A.P. Society for Knowledge Networks Jawahar Knowledge Center Student Registration Form B.E / B.

Tech

Please Use Block Letters to fill application, please read the instructions before fill the form

University Hall Ticket Number: _________________________

Personal Details
Name: _________________________________________________ Gender: Date of Birth: Male
D D

Female
M M Y Y Y Y

Please affix your recent passport size photo graph, Attestation required, do not staple the photo graph

Religion: __________________________

Category: Please tick on top of appropriate one [BCA / BCB / BCC / BC-D / BC-E / SC / ST / OC] EAMCET RANK: _______________________ Family Annual Income: Rs. ________________

Father / Mother Name, Profession: ___________________________________________________________________

Address for Correspondence

House No & Street _______________________ Location: ______________Village / Town: ___________________ District: __________________State: _________________________PINCODE: _______________________ Phone: ___________________ Mobile: _________________________

E-mail ID: _________________________________ Alternate E-mail ID: __________________________________

Institution Details
Name of the Institution: ______________________________________________________________________________ Affiliated University: _______________________ Branch: _____________ Passing out Year: 2012 2013 2014

[Details for generating JKC ID card]

University Hall Ticket Number: ________________________________________ Name: ____________________________________________________________ College Name: _____________________________________________________ Branch: ___________________________________________________________ Pass out year: 2012 2013 2014

Please affix your recent passport size photo graph, Attestation required, do not staple the photo graph

Affiliated University: ________________________________________________

A.P. Society for Knowledge Networks Jawahar Knowledge Center Student Registration Form B.E / B. Tech

Academic Details
Academic Details SSC Intermediate Diploma B. Tech 1 Year B. Tech 2 Year 1 Semester B. Tech 2 Year 2 Semester B. Tech 3 Year 1 Semester B. Tech 3 Year 2 Semester
rd nd rd st nd nd nd st st

Year of pass out

Total Marks

Marks Obtained

Do you have any gaps in education:

Yes

No

No. of Years: _______ Reason: ___________________________ No of backlogs you have as on date: __________ Registration Fee Details (Each student is supposed to draw an individual DD of Rs. 3000/- in favor of Institute for Electronic Governance payable at Hyderabad and attach the same along with the application form) Amount: Rs. ___________________________________DD Number: _______________________________ Drawn Bank & Branch: ________________________________ Drawn Date:
D D M M Y Y Y Y

Note: A nominal Registration fee for the SC and ST category students of Rs. 500/- for the Engineering students, copy of their caste certificate is to be attached along with the Registration Form(without authentic Caste certificate application will not be accepted).

Declaration
I declare that all the above details are true to the best of my knowledge. If the details are found to be incorrect at any stage, I am liable to any action taken by JKC. I understand that upon my selection to any company through JKC, I have to pay Rs. 10000/towards special fee to JKC. I agree that I have read all the terms & conditions mentioned in the JKC student registration notification and I am accepting all these terms and conditions as decided by the JKC in the interest of the program.

Date: Place: I_________________________________________________________________________, the benefit of students and I am willing to join my son/daughter/ward into this program.

[Signature of the student]

Parent / Guardian of

Mr./Ms.________________________________________ hereby declare that I am aware of the JKC program that is conducting for

Date: Place:

[Signature of the Parent/Guardian]

A.P. Society for Knowledge Networks Jawahar Knowledge Center Student Registration Form B.E / B. Tech

Authorization of the Institution Principal

The details given by the student above are verified and found to be correct. College assures that it will provide all the facilities needed to conduct the JKC training programs and extend all the support for the workshop(s)

Date: Place:

[Principals signature with college seal] Instructions for students

All fields are mandatory and use Block / Capital Letters to fill the application form Provide Religion as Christian / Muslim / Hindu / Sikh / Jain / Buddha and etc., Provide your EAMCET rank with which you have joined in Engineering Provide Working E-Mail ID & Alternative E-Mail ID, to which preparation material, information on eligibility and recruitments will be e-mailed Upon receiving this application form JKC issues the User ID and Pass word of the respective candidates to their respective TPO / JKC in-charge. So the candidates have to follow it up with their TPOs / JKC in-charges to get their login details and they have to login into their respective account on JKC portal to complete their JKC registration process

Candidates are required to attend the trainings organized in their college by JKC Faculty members from time to time Each registered candidate would be given with a user ID and password on JKC portal to check their profile which would be shared with the companies for the recruitment events. It is the responsibility of the student to check for the mistakes and update them from time to time

Students would be short listed for all the JKC recruitment events based on the data which is available with JKC, so students are advised to check their profile online regularly and in case any changes to be done then they are supposed to bring them into the notice of college TPO / JKC In-charge for updating them

Candidates have to attend the Recruitment Processes organized region wise in JKC star status colleges Candidates should submit their application form along with DD of Rs.3000/- towards JKC Registration to TPO / JKC Incharge, TPO JKC In-charge is requested to send all the applications along with the DDs to JKC Individual applications from the students will not be accepted Once the application along with the JKC Registration Fee is received at JKC, registration amount will not be refunded under any circumstances.

JKC would dispatch the set of CD & Printed material to each registered candidate to their respective colleges, so please ask for it and collect it from the concerned authorities

Terms & Conditions of the program are subjected to change as per the decisions of the Executive Council and Governing Council from time to time