Trainer Application Details

01 Name of the Applicant
02 Photo
03 Father’s / Mother’s Name
04 Permanent Address Download
Address Line 1:
Address Line 2:
District
Block
Municipality/ Panchayat
Village/ Town
PIN Code
05 Correspondence Address Address Line 1
Address Line 2
District
Block
Municipality/ Panchayat
Village/ Town
PIN Code
06 Mobile No
07 Alternate Mobile No
08 Email ID
09
Date of Birth
 Gender
 Age
10 PAN No. Download
11 Aadhaar No Download
12 UDYAM Registration No Download
13 Artisan Card No. Download
14 Brief Portfolio of the Candidate
15 Highest Educational Qualification. Download
16 Occupation.
17 Highest Professional Qualifications in the Trades Applied for
18 Recognition/ Empanelment/ Affiliation
19 Work Order / Completion Certificate of Training Programmes conducted under Govt. Organisations/ reputed Non-Govt. Organisations in last 3 years
20 Awards / Accolades (If any)
21 Photos of Training Programmes/ Awards Received
22 Transaction Details
Upload Transaction Details
Download		 Transaction No
 Date of Transaction
 Amount of Transaction
 From Bank
23 Any other Related Information
24 DISTRICTS AND TRADES APPLYING FOR EMPANELMENT
25
Date
 Place
 Signature
Download
Declaration (Individual Trainers)
I hereby declare that –
1. The information furnished above are true to best of my knowledge.
2. I would strictly abide by the Terms & Conditions stated in the “Expression of Interest” and deliver the services as required with optimum sincerity.
3. I have not been barred/ banned/ restricted from any such services from any Govt. or Non-Govt. Organisations in the past.
4. I have a clean legal background and no Criminal Case has been filed against me in the Court of Law as per my knowledge.
5. I am able to serve as a Training Provider for both short and long duration Programmes of the selected trades in the Urban and Rural Areas of the selected District/s of West Bengal along with all types of Machineries, Equipments and Training Material support as and when required.
6. I am capable of providing Marketing and Network building Support temporarily for the Target groups of Trainees.