HP GET-IT CERTIFIED TRAINING CENTRE Affix 2 Passports Photo Here.

CENSIRT ICT CENTRE OF EXCELLENCE

(A Special Training and Research Centre Adopted from India’s Rich Experience in Small Industry Promotion)

33 Ezza Road, (Presco Junction, Abakaliki Ebonyi State, Nigeria).

FORM NUMBER: ( for official use only)……….

 

  
GET-IT ADMISSION FORM  
   
PERSONAL DATA
  

TITLE: --------------------------------------------------------------------------------------------------------
SURNAME:-----------------------------------------------------------------------------------------------
NAME:-----------------------------------------------------------------------------------------------------
OTHER NAMES:-----------------------------------------------------------------------------------------
SEX:---------------------------------------------------------------------------------------------------------
MARITAL STATUS:-------------------------------------------------------------------------------------
STATE OF ORIGN:--------------------------------------------------------------------------------------
NATIONALITY:------------------------------------------------------------------------------------------
AGE (dd/mm/yy):-----------------------------------------------------------------------------------------
POSTAL CONTACT:------------------------------------------------------------------------------------
HOME CONTRACT:-------------------------------------------------------------------------------------
E-MAIL:----------------------------------------------------------------------------------------------------
WEBSITE (if any):-----------------------------------------------------------------------------------------
PHONE (+23480…):---------------------------------------------------------------------------------------

PERSONAL INFORMATION

WHY ARE YOU DOING THIS PROGRAMME?----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------PROJECT BUSINESS:-----------------------------------------------------------------------------------
DO YOU HAVE ANY COMPUTER KNOWLEDGE:---------------------------------------------
IF YES GIVE DETAILS:---------------------------------------------------------------------------------
YOUR PRESENT BUSIENSS:--------------------------------------------------------------------------

             

EDUCATIONAL BACKGROUND

ALL ACADEMIC QUALIFICATIONS (Attach all photocopies):
1  ------------------------------------------------------------------------------------------------------------
2  ------------------------------------------------------------------------------------------------------------
3  -------------------------------------------------------------------------------------------------------------4  ------------------------------------------------------------------------------------------------------------

PREVIOUS TRAINING (Attach all photocopies)
1.   ………………………………………………………………….………………………
2.   ………………………………………………………………………………………….
3.  ………………………………………………………………………………………….
WORKING PROFILE (IF ANY)

NAME OF COMPANY: --------------------------------------------------------------------------------
JOB TITLE (POSITION):--------------------------------------------------------------------------------
JOB SCOPE:-----------------------------------------------------------------------------------------------
YEARS OF WORKING EXP.:--------------------------------------------------------------------------
CONTACT ADDRESS:----------------------------------------------------------------------------------
PAST POSITION HELD:--------------------------------------------------------------------------------
(Please supply details of other organizations where you worked (If any)
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
REFEREES

NAMES OF TWO REPUTABLE REFEREES (your referees who must be reputable will be required to sign under taken if you are admitted.)
(I)   NAME…………………………………………………………………………………
       ADDRESS ……………………………………………………………….……………
       ………………………………………………………………………………………….
       PHONE NUMBER………………………………………………………...…………
       PROFESSION………………………………………………………………..………                
       RELATIONSHIP……………………………………………………………..……...
 (II) NAME………………………………………………………………………………..
ADDRESS………………………………………………….…………………………
PHONE NUMBER…………………………………………………………………. PROFESSION………………………………………………………………   RELATIONSHIP………………………………………………………………..…
 DECLARATION

I. …………………………………………hereby affirm that the information I have given above are true to the best of my knowledge. I accept to be dismissed at any time any information supplied by me is discovered to be false.

I further undertake to be of good behaviour if I am admitted.
      

SIGNATURE………………………..                               DATE …………………
This form is to be completed and mailed back to admin@censirt.org OR to the Address above
NOTE: All attachments are important.