Centre for Converging Technologies, University of Rajasthan Jaipur 302 004.
Student registration form for campus placement drive – 2014
Personal details:
1. Registration Number (CCT will allot) Photograph
2. First name
3. Middle name
4. Surname/Last Name
5. Gender
6. Mothers’ name
7. Personal mobile number
9. Email id
10. Date of Birth
11. Native place (name of place/district)
11. Local address
12. Permanent address (Parent residence)
13. Fathers’ mobile number, landline number
(residence)
Academic details (Schooling/ Junior college/Diploma) with examinations passed, % marks and year of passing
S.No. Name of the Course Name of the
Board/University
Year of Passing Marks obtained Percentage %
1. S.S.C.
2. H.S.C.
3. Diploma in -----
4. UG-B.Tech/BCA/MCA/B.Sc.
9
Declaration by the student:
Above information is provided by me and it is correct and complete. I will provide the corresponding proof as
and when required for the verification of the same.
Signature of the student
Verified and forwarded by
Principal/Director/Placement Officer
(Please Affix the seal)