APPLICATION FORM FOR EMPANELMENT OF INDIVIDUAL TRAINERS

APPLICATION FORM FOR EMPANELMENT OF INDIVIDUAL TRAINERS
01 Name of the Applicant (BLOCK LETTERS) *
02 Father’/ Mother’ name *
03 Residential Address *
04 Village / Town *
05 Block/ Municipality *
06 Sub Division *
07 Phone No. *
08 Mobile No. * Update
09 Email ID
10 PAN No. * (Attach Copy in Annexure-a)

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11 Adhaar No. * (Attach Copy in Annexure-a)
12 Educational Qualification * (Attach Copy in Annexure-b)
13 Occupation
14 Qualification For High Skill Traders / Services (Attach Copy in Annexure-b)

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15 Qualification for Other Traders / Services (If any) (Attach Copy in Annexure-b)

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16 Traders / Services for which Applicant is Applying for Empanelment / Districts of choice
17 Experience of providing Training in Trade / Service Applying for (Please provide Brief Description of Activities and Experience in the similar field including year of commencement. Use separate sheet if necessary) (Attach Copies Annexure-c)

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18 Award Received (If any) (Annexure-d)

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19 Whether any Special / Innovative Project or Capacity Building Programme taken up by the applicant (Give Details) (Annexure-d)
20 Photo documentation (optional) (Attach in Annexure-e)

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21 Any other related Information
I hereby declare that the information furnished above is true to my knowledge.
 
Declaration
1. I hereby declare that I have the capacity to arrange for / providing Machineries, Equipments and Training Materials required for organising the training programmes as Standardised by ICMARD for the traders / services I applied for.
2. I am able to serve as Trainer for both short and long term Programmes in the Urban and Rural Areas in nearby Districts of West Bengal as selected by ICMARD along with all types of Machineries, Equipments and Training Material support as and when required.
3. I am capable of providing Marketing and Network building Support and temporarily for the Target groups of Trainees for the Traders / Services under supervision of ICMARD.

Check List

Annexure-IA

Application Form

Annexure-II

LIST OF TRADERS AND SERVICES (Attached)

Annexure-a

Copy of PAN Card and Adhaar Card

Annexure-b

Qualification Certificates including Vocational Trainings, Recognition of Competent Authority (If Any)

Annexure-b

Educational Qualification

Annexure-b

Qualification For High Skill Traders / Services

Annexure-b

Qualification For Other Traders / Services

Annexure-c

Experience of Providing Training in Trade / Service Applying –

  1. Copy of Contract Letter (If Any)
  2. Copy of Programme Completion Certificates (If Any)
  3. Past and Present Empanelment as Vocational Skill Trainer (If Any)

Annexure-d

Projects and Awards received

Annexure-e

Photo Documentation (if any) of the activities (Optional)