address) an applicant to B.Tech (Evening) Course is employed as
………………………………………………………………………………………………………….(designation) in
……………………………………………………( address of the firm ) from …………………………….till date.
His/Her character is ………………………………….
……………………………………………………………………………………………………
Check list for candidates: Please make sure that the following documents are enclosed with the application before posting the same. No opportunity will be given to incorporate any missing documents to the application in a later stage. Please put a √ mark in the boxes concerned and send along with the application Self attested copies of Diploma/equivalent Degree certificate
Diploma/equivalent Degree mark list for all semesters/years
Employment and conduct certificate from the present employer (in the
form prescribed in the application form).
Relevant page of S.S.L.C book or equivalent certificate in proof of age.
Originals of Community Certificate, Nativity Certificate and Income Certificate for those
Experience Certificate to prove each claim in item No.14 of the application
form. For claiming the weightage of marks for experience in Public/Pvt Ltd companies, relevant proof that your service in the company for the period comes under the purview of ESI or EPF must be attached. Such experience alone should be considered. Service certificate for Govt. Servants clearly indicating the tenure of service.
Certificates in proof of the employment in public or private limited companies
or establishments which come under the purview of ESI or EPF. (Copy of Certificate of Incorporation duly attested by the head of the organization)
Relevant certificate to claim the seat reserved for physically challenged/Sports
A Demand Draft of ` 500 (` 250/-for SC/ST) drawn from State Bank of Travancore in favour of the Principal, College of Engineering, Trivandrum, payable at Trivandrum
Ensure that your photograph is affixed and you have signed the declaration.
Signature of the candidate
For Office Use Only Received on--------------------by hand /by post Sl. No.------------------- Branch:C/ M / E / T /R Category : G/SC/ST/PH/SP/OEC/SEBC/DT
Zürcher Fachstelle zur Prävention des Alkohol- und Medikamenten-Missbrauchs Every tenth person in Switzerland regularly takes medicine which can become addictive. According to conservative estimates, 60000 people are already addicted, and a further 170000 in serious danger of becoming addicted, to such medicines, mainly sleeping pills, painkillers and sedatives. Women are twice as likely
Product Name: Rentokil Chek-Pest Residual Insecticide Section 1 - Identification Of Chemical Product And Company Rentokil Initial Pty Ltd Emergency phone (02)8719 6264 (bus hours) Substance: Trade Name: Product Code: 55656 Product Use: Home and garden insecticide for use as described on the product label. Creation Date: February, 2004 This version issued: